Insurance Contracting and Credentialing Services

The Garrett County Health Department in Oakland, Maryland, is seeking insurance contracting and credentialing services to improve its empanelment and billing processes. This initiative aims to increase local access to covered services for rural residents, supporting earlier disease detection, improved chronic disease management, and reduced reliance on high-cost acute care. The agency also intends to promote the long-term financial sustainability of rural public health services by expanding its capacity to provide clinical services through contracts with additional insurance providers serving the local area. The scope of work covers insurance provider enrollment, credentialing, payer relations, and application processes. The selected vendor must handle contracting with Medicaid managed care organizations and commercial insurance networks, as well as coordinate direct communication with Medicaid, Medicare, and commercial insurers. Responsibilities include resolving deficiencies, rejections, or requests for additional information from contracted insurance providers to ensure timely, compliant, and complete processes. The agency requires ongoing support for revalidation, re-contracting, re-credentialing, and updates as needed throughout the contract term. The project also involves exploring the potential of aggregating rural clinicians in contracting and provider enrollment to benefit from the aggregating impact of panels and economies of scale in insurer contracts. The contract period will span one year, and the performance of the work will occur offsite. Eligibility is restricted to onshore organizations based in the United States. Bidders must submit their proposals digitally via email or online. The agency has not disclosed a specific budget and is looking for proposals to determine the cost.