Cloud-Based Integrated Medical Management Solution

The Road Accident Fund (RAF), a Schedule 3A public entity, is issuing a Request for Information (RFI) under reference RAF/2026/00068 to engage the market on a proven, cloud-based Integrated Medical Management Solution. The RFI follows an earlier procurement process that did not result in an appointment, and RAF is using this exercise to validate and refine its requirements and to inform a future sourcing approach. The RFI is strictly for information gathering and does not constitute a request for proposals, invitation to tender, offer or commitment.

The desired solution is expected to enhance clinical governance, improve operational efficiency and strengthen the management of clinical and financial risks linked to medical benefits arising from claimant injuries. Core requirements include a configurable clinical rules engine and workflows aligned to treatment protocols, tariffs, NAPPI pricing, formularies and the RAF Exclusion List; pre-authorisation and hospital benefit management; case management and serious injury assessment; past and future medical expense management; medical bill review and claims adjudication; provider network management with geo-mapping by province, district, town and suburb; and EMS data management. The solution must also provide fraud, waste, abuse, over-servicing and over-billing detection through risk stratification and provider profiling, alongside audit functionality, reporting and analytics, and integration with RAF systems, statutory data sources and approved third-party platforms via secure APIs.

Respondents are invited to describe their company profile and relevant experience with comparable medium-to-large organisations in healthcare, claims, insurance or public-sector environments, preferably in South Africa. Submissions should address implementation methodology, cloud hosting model, data security and POPIA compliance, uptime, disaster recovery (RTO and RPO), scalability, single sign-on, multi-factor authentication and role-based access control. Respondents must also provide indicative pricing and licensing models, implementation and support approaches, and disclose assumptions, dependencies, constraints and risks. Responses must be emailed to bacsecretariat@raf.co.za by 11:00 AM on 11 November 2026, with enquiries submitted in writing before the closing date.