External Medical Review Consulting

The Mississippi Division of Medicaid is seeking professional services related to independent external medical reviews for State Fair Hearings and/or State Administrative Hearings. The selected vendor will provide written clinical rationales for each determination, including a copy of any medical criteria or clinical guidelines relied upon in support of the recommendation. The vendor will also be responsible for attending telephonic hearings and providing testimony in support of their written recommendations. The contract term is anticipated to be from February 9, 2026, through February 8, 2029, with one optional two-year renewal. Some key points to consider include: • The vendor must have at least five years of experience providing independent external medical review services in the administrative appeals process for a healthcare organization. • The vendor must provide a list of past and/or current engagements for which they performed similar services. • The vendor must warrant that all physicians providing medical recommendations and attending hearings possess the necessary licenses and board certifications required to perform the services. • The vendor must provide written, detailed validation describing their ability to meet each of the qualifications and perform the scope of services.