Utilization Management Services
ID: RFP-UHAA-2025000149-2 • State: Colorado
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Description
Background
The State of Colorado, through the Department of Health Care Policy and Financing (HCPF), is seeking to procure Utilization Management Services. The goal of this contract is to ensure effective management of healthcare services provided to individuals, aligning with the agency's mission to enhance health care access and quality for Colorado residents.
Work Details
The contractor will be responsible for providing comprehensive Utilization Management Services as outlined in Exhibit B, Statement of Work. This includes:
- Assessing and reviewing requests for healthcare services to ensure they meet medical necessity criteria.
- Implementing processes for prior authorization, concurrent review, and retrospective review of services.
- Collaborating with healthcare providers to facilitate appropriate care delivery.
- Ensuring compliance with state and federal regulations regarding utilization management practices.
- Providing training and support to staff involved in utilization management activities.
- Generating reports on utilization trends and outcomes as required by the State.
Period of Performance
The contract will commence on the Effective Date as specified in the contract cover page and will continue for an initial term as defined therein, with options for extensions up to five years total, subject to state discretion.
Place of Performance
The services will be performed primarily within the State of Colorado, with potential provisions for remote service delivery as agreed upon.
The State of Colorado, through the Department of Health Care Policy and Financing (HCPF), is seeking to procure Utilization Management Services. The goal of this contract is to ensure effective management of healthcare services provided to individuals, aligning with the agency's mission to enhance health care access and quality for Colorado residents.
Work Details
The contractor will be responsible for providing comprehensive Utilization Management Services as outlined in Exhibit B, Statement of Work. This includes:
- Assessing and reviewing requests for healthcare services to ensure they meet medical necessity criteria.
- Implementing processes for prior authorization, concurrent review, and retrospective review of services.
- Collaborating with healthcare providers to facilitate appropriate care delivery.
- Ensuring compliance with state and federal regulations regarding utilization management practices.
- Providing training and support to staff involved in utilization management activities.
- Generating reports on utilization trends and outcomes as required by the State.
Period of Performance
The contract will commence on the Effective Date as specified in the contract cover page and will continue for an initial term as defined therein, with options for extensions up to five years total, subject to state discretion.
Place of Performance
The services will be performed primarily within the State of Colorado, with potential provisions for remote service delivery as agreed upon.
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Overview
Opportunity Type
Request for Proposals (RFP)
Opportunity ID
RFP-UHAA-2025000149-2
Response Deadline
May 5, 2025
Past Due
Date Posted
March 28, 2025
Est. Value Range
Experimental
$5,000,000 - $15,000,000
(AI estimate)
Agency Distribution
High
Source
Source Notes
Source does not have a linkable page for this opportunity. To find the opportunity, go to the Source website listed above and search for the Opportunity ID.
On 3/28/25 HCPF - Executive Directors Office in Colorado issued Request for Proposals (RFP) Utilization Management Services with ID RFP-UHAA-2025000149-2 due 5/4/25.
Contacts
Documents
Posted documents for Utilization Management Services
Opportunity Assistant
Classifications
Opportunity Classification
Personal Svcs