RFI for Third Party Liability and Coordination of Benefits Services

The Connecticut Department of Social Services is seeking information on third party liability and coordination of benefits services to identify and recover Medicaid funds. The agency wants to solve the problem of latency between a member obtaining other insurance and the state systems being updated. To address this, the agency requires innovative data mining and matching techniques to identify unreported active commercial insurance, Medicare, and Tricare coverage. The scope of work covers continuous, real-time or near real-time verification of member coverage and the recovery of funds for claims previously paid by Medicaid where a liable third party existed. The selected partner must demonstrate expertise in managing complex billing and recovery processes with commercial carriers and Medicare. The agency is requesting the use of advanced analytics, artificial intelligence, or machine learning to predict third party liability and streamline workflows. The requested system architecture must align with the Centers for Medicare and Medicaid Services and the State of Connecticut Medicaid Enterprise Systems. Eligibility is restricted to onshore, United States organizations only. The agency requires the performance of the work to be offsite, and respondents may submit their responses digitally via email or online. The agency is looking for proposals to determine budget parameters. Interested parties must submit all questions no later than June 18, 2026.