ACADM RFS Rev 1.pdf
Posted: Aug. 26, 2026
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Summary
This **Request for Solution (RFS)**, issued by the Defense Healthcare Management Systems Modernization (DHMSM) Program Management Office, seeks innovative prototype solutions under 10 U.S.C. ยง 4022 Other Transaction Agreements for **Autonomous Coding (AC)** and **Automated Appeals & Denials Management (ADM)** supporting the Department of War electronic health record (DoW EHR) and MHS GENESIS.
The Government may award one or more agreements, make partial or complete capability awards, or make no award. AC solutions must use explainable, auditable AI/ML to assign ICD-10, CPT, and HCPCS codes from clinical documentation without human intervention across inpatient, outpatient, specialty, and ancillary environments, while improving coding accuracy and efficiency and reducing Discharged-Not-Final-Coded volume and Accounts Receivable days.
ADM solutions must automate denial analysis, appeal preparation and submission, documentation release, payer-performance monitoring, and recovery prioritization to reduce aged A/R and improve collections. However, the system may not autonomously write off, adjust, or otherwise dispose of claims, and all financial dispositions require human approval.
Interested companies may propose AC, ADM, or both. Companies proposing both must submit two separate unclassified white papers, each no more than 10 written pages, in PDF format; the cover page, bill of materials, and specified addenda do not count toward the limit.
Submissions must identify:
- Proposed capability
- Solicitation number
- Companies
- Websites
- Points of contact
- Non-traditional defense contractor or nonprofit status
- Licensing terms
- Confidentiality restrictions
White papers must address:
- EHR integration experience, particularly anticipated collaboration with Leidos, the MHS GENESIS system integrator
- AI/ML documentation and decision-support capabilities
- Bias mitigation and performance monitoring
- Required DoW EHR data-retention periods
- Relevant experience
- Project management
- Collaboration
- High-level bill of materials (BOM)
- Engine provenance and data rights
Required security and compliance information includes:
- DODI 8510.01 Risk Management Framework (RMF)
- Annual FISMA testing
- At least DoD Impact Level 4 authorization, with DoD Impact Level 5 preferred
- FedRAMP status
- SPRS access and assessment status
- CMMC Level 2 status
- CJCSM 6510.01B incident handling
- HIPAA compliance
- Encryption
- CAC/PIV authentication
- U.S. source-code custody and personnel access
- Acceptance of the DHA Business Associate Agreement
AC respondents must quantify projected final-coded encounter percentages at startup and at 3-, 6-, 9-, and 12-month intervals. They must also identify exclusions and exclusion rates; explain code-selection accuracy measurement, denial and appeal impacts, savings, and validation; and describe editing, auditing, and Clinical Documentation Improvement trails.
ADM respondents must describe:
- Automated appeal workflows and decision logic
- Denial-prevention methods
- Payer dashboards and key performance indicators
- Financial and audit reporting
- Outcome-based measurement tied to claims collected or overturned rather than appeals generated
- Dollar recovery reporting
- Evidence-based ranking of recoverable claims by expected value
Evaluation will occur in three phases:
1. White-paper review
2. Interactive team discussions followed by prototype and production cost estimates
3. Live demonstrations using vendor-provided sample data
Questions are due by **August 13, 2026, at 10:00 AM ET**, and white papers are due by **August 19, 2026, at 1:00 PM ET**.
The Government will not reimburse submission-preparation costs and may down-select, retain vendors for later consideration, award multiple agreements, or make no award.
The Government may award one or more agreements, make partial or complete capability awards, or make no award. AC solutions must use explainable, auditable AI/ML to assign ICD-10, CPT, and HCPCS codes from clinical documentation without human intervention across inpatient, outpatient, specialty, and ancillary environments, while improving coding accuracy and efficiency and reducing Discharged-Not-Final-Coded volume and Accounts Receivable days.
ADM solutions must automate denial analysis, appeal preparation and submission, documentation release, payer-performance monitoring, and recovery prioritization to reduce aged A/R and improve collections. However, the system may not autonomously write off, adjust, or otherwise dispose of claims, and all financial dispositions require human approval.
Interested companies may propose AC, ADM, or both. Companies proposing both must submit two separate unclassified white papers, each no more than 10 written pages, in PDF format; the cover page, bill of materials, and specified addenda do not count toward the limit.
Submissions must identify:
- Proposed capability
- Solicitation number
- Companies
- Websites
- Points of contact
- Non-traditional defense contractor or nonprofit status
- Licensing terms
- Confidentiality restrictions
White papers must address:
- EHR integration experience, particularly anticipated collaboration with Leidos, the MHS GENESIS system integrator
- AI/ML documentation and decision-support capabilities
- Bias mitigation and performance monitoring
- Required DoW EHR data-retention periods
- Relevant experience
- Project management
- Collaboration
- High-level bill of materials (BOM)
- Engine provenance and data rights
Required security and compliance information includes:
- DODI 8510.01 Risk Management Framework (RMF)
- Annual FISMA testing
- At least DoD Impact Level 4 authorization, with DoD Impact Level 5 preferred
- FedRAMP status
- SPRS access and assessment status
- CMMC Level 2 status
- CJCSM 6510.01B incident handling
- HIPAA compliance
- Encryption
- CAC/PIV authentication
- U.S. source-code custody and personnel access
- Acceptance of the DHA Business Associate Agreement
AC respondents must quantify projected final-coded encounter percentages at startup and at 3-, 6-, 9-, and 12-month intervals. They must also identify exclusions and exclusion rates; explain code-selection accuracy measurement, denial and appeal impacts, savings, and validation; and describe editing, auditing, and Clinical Documentation Improvement trails.
ADM respondents must describe:
- Automated appeal workflows and decision logic
- Denial-prevention methods
- Payer dashboards and key performance indicators
- Financial and audit reporting
- Outcome-based measurement tied to claims collected or overturned rather than appeals generated
- Dollar recovery reporting
- Evidence-based ranking of recoverable claims by expected value
Evaluation will occur in three phases:
1. White-paper review
2. Interactive team discussions followed by prototype and production cost estimates
3. Live demonstrations using vendor-provided sample data
Questions are due by **August 13, 2026, at 10:00 AM ET**, and white papers are due by **August 19, 2026, at 1:00 PM ET**.
The Government will not reimburse submission-preparation costs and may down-select, retain vendors for later consideration, award multiple agreements, or make no award.
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