RFP SD25-00019 Health Care Provider Network and Prior Authorization Services

The California Department of Corrections and Rehabilitation (CDCR) seeks a qualified contractor to design, build, and manage a statewide health‑care provider network for its correctional facilities and to optionally deliver an electronic prior‑authorization (PA) platform. The contractor must contract with roughly 99 hospitals, 1,000 physicians and other specialty providers, ensure geographic coverage standards, handle credentialing, integrate with CDCR’s designated Third‑Party Administrator, and meet extensive performance guarantees. The work is fee‑per‑claim based, with a five‑year base term and up to five one‑year extensions, and includes detailed reporting, change‑management, disaster‑recovery, and training obligations. • Build and maintain a provider network covering hospitals, physicians, labs, imaging centers, ambulances, telemedicine, and specialty services across California (and bordering counties). • Optional development and operation of an electronic prior‑authorization system that integrates with CDCR’s TPA and EMR. • Deliver quarterly quality/utilization reports, monthly progress updates, and comprehensive implementation, training, and continuity plans. • Meet strict performance guarantees (e.g., 80 % network operational within six months, turnaround times for urgent and routine services, and at‑risk fee reductions for non‑compliance).