SW-119972 - USA (California) - Claims Editing Software - Deadline October 23,2026

(1) Vendor needs to provide claims editing software to implement a comprehensive post‑adjudication, pre‑payment claims editing solution that provides a full suite of editing capabilities – including standard rule‑based edits, complex logic edits, historical claims review, and specialized edits for areas vulnerable to fraud, waste, and abuse (such as hospice and laboratory services).– The service will include standard rule‑based edits, complex logic editing, historical claims review, and specialty‑focused editing in high‑risk areas (including, but not limited to, hospice and laboratory services).– The vendor must provide robust 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.(2) All question must be submitted no later than October 14, 2026.