(1) Vendor needs to provide revenue cycle management service.– Revenue cycle management expectations include a) claims tracking, b) EOB/ERA, c) accounts receivable management and denials (including requests for additional information (RAIs), d) optionally credentialing, and e) overall, ongoing quality improvement and assessment of the revenue cycle.– Selected vendor will assist with claim rejections and denials; (ii) communicate with third party payers on agency’s behalf; (iii) identify and target specific payer and provider challenges with accompanying mitigation solutions; and (iv) provide education to improve reimbursement, including accurate documentation and coding updates, streamlined process suggestions and fee schedule recommendations.– Maximize revenue by expediting claims processing/reprocessing to achieve at least 98% of claims accepted and paid after first submission (clean claims).– Achieve cost containment and proper balance in service and cost.– Provide education regarding accurate coding (ICD & CPT) for providers and billing personnel.– Assist with achieving a 5% or lower claim denial rate.(2) Contract period will be for four years.
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