Professional services related to independent external medical reviews for State Fair Hearings and/or State Administrative Hearings

Location:	Mississippi
Posted:	Oct 31, 2025
Due:	Dec 12, 2025
Agency:	State Government of Mississippi
Type of Government:	State & Local
Category:	R - Professional, Administrative and Management Support Services
Solicitation No:	1628-26-R-IFBD-00003
Publication URL:	To access bid details, please log in.

Procurement Details

Smart Number	1628-26-R-IFBD-00003	Advertised Date	10/31/2025 12:30 PM
RFx #	3160007625	Submission Date	12/12/2025 2:00 PM
RFx Status	Open	Major Procurement Category	PERSONNEL SERVICES NON-IT
RFx Opening Date	12/12/2025 2:00 PM	Sub Procurement Category	PERSONNEL SERVICE - NON-TECHNOLOGY
RFx Type	Invitation for Bid
Agency	MS DIVISION OF MEDICAID
RFx Description	The Division of Medicaid seeks offers from qualified, experienced, and responsible entities to provide professional services related to independent external medical reviews for State Fair Hearings and/or State Administrative Hearings.

Contact Information

Name	Jeanette Crawford	Email	JEANETTE.CRAWFORD@MEDICAID.MS.GOV
Phone	6013592664	Fax

RFx Items

PRODUCT CATEGORY	PRODUCT DESCRIPTION
91858	Serv ConsultGov

Awarded

VENDOR NAME

VENDOR NUMBER

AWARD DATE

AWARD AMOUNT

FUNDING SOURCE

Bid Attachments

Attachments IFB #20251031 - PDF
Attachments IFB #20251031 - WORD

Attachment Preview

MISSISSIPPI DIVISION OF MEDICAID PROCUREMENT

INVITATION FOR BID

IFB #20251031

RFX #3160007625

External Medical Review Consulting

Issue Date: October 31, 2025

Mandatory Letter of Intent Deadline: November 14, 2025, 2:00 p.m. CST

Pre-Bid Conference: November 17, 2025, 10:00 a.m. CST

Written Questions Deadline: November 19, 2025, 2:00 p.m. CST

Bid Response Deadline: December 12, 2025, 2:00 p.m. CST

Procurement Contact:

Jeanette Crawford, Procurement Officer

Telephone: 601-359-2664

E-Mail: procurement@medicaid.ms.gov

DOM WELCOMES PARTICIPATION OF MINORITY BUSINESSES

Table of Contents

1.0 PROCUREMENT OVERVIEW..................................................................................................................3

1.1 Purpose .................................................................................................................................................... 3

1.2 Authority..................................................................................................................................................3

1.3 Procurement Timeline..............................................................................................................................4

1.4 Request for Reconsideration of the Terms of the Solicitation ................................................................. 4

1.5 Pre-Submission Requirements ................................................................................................................. 4

1.6 Bid Submission Requirements ................................................................................................................. 6

1.7 Expenses Incurred in the Procurement Process ....................................................................................... 7

1.8 Type of Contract ...................................................................................................................................... 7

1.9 Written Bids.............................................................................................................................................7

1.10 Minimum Qualifications Criteria.............................................................................................................7

1.11 Accuracy of Statistical Data.....................................................................................................................9

1.12 Procurement Regulations ......................................................................................................................... 9

1.13 Property Rights ........................................................................................................................................ 9

1.14 Contract Rights ...................................................................................................................................... 10

1.15 Electronic Access to Materials...............................................................................................................10

2.0 PROJECT OVERVIEW............................................................................................................................. 11

2.1 Scope of Services...................................................................................................................................11

2.2 System Requirements ............................................................................................................................ 13

2.3 Travel.....................................................................................................................................................14

2.4 Contractor Payment ............................................................................................................................... 14

3.0 PROCUREMENT PROCESS....................................................................................................................15

3.1 Approach................................................................................................................................................ 15

3.2 Multi-Term Contracts ............................................................................................................................ 15

3.3 Rules of Procurement.............................................................................................................................15

3.4 Bid Evaluation ....................................................................................................................................... 16

3.5 Bid Receipt and Bid Opening ................................................................................................................ 20

3.6 Notice of Intent to Award ...................................................................................................................... 21

3.7 Approval of PPRB ................................................................................................................................. 21

3.8 Mississippi Contract/Procurement Opportunity Search Portal .............................................................. 21

3.9 Attachments ........................................................................................................................................... 21

3.10 Right to Reject, Cancel and/or Issue Another Solicitation.....................................................................21

Attachment A – Bid Cover Sheet IFB #: 20251031 ........................................................................................... 24

Attachment B - Bid Form......................................................................................................................................25

Attachment C – Contract Draft Acknowledgement............................................................................................29

Attachment D - DHHS Certification Drug-Free Workplace..............................................................................30

Attachment E - DHHS Certification Debarment, Suspension, and Other Responsibility Matters ................ 33

Attachment F – Proprietary Information Form..................................................................................................34

Attachment G – References...................................................................................................................................35

Attachment H – Bidder’s IFB Response Checklist ............................................................................................. 36

IFB Attachment I – Mandatory Letter of Intent.................................................................................................37

Appendix 1 - Reference Survey Score Sheet (Sample Only) .............................................................................. 38

Appendix 2 - Historical Data................................................................................................................................. 40

Appendix 3 – Contract Draft ................................................................................................................................ 43

Page 2 of 61

External Medical Review Consulting

IFB #20251031

Mississippi Division of Medicaid

1.0 PROCUREMENT OVERVIEW

1.1 Purpose

The Mississippi Division of Medicaid (DOM) Office of Procurement issues this Invitation for

Bid (IFB) to solicit offers from qualified, experienced, and responsible entities to provide DOM

Office of Appeals with professional services related to independent external medical reviews for

State Fair Hearings and/or State Administrative Hearings. These reviews may include but are

not limited to adverse benefit determinations, adverse provider determinations, investigations,

and audit conclusions made by Medicaid managed care organizations (MCOs) and/or its

subcontractors.

Any IFB provisions and/or requirements designated as “Minimum Qualifications” are

mandatory and must be met to be considered a responsive and responsible bidder. Failure to

meet these minimum qualifications may result in the bid being rejected and disqualified from

consideration. The Bidder is disallowed from taking exceptions to these “Minimum

Qualifications”. Any exceptions and/or deviations to or from these “Minimum Qualifications”

may also be cause for rejection.

Bidders will be directed to DOM’s website throughout this procurement. Please note that all

historic data, if any, referenced in this IFB may be found on DOM’s website at:

https://medicaid.ms.gov/resources/procurement/

1.2 Authority

This IFB is issued under the authority of Title XIX (Medicaid) and Title XXI (Children’s Health

Insurance Program) of the Social Security Act as amended, along with their implementing

regulations. It is also authorized under the provisions of the Mississippi Code of 1972, as

amended and pursuant to 42 CFR § 438.402, which sets forth requirements for a state’s Medicaid

managed care appeal process, including the provision for independent external medical reviews.

All prospective Contractors are charged with presumptive knowledge of all requirements of the

cited authorities in this IFB. The submission of a valid executed bid by any prospective

Contractor shall constitute admission of such knowledge on the part of each prospective

Contractor. Any bid submitted by any prospective Contractor which fails to meet any published

requirement of the cited authorities may, at the option of DOM, be rejected without further

consideration.

Medicaid is a program of medical assistance for individuals with low income and limited

resources, administered by the states using state appropriated funds and federal matching funds

within the provisions of Title XIX of the Social Security Act, as amended. Section

1902(a)(30)(A) of the Social Security Act (42 USC §1396a(a)(30)(A)), as amended, requires

that State Medicaid Agencies provide methods and procedures to safeguard against unnecessary

utilization of care and services and to assure “efficiency, economy, and quality of care.”

The selected vendor shall perform such reviews in accordance with all applicable federal and

state regulations, including but not limited to 42 CFR §§ 438.400 through 438.424, ensuring

Page 3 of 61

External Medical Review Consulting

IFB #20251031

Mississippi Division of Medicaid

timely, impartial, and expert medical determinations that support the integrity and accountability

of the state’s appeal process.

1.3 Procurement Timeline

The following timetable is the estimated and anticipated timetable for the IFB and procurement

process. DOM reserves the right to amend the Procurement Timetable.

Figure 1.1: Procurement Timetable

Date

Process

10/31/2025

11/14/2025

11/17/2025

11/19/2025

11/26/2025

12/12/2025

1/02/2025

2/04/2026

2/09/2026

Release of Invitation for Bid

Mandatory Letter of Intent (by 2:00 p.m.)

Pre-Bid Conference (10:00 a.m.)

Written Questions Deadline (by 2:00 p.m.)

Anticipated Date of Posting Written Answers (by 5:00 p.m.)

Bid Deadline (by 2:00 p.m.)

Anticipated Date of Notice of Intent to Award

Public Procurement Review Board meeting date (proposed)

Anticipated Contract Start

1.4 Request for Reconsideration of the Terms of the Solicitation

Any potential bidders are advised that they may request reconsideration of this solicitation.

Specific guidelines and procedures for such requests can be found in Section 5.2.4 of the PPRB

OPSCR Rules and Regulations.

1.5 Pre-Submission Requirements

1.5.1 Mandatory Letter of Intent

To be eligible to submit a Bid, the Bidder is required to submit IFB Attachment I: Mandatory

Letter of Intent via email to: procurement@medicaid.ms.gov.

The Mandatory Letter of Intent is due by Friday, November 14, 2025, by 2:00 p.m. CST. The

Mandatory Letter of Intent must be signed by an individual authorized to commit the Bidder to

the work proposed.

Failure to submit the Mandatory Letter of Intent by the deadline listed above will disqualify the

submitted bid from consideration. It is the responsibility of the Bidder to ensure that the

Mandatory Letter of Intent is delivered timely, and the Bidder bears all risks of delivery.

Submission of the Mandatory Letter of Intent does not bind a prospective Bidder to submit a bid.

For the purposes of accessing DOM’s SharePoint site that will be used for submission of bids,

the Bidder must include on the Mandatory Letter of Intent two (2) individuals’ email addresses

Page 4 of 61

External Medical Review Consulting

IFB #20251031

Mississippi Division of Medicaid

for the person(s) responsible for uploading the bid to the SharePoint site. A field is included on

the Mandatory Letter of Intent for that purpose. Please ensure all email addresses are typed or

printed clearly for guaranteed legibility. Shared email addresses are not eligible; they must be

individual email accounts.

1.5.2 Pre-Bid Conference

A pre-bid conference will be held Monday, November 17, 2025, 10:00 a.m. CST, via a

Microsoft Teams link that will be distributed to potential bidders that submit a Mandatory Letter

of Intent. Please note that attendance is not mandatory. A record of all bidders who attend the

conference shall be made. The pre-bid conference is to discuss the procurement submission

requirements and not an opportunity to ask questions about the IFB.

Nothing stated at the pre-bid conference shall change the IFB unless stated in a written

amendment.

1.5.3 IFB Questions and Answers

Multiple questions may be submitted Wednesday, November 19, 2025, no later than 2:00 p.m.

CST, using the Question and Answer template found at:

https://medicaid.ms.gov/resources/procurement/. Questions must be submitted using the

referenced template and sent via e-mail to: procurement@medicaid.ms.gov with the subject

line: External Medical Review Consulting IFB – Questions. The Bidder bears all risk and

responsibility for ensuring timely delivery. Questions received after the deadline and Questions

submitted by Bidders who do not submit a timely Mandatory Letter of Intent will not be

addressed by DOM.

DOM anticipates written answers will be available 5:00 p.m. CST, Wednesday, November 26,

2025, via DOM’s procurement website at: https://medicaid.ms.gov/resources/procurement/

and the Mississippi Contract/Procurement Opportunity Search portal website at:

https://www.ms.gov/dfa/contract_bid_search/Bid?autoloadGrid=False

DOM will submit a register of all questions, exactly as submitted, along with the corresponding

answers. The register of all questions and answers shall be issued as an Amendment to the IFB.

DOM’s responses to questions will be treated as amendments to the IFB and will require

acknowledgment.

Written answers provided for the questions are binding. Questions and answers shall become

part of the final contract as an attachment.

1.5.4 Acknowledgement of Amendments

Should an amendment to the IFB be issued, an amendment will be posted on the Mississippi

Contract/Procurement Opportunity Search Portal website and DOM’s website in a manner that

all bidders will be able to view.

Page 5 of 61

This is the opportunity summary page. It provides an overview of this opportunity and a preview of the attached documentation.

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Professional services related to independent external medical reviews for State Fair Hearings and/or State Administrative Hearings

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