SW-116303 - USA (Washington, DC) - RFI for Medical Claims Processing System - Sources Sought - Deadline July 17,2026

(1) Vendor needs to provide medical claims processing system. • Capable of providing a comprehensive medical claims processing system. • The system must support claims adjudication, reimbursement, program integrity, and related functions• Claims processing technology that can adjudicate medical and dental claims submitted from community providers (emerging technologies) including the system’s functionality, compliance with federal standards, average adjudication time frame per claim, timely filing practice, appeals process, and denial rates.• Solution supports the acceptance of paper claims in addition to electronic submissions• Automation versus manual review in your medical claims adjudication process• Medical claims processor have analytic capabilities to ensure program integrity• System scalable to handle large volumes of claims and users• System integrate with other government systems, such as electronic health record• Ability to manage a full–scale provider network to include credentialing, enrollment, and maintenance• Reporting or dashboard capabilities do you currently use for real–time data sharing• Artificial Intelligence (AI) and Machine Language (ML) tools that you have used to detect duplications, fraud, waste, abuse, and missing data values.