West Virginia Public Employees Insurance Agency Special Investigation Unit Services RFP - ARFP PEI2700000001
West Virginia Public Employees Insurance Agency | State of West VirginiaState · Charleston, WV- Due
- Nov 13, 2026
- 15 days left
- Posted
- Sep 25, 2026
- Contract term
- 3 years
- Primary contact
- Sam Revercomb
- (877) 233-4295
The 30-second brief
The West Virginia Public Employees Insurance Agency is seeking proposals from qualified vendors to provide post-payment claim review services, including recognizing and flagging member eligibility and provider billing abnormalities indicative of fraud, waste, or abuse (FWA), identifying and recovering overpayments, and collaborating with the Agency's Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM). The scope covers medical and pharmaceutical claims data analysis, auditing medical records on an itemized line-by-line basis, conducting complex FWA investigations, and maintaining a secure case file management system. Bids are due by November 13, 2026, with a question deadline of October 9, 2026. The contract requires a minimum 2:1 Return on Investment (ROI) and mandates comprehensive general liability, professional liability, and cyber liability insurance.
Technical Proposal (60 points), Cost Proposal (40 points)
Bids like this start as pre-RFPs. Get the next ones early.
Get matched pre-RFPs freeFree account · 30-second setup · No credit card
Summary
The West Virginia Public Employees Insurance Agency is seeking proposals from qualified vendors to provide post-payment claim review services, including recognizing and flagging member eligibility and provider billing abnormalities indicative of fraud, waste, or abuse (FWA), identifying and recovering overpayments, and collaborating with the Agency's Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM).
The scope covers medical and pharmaceutical claims data analysis, auditing medical records on an itemized line-by-line basis, conducting complex FWA investigations, and maintaining a secure case file management system. Bids are due by November 13, 2026, with a question deadline of October 9, 2026. The contract requires a minimum 2:1 Return on Investment (ROI) and mandates comprehensive general liability, professional liability, and cyber liability insurance.
EVALUATION CRITERIA
Technical Proposal (60 points), Cost Proposal (40 points)
REQUIRED ATTACHMENTS
Title Page, Introduction, Table of Contents, Certification and Signature Page, Technical Response Questions, Attachment 1: Intent to Bid Form, Attachment 2: Cost Proposal, Attachment 3: Mandatory Requirements Confirmation, Attachment 6: WV-96 Form, Attachment 7: WV Data Management Addendum & Appendix A, Attachment 8: State of WV Executive Branch BAA & Appendix A, Attachment 9: Litigation Waiver Form or Litigation Bond, Attachment 10: WV Redaction Attestation Form, Attachment 12: Subcontractor Information Form, Attachment 13: Vendor Experience Form, Attachment 14: Staff Resumes, Attachment 15: Deviations Page, Attachment 16: Addendum Acknowledgement Form
- Submit to
- [email protected]
- Duration
- 36 months
- Scope location
- Charleston, West Virginia
- Reported agency
- West Virginia Public Employees Insurance Agency
Questions about this RFP
How do I respond to this RFP from West Virginia Public Employees Insurance Agency | State of West Virginia?
Review the full solicitation document for submission requirements, evaluation criteria, and deadlines. The submission deadline is November 13, 2026. Be sure to include all required attachments as outlined in the solicitation. Submissions should be delivered to: [email protected]. For questions, contact Sam Revercomb.
Can small businesses or minority-owned firms bid on this RFP?
Most government agencies, including West Virginia Public Employees Insurance Agency | State of West Virginia in WV, encourage participation from small businesses, minority-owned, women-owned, and disadvantaged business enterprises (MBE/WBE/DBE). Check the full solicitation for any small business participation goals.
What happens after the RFP submission deadline?
After the deadline, the issuing agency reviews all submissions against the stated evaluation criteria. This typically includes a compliance check, technical evaluation, cost analysis, and may involve oral presentations with shortlisted vendors.
Can I ask questions about this solicitation before submitting?
Yes, most solicitations allow vendors to submit questions during a designated period. The primary contact is Sam Revercomb at (877) 233-4295. Questions and answers are typically shared with all prospective bidders.
Show 6 more questions
What are the evaluation criteria for this solicitation?
This solicitation includes specific evaluation criteria that will be used to score proposals. The criteria include: "Technical Proposal (60 points), Cost Proposal (40 points)" Vendors should carefully align their proposals with each criterion to maximize their score.
Where can I find more RFPs from West Virginia Public Employees Insurance Agency | State of West Virginia?
All active and historical solicitations from West Virginia Public Employees Insurance Agency | State of West Virginia are tracked and searchable. As a state agency, West Virginia Public Employees Insurance Agency | State of West Virginia regularly publishes solicitations. Visit the agency profile to see current open bids, past contracts, vendor relationships, and decision-maker contacts.
What is the contract term for this solicitation?
The anticipated contract term is 3 years. Contract terms may include renewal options.
Is this solicitation still open for submissions?
Based on the posted deadline of November 13, 2026, this solicitation appears to still be accepting submissions. Deadlines may change through amendments or addenda, so always verify the current status directly with the issuing agency before preparing your response.
What documents are required to bid on this RFP?
Requirements vary by solicitation, but common documents include a technical proposal, cost/price proposal, proof of insurance, relevant certifications, past performance references, and any forms specified in the solicitation. This solicitation specifically requires the following attachments: Title Page, Introduction, Table of Contents, Certification and Signature Page, Technical Response Questions, Attachment 1: Intent to Bid Form, Attachment 2: Cost Proposal, Attachment 3: Mandatory Requ. Review the full document from West Virginia Public Employees Insurance Agency | State of West Virginia for the complete list.
What is the scope of this project?
This solicitation defines a specific project scope. The scope covers the following locations: Charleston, West Virginia. Review the full solicitation for detailed scope requirements.