Request for Proposal – General Claims Audit

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General Claims Audit – Request for Proposal Summary

The Federal Public Service Health Care Plan (PSHCP) Administration Authority is soliciting proposals from qualified consulting firms for a PSHCP general claims audit, which will verify and evaluate the accuracy of the paid claims processed as well as the systems and processes in place for the adjudication of PSHCP claims for each: Canada Life, and their sub-contractors (i) TELUS and (ii) MSH.

Key Details:

  • Audit Period: April to September 2025 *
  • Final Deliverable: September 30, 2025 *
  • Proposal Submission Deadline: February 28, 2025 **

* The proposed timeline for the completion and delivery of this work is flexible and may be adjusted based on the bidder’s availability and recommendations, to accommodate project needs and ensure successful delivery, as reviewed and approved by the Administration Authority. 

** If circumstances prevent submission by this date, bidders may submit a written request for an extension by January 31, 2025, including a proposed alternate deadline and justification. Extension requests will be considered at the discretion of the Administration Authority.

Scope and Objective:

The PSHCP Administration Authority is conducting the general claims audit to achieve the following objectives:

  • To fulfil the audit requirements stated in the ASO Contract Statement of Work.
  • To provide assurance that Canada Life and its sub-contractors (TELUS and MSH) are in compliance with the terms in the PSHCP Contract relating to claims processing and claims payment services.
  • To determine the accuracy of claims adjudication with respect to Plan provisions.
  • To ensure Contractor and sub-contractors’ adherence to and compliance with the PSHCP Directive, the PSHCP Statement of Work, claims processing Standard Operating Procedures and administrative manuals, and the Contractor’s Quality Assurance Program documentation.

Submission Instructions:

  • Enquiries should be directed to Daniel Lockward at dlockward@pshcp.ca by January 31, 2025.
  • Proposals must be submitted by February 28, 2025 by 5:00 P.M. (ET)

For detailed instructions, evaluation procedures, and contractual information, refer to the full RFP document.

Request for Proposal – PDF