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Medical Appeals & Utilization Review

Healthcare funding, procurement and contracting opportunities for independent medical review, utilization review, medical-necessity determinations, provider or member appeals, payment review and related clinical adjudication services.

Atlas IndexGrant Category Intelligence
Latest verification: September 16, 2026
Verified records3
Active opportunities1
Top opportunity score87/100
States represented2

GeographyNational · Texas

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Active Atlas Opportunity Score 87/100
498 days leftVerified September 2, 2026

Texas Health and Human Services Commission (HHSC)

Texas HHSC Independent Review Organizations — Medicaid & CHIP Medical/Utilization Appeals Open Enrollment (HHS0015818)

Texas HHSC is accepting qualified Independent Review Organization applications through January 31, 2028 at 5:00 PM CST to conduct Medicaid and CHIP medical, utilization-review, provider-resolution and administrative appeal reviews under a per-review fee schedule.

FundingFee-for-service contracting. Current Exhibit F lists $325 per review for Admission Denial, Denied Days, DRG Revision, Outlier Days and Acute Care Surveillance reviews, and $150 per review for OIG Targeted Query retrospective payment reviews and Recovery Audit Contractor automated reviews. No guaranteed contract volume or total value is stated on the public solicitation page.
DeadlineJanuary 31, 2028 at 5:00 PM CST
Required next actionReview the current Open Enrollment, Statement of Work, Solicitation Affirmations, Data Use Agreement, Fee Schedule and all addenda; confirm Independent Review Organization qualifications and clinical-review capacity; complete all required application and security/compliance documentation; and submit the complete application by January 31, 2028 at 5:00 PM CST.
Open Atlas Opportunity Score 62/100
1795 days leftVerified September 11, 2026

Health Resources and Services Administration (HRSA)

HRSA Medical Case Reviewer Services for VICP/CICP — 75R60225Q00181

Open HRSA total small-business procurement for qualified medical experts and case reviewers supporting the Vaccine Injury Compensation Program and Countermeasures Injury Compensation Program.

Funding$7.5 million stated BPA ceiling; individual call orders subject to the solicitation and BPA terms; ceiling is not a guaranteed award
DeadlineSAM.gov response deadline August 20, 2031 at 5:00 PM EDT; Amendment P0001 states the solicitation is open with no formal closing date
Required next actionVerify active SAM/UEI registration and mandatory vaccine-injury medical case-review qualifications before any direct bid. If not verified, pursue only through a qualified small-business clinical partner or hold as no-bid.
Open Atlas Opportunity Score 58/100
2 days leftVerified September 16, 2026

Health Resources and Services Administration (HRSA)

HRSA/MCHB Newborn Screening Systematic Evidence Review IDIQ and Task Order 1 — 75R60226R00026

Open HRSA Maternal and Child Health Bureau procurement for systematic clinical evidence reviews, scientific methodology, expert-panel support, and newborn-screening program support.

Funding$15,111,361 aggregate collective IDIQ ceiling; not a guaranteed award amount
DeadlineSeptember 22, 2026 at 5:00 PM EDT
Required next actionHUMAN ACTION REQUIRED by September 18, 2026 at 5:00 PM EDT: verify current active SAM registration for UEI D5Y3QJU5GG55, document qualified newborn-screening/systematic evidence-review personnel and directly relevant capability, and identify three genuine prime or major-subcontractor client references able to submit the required PPQs directly to HRSA. The September 16 SAM.gov notice is informational only, not a new amendment; Amendment 0001 remains controlling and the final proposal deadline remains September 22, 2026 at 5:00 PM EDT. If the required evidence and references cannot be verified, do not bid direct; retain a no-bid or qualified-partner posture. Any final proposal must use Amendment 0001 Attachment 2a and include signed SF-30 acknowledgment.