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

ID: HT0038RFSACADM • Notice Type: Solicitation • Match:  100%
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Description

Background
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).

This initiative aims to address high encounter coding volume, increased coding errors, and a growing volume of denied claims within Military Treatment Facilities (MTFs) across the Defense Health Agency (DHA).

Work Details
The contract involves two distinct capability areas:
1) Autonomous Coding (AC): A solution that utilizes advanced AI/ML processes to autonomously assign medical billing codes from clinical documentation without human intervention, ensuring full auditability and explainability. The solution should process approximately 143K encounters daily with a turnaround time of no later than 24 hours.

2) Automated Appeals & Denials Management (ADM): A phased automated solution designed to manage backlogged aged Accounts Receivable (A/R), improve first-pass claim success, accelerate documentation release, and automate appeals submission to third-party payers. Vendors may submit solutions for either or both capabilities. Additionally, if multiple vendors are selected, they must collaborate on integration requirements including comprehensive reporting dashboards, interdependent algorithm learning, and secure data exchange with MHS GENESIS.

Period of Performance
The estimated period of performance is approximately 13-16 months following an award date of August 2026, with key milestones including onboarding and cybersecurity within 90 days post-award and production entry beginning in June 2027.

Place of Performance
Rosslyn VA UNITED STATES

Bidder Requirements
Bidders must ensure all personnel assigned to the project are credentialed (CAC) and comply with Risk Management Framework (RMF) requirements for cybersecurity. They must also demonstrate capabilities in AI/ML technology relevant to autonomous coding and appeals management.
— Amendment Summary: Remaining government responses to previously deferred questions are now available in ACADM Phase 1 QA 082626.pdf. The Government also revised the solicitation and objectives documents; bidders should review highlighted changes in ACADM RFS Rev 1.pdf and Draft SOO ACADM Rev 1.pdf.
Government Description:

August 26, 2026: The remaining responses previously marked as to be provided at a later date are now available in attached ACADM Phase 1 QA 082626'. The RFS and SOO have been revised accordingly; please see the yellow-highlighted sections in the attached ACADM RFS Rev 1' and ACADM SOO Rev 1'.

August 21, 2026: Responses to submitted questions are now available in the attached document, 'ACADM Phase 1 QA 082126'. This document also specifies which questions will receive responses at a later date.

August 17, 2026: Revision 2, RFS has been extended to 8/28/2026 to allow the government additional time to respond to questions. Question period has not been extended.

August 5, 2025: Revision 1, to correct the SAM.gov solicitation close date to 8/19/2026

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.

— Amendment Summary: Responses to bidder questions have been posted in ACADM Phase 1 QA 082126.pdf. The Q&A clarifies submission limits, security and authorization expectations, data access, integration responsibilities, evaluation, and draft performance targets. It confirms the white-paper deadline remains August 28, 2026, while the question period was not extended.
— Amendment Summary: The response deadline has been extended from August 19, 2026 at 5:00 PM UTC to August 28, 2026 at 2:00 PM UTC. The question period was not extended. Revision 2 cites additional time for the Government to respond to questions.
— Amendment Summary: The response deadline moved earlier from August 21, 2026 at 6:00 PM UTC to August 19, 2026 at 5:00 PM UTC.
Posted:

Overview

Agency
Defense Health Agency (DHA) [DoD]
Response Deadline
Past Due
Original deadline:
Posted Date
Last updated:
Set Aside
None
NAICS
541511 - Custom Computer Programming Services
PSC
DA01 - IT And Telecom - Business Application/Application Development Support Services (Labor)
Place of Performance
Rosslyn, VA United States
Source
Open
Estimated Contract Value
$3,000,000 - $15,000,000
Pricing Structure
Likely Fixed Price
Estimated Competition Level
Average
Current SBA Size Standard
$34 Million
On 8/5/26 Defense Health Agency issued Solicitation HT0038RFSACADM for Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM) due 8/28/26. The opportunity was issued full & open with NAICS 541511 and PSC DA01.
Primary Contact
Name
Sharjeel Javaid   Profile
Email
sharjeel.j.javaid.civ@health.mil
Phone
None

Secondary Contact

Name
Dominique Brown   Profile
Email
dominique.u.brown.civ@health.mil
Phone
None

Documents

Posted documents for Solicitation HT0038RFSACADM

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Additional Details

Source Agency Hierarchy
DEPT OF DEFENSE > DEFENSE HEALTH AGENCY (DHA) > DEFENSE HEALTH AGENCY
FPDS Organization Code
97DH-HT0038
Source Organization Code
100501221
Last Updated
Last Updated By
sharjeel.j.javaid.civ@health.mil
Archive Date