Description
The State of Missouri, through its Department of Commerce and Insurance, is seeking a qualified contractor to provide Medical Care Utilization Review Services for a one‑year contract. The contractor will perform external medical necessity reviews of health‑plan claims, provide medical expertise for regulatory activities, and may be called upon for expedited reviews. The award will be based on a sealed, electronic proposal submitted via MissouriBUYS. Vendors must be certified as utilization review agents, possess IRO accreditation, and demonstrate at least one year of similar experience with a state entity. Key compliance requirements include business entity certification, E‑Verify participation, and anti‑boycott certifications. • Scope: review of medical cases, determination of necessity/appropriateness, and provision of expert medical input. • Contract length: 1 year, with potential for renewal but not stated. • Minimum qualifications: 1 + year utilization review experience, IRO certification, no disciplinary history. • Submission: electronic only, deadline Oct 5 2026 2 PM CT. • Required exhibits: proposal signature, pricing, experience, technical methodology, compliance documents. • Location: services performed within the United States; no site visits required.