Claims Audit Services

The agency is seeking claims audit services to conduct medical claim audits, prescription drug claim audits, pharmacy rebate audits, and clinical validation reviews. This initiative aims to solve the problem of ensuring accuracy, compliance, and financial integrity across the agency's medical and pharmaceutical benefit programs. The scope of work covers these four distinct audit areas, which must be performed entirely offsite. Bidders must be onshore organizations based exclusively in the United States to be eligible for this opportunity. The agency is looking for proposals to determine the budget and pricing structure for these services. No specific evaluation criteria are outlined in the initial request. The agency will hold a pre-proposal conference on June 25, 2026, to discuss the project requirements. Bidders must submit all questions regarding the solicitation no later than July 1, 2026.