Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM)

Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM) Opportunity Overview The Defense Healthcare Management Systems Modernization (DHMSM) Program Management Office (PMO), in conjunction with the Defense Healthcare Management Systems Program Executive Office (DHMS PEO) is seeking innovative, Artificial Intelligence and Machine Learning (AI/ML) enabled solutions to enhance healthcare delivery and strengthen financial recovery operations across the Military Health System (MHS). Pursuant to 10 U.S.C. § 4022, the Government intends to award one or more prototype Other Transaction Agreements (OTAs) through this competitive Request for Solutions (RFS) process. Under this RFS, the DHMSM PMO is seeking solutions for two distinct capability areas. Industry partners may submit a solution for either capability individually or for both capabilities: Capability 1: Autonomous Coding (AC) – A solution that uses advanced, human-like AI/ML computational processes to assign medical billing codes from clinical documentation without human intervention, while maintaining full auditability and explainability. Capability 2: Automated Appeals & Denials Management (ADM) – A phased, automated solution designed to address backlogged aged Accounts Receivable (A/R), improve first-pass claim success, accelerate documentation release, and automate the generation and submission of appeals to third-party payers. Important Instructions for Interested Parties Interested parties are strongly encouraged to review the attached documents in their entirety for complete details regarding this opportunity, including submission requirements and other specific instructions.