Independent Medical Review (IMR) RFP # 24CSMC-041C

Background
The California Department of Insurance (CDI) is issuing this Request for Proposal (RFP) # 24CSMC-041C to solicit proposals for Independent Medical Reviews (IMR).
The CDI aims to award one contract for a duration of three years, with the possibility of two one-year extensions.
The purpose of this RFP is to select a prime contractor capable of providing IMRs related to insurance determinations under California Insurance Code sections 10145.3 and 10169-10169.5.
The CDI reserves the right not to award any contracts associated with this RFP.

Work Details
The selected contractor will be responsible for conducting IMRs as per the following requirements:
1. Conduct IMRs based on requests from insured individuals regarding health care services denied by insurers.
2. Provide timely, complete, and professional case analysis and determinations.
3. Maintain sufficient administrative facilities and qualified medical reviewers free from conflicts of interest.
4. Process IMR requests through a defined five-step process involving application submission, eligibility determination, information forwarding, review assignment, and final determination reporting.
5. Ensure compliance with all relevant California Insurance Code sections.
6. Provide consulting and research services related to health care treatments or clinical issues that assist the CDI in non-grievance matters.
7. Submit monthly reports detailing completed reviews including case numbers, insurer names, determination dates, and reviewer qualifications.

Period of Performance
The contract will be performed over a period of three years with options for two additional one-year extensions.

Place of Performance
The services will be performed within California as required by the California Department of Insurance.