Recovery Audit Services
- Client
- Baltimore, Maryland
- RFP Number
- ACCT-26850
- Posted
- 10/3/2026
- Category
- Auditing, Finance and Accounting
- Budget
- Looking for Proposal
- NAICS
- —
- Set-aside
- —
- Contact
- —
Description
AI GeneratedThe Maryland Department of Health needs a contractor to provide recovery audit services, including completing ongoing hospital audits and assisting the department with external federal or state oversight audits. The contractor must establish and maintain a web-based provider portal to support audit activities and build a hospital claims audit database covering general in-state, out-of-state, and in-state psychiatric hospitals. Performance of the work will take place offsite. Only onshore U.S. organizations certified by the Governor’s Office of Small, Minority & Women Business Affairs as small businesses are eligible to bid under this Small Business Reserve Procurement. Interested vendors must attend a pre-bid meeting on October 14, 2026, and submit all questions by November 4, 2026. Proposals are evaluated based on the technical response and work plan, staff experience, organizational capabilities, economic benefit to Maryland, and total financial proposal price. Recommended awardees must supply proof of required insurance, including $5,000,000 in cyber security coverage, within five business days of notice.
Key solicitation details
AI-extracted from Recovery_Audit_Contract__RAC__RFP_OCMP_26-25113__2027_.pdf. Confirm against the original documents before bidding.
The Maryland Department of Health is seeking a Medicaid Hospital Claims Audit Contractor to perform recovery audits. The contract is designated as a Small Business Reserve procurement, limiting eligibility to certified small businesses. The procurement follows the Competitive Sealed Proposals method to select a contractor for hospital claims and payment auditing.
- Issued by
- Maryland Department of Health
- RFP Issue Date
- October 2, 2026
- RSVP for Pre-Proposal Conference
- Monday, October 12, 2026
- Pre-Proposal Conference
- Wednesday, October 14, 2026 at 2 p.m. Local Time
- Questions Due Date and Time
- Wednesday, November 4, 2026 at 2 p.m. Local Time
- Proposal Due (Closing) Date and Time
- Friday, November 20, 2026 at 2 p.m. Local Time
- How to submit
- Electronic via eMaryland Marketplace Advantage (eMMA)
- Submission details
- Proposals must be submitted on emma.maryland.gov under Solicitation Number OCMP-26-25113 using a two-envelope process (Volume I Technical Proposal and Volume II Financial Proposal in searchable PDF format).
- Contract term
- Three (3) base years beginning August 1, 2027, with two (2) one (1) year option periods.
- Set-aside
- Small Business Reserve Procurement
- Place of performance
- Contractor's location
- Insurance and bonding
- Crime Insurance/Employee Theft Insurance; Cyber Security / Data Breach Insurance ($5,000,000 per occurrence); Worker's Compensation; Automobile or Commercial Truck Insurance.
- Funding
- Federal Funding
How proposals are evaluated
| Offeror's Technical Response to Requirements and Work Plan | |
| Experience and Qualifications of Proposed Staff | |
| Offeror Qualifications and Capabilities, including proposed subcontractors | |
| Economic Benefit to the State of Maryland | |
| Financial Proposal Evaluation (Total Proposal Price) |
Scope of work
- Provide hospital claims and payments audit services
- Create and maintain a web-based Provider portal to track and support audit activity
- Maintain a hospital claims audit database for general in-state, out-of-state, and in-state psychiatric hospitals
- Complete existing hospital audits in progress
- Support the Department in responding to external audits involving hospitals
- Copy and retain relevant portions of medical records for future audit support
Minimum qualifications
- Certified as a small business by GOSBA Small Business Reserve Program
- At least three years of experience providing hospital claims and payments auditing within five years prior to proposal submission
- Must not be on the federal LEIE or SAM exclusion lists
- Project Manager with at least three years of project management experience in Medicaid provider audits
- Quality Assurance Manager with at least five years of healthcare experience in quality improvement, data analyses, or utilization review
Documents to include with the bid
- Attachment A - Offeror Information Sheet
- Attachment B - Financial Proposal Instructions and Price Form
- Attachment C - Proposal Affidavit
- Attachment D - Minority Business Enterprise (MBE) Forms
- Attachment E - Veteran-Owned Small Business Enterprise (VSBE) Forms
- Letter of self-certification regarding LEIE and SAM exclusion lists
- Letter of attestation regarding no non-compete agreements for recovery audit services
- Proof of meeting minimum experience requirements
- Staffing Plan
- Maryland Living Wage Requirements Affidavit of Agreement
Source and verification
Cached documentsCraxy AI summarizes this opportunity from the source listing and available solicitation documents. Confirm submission instructions and amendments with the issuing source before responding.
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