State of South DakotaIssuing agency·South Dakota·via the State of South Dakota posting board (ESM Solutions)Wellmark Blue Cross Blue Shield of South Dakota (“Wellmark”) has been administering the State’s self-funded medical and pharmacy plans since July 1, 2021. Approximately 12,150 State employees and COBRA participants enrolled in four (4) State of South Dakota State Employee Health Plans (“SDSEHP”) which includes 2 low-deductible Preferred Provider Organization (“PPO”) plans and 2 high-deductible plans which offer a Health Savings Account (“HSA"). The total number of plan participants including spouses and dependent children is approximately 26,800. As of May 1, 2026, 65.00% of plan members were enrolled in the high-deductible health plans and 35.00% were enrolled in the low-deductible plans. Annual paid claims volume is approximately 314,300 medical claims and 282,700 pharmacy claims. For Fiscal Year 2026 (ended on June 30, 2026), the SDSEHP paid a total of approximately $160 million in total health plan costs (medical claims, prescription drug claims, and administrative fees), of which approximately $108 million was for medical claims alone.
The Bureau of Human Resources & Administration (“BHRA”) is soliciting proposals from vendors who can conduct a performance review of medical claims processing performed by Wellmark. The auditor selected through this RFP process will be required to execute a Non-Disclosure Agreement “(NDA”) with Wellmark.
All written questions should be sent to: Peggy.Canter@state.sd.us, only emailed questions will be accepted.
Each offeror may submit questions via email concerning this RFP to obtain clarification of requirements. No questions will be accepted after the date and time indicated in the above schedule of activities. Email questions to the email address listed above with the subject line “RFP#26RFP19878”. The questions and their answers will be sent to all offerors that submitted Letters of Intent, submitted questions, or requested the questions and answers via email before the proposal submittal date and will be sent by the date and time indicated in the above calendar of events. Offeror may not rely on any other statements, either of a written or oral nature, that alter any specification or other term or condition of this RFP that have not originated from the SD RFP Project Contact. Offerors will be notified in the same manner as indicated above regarding any modifications to this RFP. Offerors and their agents may not contact any state employee other than the buyer of record regarding any of these matters during the solicitation and evaluation process. Inappropriate contacts are grounds for suspension and exclusion from specific procurements.
Invitation Only · Ready for Responses
Documents (1):
• RFP Document.pdf (442 KB)
View the full solicitation and download documents on South Dakota's posting board.
The audit covers three audit periods: FY2028 (July 1, 2027 – June 30, 2028), FY2029 (July 1, 2028 – June 30, 2029), and FY2030 (July 1, 2029 – June 30, 2030). For each period, the vendor must perform electronic screening of 100% of paid medical claims to measure claims processing accuracy rate, payment incidence accuracy rate, financial accuracy rate, claims turnaround time, and identification of recovery/savings potential. The vendor must also review a combined financial stratified/attribute statistical sample of 200 claims per period, a judgment sample of 50 inpatient DRG hospital claims per period, and a randomly selected sample of 20 out-of-network claims per period. Results must be compared to industry standards and Wellmark's self-reported performance.
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Source: South Dakota Procurement (event 19878), retrieved via the State of South Dakota posting board (ESM Solutions). View the official posting, and always confirm requirements and deadlines with the issuing agency.
