Health Care Provider Network and Prior Authorization Services

A government authority in California is seeking a vendor to provide a health care provider network and prior authorization services. The agency needs a community-based network of specialty medical services providers to ensure patients receive necessary care. To solve integration challenges, the agency requires a system that integrates claims with authorized services and connects seamlessly with their electronic medical records system. The scope of work includes ensuring the prior authorization system complies with all local information technology requirements. The selected vendor must customize prior authorization parameters throughout the life of the contract as needed and educate providers and vendors on the proper processes for requesting or fulfilling services. Additionally, the agency requires regular reporting on comparative effectiveness, provider utilization profiling, quality of care benchmarks, and other metrics. Eligible bidders must be onshore organizations based entirely in the United States. The agency will allow the performance of all contracted work to occur offsite. While the agency has not disclosed a specific budget and is looking for proposals to determine cost, they have scheduled a pre-bid meeting for July 8, 2026.