Claims Editing Software

The buyer seeks a vendor to provide a claims editing software that implements a comprehensive post-adjudication, pre-payment claims editing solution. The requested scope includes providing standard rule-based edits, complex logic edits, historical claims reviews, and specialized edits for areas vulnerable to fraud, waste, and abuse, such as hospice and laboratory services. Furthermore, the vendor must deliver capabilities to configure and create custom edits, simulate complex methodologies, and perform targeted analytics to identify emerging billing risks, missed savings opportunities, and complex coding inaccuracies prior to payment. Eligibility requires the vendor to be an onshore, United States organization only. The vendor must perform all work offsite at its own office premises. Regarding the budget, the buyer is looking for proposals. Interested vendors must submit all questions no later than October 14, 2026.