- Org
- Multnomah
- Type
- RFP
- Title
- Medical Claims Audit
- Number
- RFP-12-2027
- Source
- MULTNOMAH_CO
- Status
- Open
- Event Id
- 1414202
- Open Str
- 8/21/2026, 8:00 AM PDT
- Pdf Text
- 21 August 2026
Medical Claims Audit
Multnomah County is seeking a qualified vendor to conduct a comprehensive Medical Claims Audit of its
self-insured health plans.
21 August 2026
Open 8/21/2026, 8:00 AM PDT Type Request for Proposal (RFP)
Close 9/23/2026, 4:00 PM PDT Number RFP-12-2027
Currency US Dollar
Sealed Until 9/23/2026, 4:00 PM PDT
Payment
Terms 0% 0, Net 30
21 August 2026
Contacts
Jun Zhu
jun.zhu@multco.us
Phone +1 503-988-7603 ext. 87603
21 August 2026
Commodity Codes
Commodity Code Description
80101599 Consulting Services, General
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IMPORTANT: Suppliers who do not currently have access to the Multco Marketplace Supplier Portal
will need to complete the "MMP Supplier Access Request Form". In order to allow the County
sufficient time to review your request, the MMP Supplier Access Request form should be completed
no fewer than 5 days prior to the Sourcing Event closing date.
Pre-Proposal Conference
There will be a virtual Pre-proposal Conference for this sourcing event.
Date: Wednesday, September 2nd, 2026
Time: 1:30pm PST
Google Meet Video Link: https://meet.google.com/hxf-iozj-xnf
Or Call: (US) +1 405-358-3143 PIN: 404 556 057#
Confidentiality
If your proposal has confidential information, read over the CONFIDENTIALITY statement in the
Prerequisites section and then attach the necessary documentation in the “Suppliers Attachments” tab
of the event.
Upload the information for those sections or questions marked as confidential as a PDF in the
“Suppliers Attachments” tab of the event. The same page, text, or character limits that applied within
the original sections or questions will apply to this uploaded PDF file.
SERVICE DESCRIPTION, FUNDING AND CONTRACTING INFORMATION
PURPOSE AND OVERVIEW
Project Overview
The County seeks proposals from qualified contractors to conduct comprehensive claims audits and
operational assessments for its self-funded health plan. The selected contractor will perform
independent audits at the discretion of the County, the scope to be determined at the discretion of the
County.
Introduction and Program History
Employee Benefits administers benefits including health, life insurance, disability insurance, long term
care insurance, HRA VEBA, and FSA for nearly 6,000 County employees. Approximately 2,300
employees and retirees are enrolled in the County’s self-funded PPO medical plans and
approximately 2,600 employees and retirees enrolled in the County’s self-funded dental plan.
The County is seeking a qualified vendor to conduct a comprehensive Medical Claims Audit of its self-
insured health plans. The primary objective is to ensure fiscal accountability, verify compliance with
plan documents, and identify opportunities for cost recovery and process improvement. The selected
Description
firm must demonstrate independence and possess significant experience auditing public sector health
plans of similar size and complexity.
Goals, Values, and Other Important Considerations
Funding
The County has budgeted sufficient funds to conduct the services outlined below in the Scope of
Services.
Scope of Services
Conduct medical, prescription, and dental audits of self-funded health plans.
• Stakeholder Engagement:
Provide a stakeholder engagement plan, including semimonthly progress reports in a mutually
agreed format (e.g., written updates or virtual dashboards) and a process for escalating issues
to the County within 24 hours.
• Quality Assurance:
Implement robust quality assurance processes, including internal review protocols and error-
checking methodologies, to ensure audit accuracy.
Provide a plan for resolving disputes with health plan over claims findings, with examples of
successful resolution from past projects (e.g., percentage of disputed claims resolved).
• Knowledge Transfer:
Include a knowledge transfer plan to equip County staff with insights from the audit, such as a
training session on key findings or documentation of audit methodologies and CAP monitoring
processes. This plan should be included within the proposed fees unless otherwise specified.
• Additional Projects:
Additional projects requested by the County, individually not expected to exceed $10,000, may
be proposed and billed on (i) a time-and-expense basis (based on the Contractor ’s hourly
billing rates in effect at the time), (ii) a fixed-fee basis, or (iii) as otherwise mutually agreed in
writing. All such projects will be subject to the terms of the resulting contract.
• Innovation and Value-Added Services:
Contractors are encouraged to propose innovative approaches or value-added services, such
as predictive analytics to identify future claims risks, benchmarking against industry standards,
or training sessions for County staff. Proposals should detail how these additions align with the
project’s objectives and budget constraints.
• Assumptions:
o Full and timely cooperation by health plan throughout the audit process, including timely
resolution of open issues.
o Health plan and the County provide complete, accurate, and timely information,
materials, and data.
o Fees do not include any charges that Contractors may impose for providing claims
history data. Contractors must disclose any anticipated third-party fees in their
proposals.
County Responsibilities
To support the audit, the County may assist with the following:
• Notify health plan that a contractor has been engaged to conduct the audit, using sample
language provided by the contractor if needed.
• Provide the contractor with plan description materials, such as updated Summary Plan
Descriptions (SPD), Summary of Benefits and Coverage (SBC), and/or benefit summaries in
effect during the audit period.
• Review and sign, as approved by the County’s legal counsel, any audit agreements required by
health plan.
• Be available to assist with plan intent benefit clarifications, as necessary.
Compensation and Billing
Proposals must include fixed fees for services and travel, along with hourly rates for any potential
additional work or extensions. Proposals must include standard hourly billing rates by role or expertise
level for any additional work. See Proposal Question 2.1.3.
Subcontractors
The contractor may utilize subcontractors for tasks such as printing and mailing, development of
interactive tools, graphic design, SaaS hosting, etc. The County consents to the use of
subcontractors, provided they are disclosed in the proposal. The contractor must ensure that
subcontractors receive the County’s confidential information only on a need-to-know basis and under
appropriate confidentiality agreements. The contractor remains fully responsible for the performance
of all services, including those performed by subcontractors.
Data Security and Compliance
Contractors must describe their data security protocols for handling protected health information (PHI)
in compliance with HIPAA, HITECH, and other relevant regulations. Proposals should detail
encryption methods, access controls, and incident response plans used in similar audits to ensure the
security of County and health plan data.
The County reserves the right to negotiate terms and fees with the selected contractor. Proposals will
be evaluated based on criteria including cost, expertise, methodology, innovation, and alignment with
the County’s needs. Contractors are encouraged to seek clarification during the RFP process via a
designated Q&A period to address any ambiguities.
Contract Term
The County may issue a contract not to exceed five years.
Contract Negotiations
The County will initiate contract negotiations with the responsive and responsible Proposer with the
highest scoring proposal. Multnomah County may, at its option, elect to negotiate general contract
terms and conditions, services, pricing, implementation schedules, and such other terms as the
County determines are in the County’s best interest. If negotiations fail to result in a contract, the
County reserves the right to terminate the negotiations and initiate contract negotiations with the next
highest scoring responsive and responsible Proposer. This process may continue until a contract
agreement is reached.
Contract Award
Through this Sourcing Event process, the County is seeking to award one contract. Award, as
determined by the County, will be made to the responsible Proposer whose Proposal the County
determines is most advantageous to the County based on the evaluation process and evaluation
factors described in this Sourcing Event.
Multnomah County strongly encourages the participation of Minority-Owned, Women-Owned, and
Emerging Small Businesses and Organizations in providing these services.
Insurance Requirements
• Professional Liability (Errors & Omissions): $1,000,000 per occurrence / $2,000,000
aggregate.
• Commercial General Liability: $1,000,000 per occurrence / $2,000,000 aggregate (bodily
injury, property damage, contractual liability).
• Automobile Liability: $500,000 combined single limit (if applicable, and only if travel
reimbursement is permitted).
• Workers’ Compensation: Per ORS 656.017; statutory limits (minimum $500,000).
• Cyber Liability: $1,000,000 per occurrence / $2,000,000 aggregate (for data handling).
• Additional Insured: County named on General Liability policies.
Minimum Requirements
At Proposal Submission: Proposers must meet the following minimum requirements. Failure
to provide any of the required documents or meet any of the below requirements shall result in
rejection of the proposal.
• Submit via County’s sourcing portal by 4:00 PM PT on the Proposal due date.
• Certify to the Representations and Certifications (Pre-requisite page).
At Contracting
• Registered to do business in Oregon (ORS 60.701).
• Submit verification that all insurance requirements are met.
• No unresolved conflicts or litigation related to similar services.
Failure to meet requirements may result in rejection or cancellation.
Required to View Event
Prerequisites Required to Enter Bid
21 August 2026
1. Proposer/Bidder agrees to receive all correspondence electronically and are responsible for keeping their
supplier portal updated with current contact information.
2. CONFIDENTIALITY - Please read the statutory requirements in the prerequisite link.
3. Please review the statements in this certification regarding Assurances, Certification Regarding Debarment,
Suspension and Other Responsibility Matters and Certification Regarding Conflict of Interest.
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Buyer Attachments
1. How to Complete and Submit a Response to a Sourcing Event - MMP Supplier Guide
2. Procedural Instructions_Proposals 04_02_2024.pdf
3. SAMPLE General Services Agreement.pdf
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Questions Required Questions
Group 1.1: Company Certification Information - This section is not scored
Instructions:
1.1.1 State of Incorporation
1.1.2 Date of Incorporation
1.1.3
ASSURANCES - Proposer attests that Proposer is either a non-resident proposer or a
resident proposer (as described in Representation and Certification Prerequisite and ORS
279A.120) of the State of _________ and has not discriminated against any minority,
women, or emerging small business enterprises certified under ORS 200.055 or a
business enterprise that is owned or controlled by or that employs a disabled veteran as
defined in ORS 408.225 in obtaining any required subcontracts, in accordance with ORS
279A.110. Enter state of residency here:
1.1.4 Where Proposer is unable to certify to any of the statements in Proposer Representations and
Certifications of the Prerequisite, Proposer shall provide an explanation to their offer here.
1.1.5
The Proposer certifies to the best of its knowledge and believes that neither it nor any of its principal
participants and agents has or has had the following relationships with the specific
firm(s)/individual(s), identified in this sourcing event, which may be determined to be an organizational
conflict of interest. I understand that based on the information provided by Proposer, Multnomah
County may exclude the Proposer from further consideration and may withdraw its selection if the real
or apparent organizational conflict of interest cannot be avoided or mitigated. Proposer further
certifies that the degree and extent of the relationship of the Proposer with these named
firm(s)/individual(s) will be fully disclosed:
1.1.6 Upload additional explanation as needed
1.1.7 Name of person submitting the Proposal:
1.1.8 Title of person submitting the Proposal:
1.1.9 I represent that I am at least eighteen (18) years of age.
1.1.10 I represent that the printing of my name and the submittal of a Proposal is intended to
authenticate this writing and to have the same force and effect as my manual signature.
1.1.11 I represent that I am either authorized to bind the Proposer, or that I am submitting the
Proposal on behalf of and at the direction of the Proposer's representative authorized to
contractually bind the Proposer.
1.1.12 I represent that the Proposer and/or its applicable representative(s) has reviewed the
information contained in this Proposal and that the information submitted is accurate.
Group 2.1: Programmatic Questions (75%)
Instructions:
2.1.1
Methodology and Approach: Describe your step-by-step methodology for conducting the
100% electronic claims audit and targeted sample audit, including how you ensure
accuracy, compliance with industry standards, and integration with health plan systems.
(15 points)
2.1.2
Experience and Qualifications: Provide details on your firm's experience with similar
claims audits and operational assessments for public sector clients, including at least
three relevant case studies or references, with outcomes such as error rates identified,
overpayments recovered, and corrective action plan. (10 points)
2.1.3
Fees and Hourly Rates: Provide a breakdown of your proposed fixed fees for each scope
of service (as outlined in the RFP), along with your standard hourly billing rates for any
additional work or extensions, including how these rates are structured by role or expertise
level. (10 points)
2.1.4 Subcontractor Management: If you plan to use subcontractors, describe their roles,
qualifications, and how you will ensure they comply with confidentiality requirements and
maintain the same quality standards as your primary team. (5 points)
2.1.5 Conflict of Interest Disclosure: Disclose any potential conflicts of interest, such as prior or
current relationships with health plan administrators, and explain how you would mitigate
them to ensure an independent and unbiased audit. (5 points)
2.1.6
Follow-Up and Reporting: Explain your process for developing and monitoring the
Corrective Action Plan (CAP), including how you will conduct the semimonthly calls, track
progress, and deliver the final report to ensure recommendations are actionable. (10
points)
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2.1.7
Data Security and Compliance: Describe your firm's policies and procedures for handling
sensitive health data, including compliance with HIPAA, data encryption methods, breach
response protocols, and any relevant certifications. Provide examples of how you've
managed data security in past audits involving protected health information. (5 points)
2.1.8
Technology and Tools: Detail the specific software, AI-driven tools, or analytics platforms
your firm will use for the claims audit and operational assessment. Explain how these
technologies enhance accuracy, efficiency, and error detection compared to manual
processes. (8 points)
2.1.9
Risk Management and Contingencies: Outline your approach to identifying and mitigating
risks during the audit, such as data inaccuracies from health plan, delays in information
provision, or disputes over findings. Include examples of how you've handled similar risks
in prior engagements. (10 points)
2.1.10
Innovation and Value-Added Services: Beyond the core scope, what innovative tools,
technologies, or methodologies (e.g., AI-driven claims analysis or predictive analytics) do
you employ to enhance audit efficiency and outcomes? Describe any value-added
services you could offer at no additional cost, such as preliminary data analytics or
benchmarking against industry standards. (12 points)
2.1.11 Performance Metrics and Outcomes: How do you define and measure success for medical
claims audits? (10 points)
Group 2.2: Responsible Business Practice Questions (25%)
Instructions:
2.2.1
Describe the energy conservation practices your firm utilizes to minimize the carbon
footprint associated with data management and remote operations for this contract.
Specifically, address how your data storage protocols or chosen SaaS hosting
subcontractors optimize energy efficiency (e.g., utilizing energy-efficient data centers,
green cloud hosting, or low-power server management) and how your reliance on virtual
dashboards and electronic data transfers will be managed to minimize unnecessary
energy consumption. (40 points)
2.2.2
How does your firm integrate equity-focused principles and demographic analysis into its
auditing methodology to identify health plan disparities or barriers to care among
historically underrepresented or marginalized employee populations? Additionally,
describe the diversity of the leadership and key personnel who will oversee this project,
including how your firm ensures culturally competent analysis and reporting. (30 points)
2.2.3
Provide an overview of the economic impacts your firm generates through its employee
healthcare benefits, living wage standards, and workforce wellness programs. How does
your firm utilize employee assistance, mental health support, or flexible work wellness
initiatives to reduce auditor burnout, support staff retention, and directly ensure consistent,
high-quality delivery and rigorous quality assurance over the course of this five-year
contract? (30 points)
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Product Line Items Product Line Items
There are no Items added to this event.
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Service Line Items Service Line Items
1.
# Item Name, Commodity Code, Description Allow
Alternates Qty. UOM Requested Service Delivery
S1 N/A: DO NOT COMPLETE 1
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- Close Str
- 9/23/2026, 4:00 PM PDT
- Contact Name
- Jun Zhu
- Description
- Multnomah County is seeking a qualified vendor to conduct a comprehensive Medical Claims Audit of its self-insured health plans.
- Contact Email
- jun.zhu@multco.us
- Sci Docs Fetched
- Yes
Multnomah CountyIssuing agency·Portland, OR·via a public procurement portal