REQUEST FOR INFORMATION (RFI) - Intelligent Coding Assistance Tool

The Centers for Medicare & Medicaid Services (CMS) has issued a second Request for Information (RFI) to conduct market research for an Intelligent Coding Assistance Tool (ICAT). This tool must be a developed, commercial off-the-shelf (COTS) or open-source artificial intelligence (AI) product compatible with or integrated into CMS’s Salesforce-based Customer Service Response Management System (CCRMS). Seeking deployment within six months of award, CMS aims to procure this tool in FY 27 to assist first-level medical chart reviews and diagnosis abstraction for the HHS-operated Risk Adjustment Data Validation (HHS-RADV) program. The primary goals of the ICAT are to reduce medical coder review times, improve diagnostic accuracy, lower CMS operational costs, and deliver a clear return on investment (ROI). The RFI is structured around four main areas of inquiry for respondents: technical feasibility (including Salesforce integration and FedRAMP certification), operations and maintenance (focusing on licensing, updates, and cost-benefit projections), acquisition strategy (exploring modular contracting structures and live demonstration capabilities), and potential conflicts of interest under regulatory standards. Responses will help CMS refine future Request for Proposals (RFPs) and schedule vendor demonstrations during the summer and fall of 2026. Submissions are due by August 20, 2026.

This Request for Information (RFI) is issued by the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), to conduct market research for the HHS-Operated Risk Adjustment Data Validation (HHS-RADV) program. CMS is seeking a Commercial Off-The-Shelf (COTS), open-source, or AI-driven Intelligent Coding Assistance Tool (ICAT) that integrates with its Salesforce-based CCIIO Customer Service Response Management System (CCRMS). The tool’s primary objective is to streamline and accelerate first-level medical chart reviews and diagnosis abstraction for the Second Validation Audit (SVA), reducing labor costs while maintaining high accuracy. CMS targets a fiscal year 2027 procurement, requiring a developed product that can deploy in at least a pilot phase within six months of award with minimal custom coding. The RFI organizes industry inquiries into four key areas: 1. **Technical Feasibility:** Seeking information on architecture, deployment timelines, Salesforce integration, and FedRAMP security certifications. 2. **Operations and Maintenance:** Requesting cost projections, licensing models, training requirements, and one- to five-year Return on Investment (ROI) estimations. 3. **Acquisition Strategy:** Gathering feedback on multi-contract structures, modular procurement, and vendor willingness to participate in live, de-identified product demonstrations. 4. **Conflict of Interest:** Soliciting comments on potential sourcing constraints related to regulatory conflict-of-interest standards. Responses are due by August 20, 2026, and will be used to shape future procurement strategies.