Revenue Cycle Management/Billing Services
Louisiana > Capital Area Human Services District
Invitation for Bids: 14140950
Listing Information/Advertisement:


CAHSD is conducting a fair and impartial competitive procurement process to solicit proposals in order to meet the following goal: Provide a comprehensive Revenue Cycle Management/Billing Service system that covers the entire life span of the outpatient clinic clients’ engagement from eligibility assessment for services through receipt of payment for the final behavioral health treatment service provided at the CAHSD. Contractor shall perform all activities and functions as it relates to Revenue Cycle Management that are necessary to ensure the following objectives are achieved: 1. Timely and accurate filing and/or refiling a claim (claim processing time 2 to 7 days of service and/or rejection); 2. First claim submission to the clearinghouse with a 90% Acceptance Rate or better; 3. Error Rate 5% or less; 4. Reduce bad debt percentage and maintain at 5% or more below the national average. Residential/inpatient and private (non-insurance) contracts/grants are excluded from this RFP. The CAHSD reserves the right to negotiate for these services at a later date.

Additional Notes/Requirements
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SUBMITTAL INFORMATION
Creator Username: CAHSDOB
Bidding Privacy: Bid encryption
Started: 10-Feb-2025 12:00:00 PM CST
Ends: 12-Mar-2025 4:00:00 PM CDT ( 18d, 16h+ )
History: 243 Views, 25 Messages
Event Status: Event open for bids
Actions: Sign-In to Bid
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Visitors: Visitors/Central Bidding Plan Holders
PUBLIC MESSAGE BOARD
Discuss questions with the owner/creator of this Listing.
CAHSDOB on 12-Feb-2025 11:22:24 AM CST
Question #1. What is the monthly volume of claims monthly? Response: 8,000 claims per month
CureMD on 19-Feb-2025 7:41:18 AM CST
1. What is the estimated annual claim volume and revenue?
CureMD on 19-Feb-2025 7:41:41 AM CST
2. What is the current payer mix (Medicaid, Medicare, private insurance, self-pay, grants)?
CureMD on 19-Feb-2025 7:41:55 AM CST
3. What Practice Management or Billing software is being used?
CureMD on 19-Feb-2025 7:42:13 AM CST
4. Is the department willing to switch to another Practice management system and Clearing house?
CureMD on 19-Feb-2025 7:42:27 AM CST
5. Does the department require real-time eligibility verification and prior authorization services?
CureMD on 19-Feb-2025 7:42:40 AM CST
6. Does the department require Coding Services?
CureMD on 19-Feb-2025 7:42:51 AM CST
7. Does the department require Credentialing Services?
CureMD on 19-Feb-2025 7:43:07 AM CST
8. What are the top denial reasons currently faced by your department?
CureMD on 19-Feb-2025 7:43:29 AM CST
9. How many locations do you have.
CureMD on 19-Feb-2025 7:43:46 AM CST
9. How many Providers with NPI numbers do you have.
CureMD on 19-Feb-2025 7:43:56 AM CST
10. Are there any specific compliance or state reporting requirements the vendor must adhere to?
CureMD on 19-Feb-2025 7:44:08 AM CST
11. What level of customer service support is required?
CAHSDOB on 19-Feb-2025 3:25:44 PM CST
Question #2: What is the current payer mix (Medicaid, Medicare, private insurance, self-pay, grants)? Response: The payer mix to date is as follows for SFY 2025: Medicaid 74% Commercial (including Medicare Advantage Plans) 19% Medicare 4% SP 3% Contract payers will not be included in this RFP.
CAHSDOB on 19-Feb-2025 3:33:50 PM CST
Question #3: What Practice Management or Billing software is being used? Response: Qualifacts CareLogic
CAHSDOB on 19-Feb-2025 3:36:50 PM CST
Question # 4: Is the department willing to switch to another Practice management system and Clearing house? Response: No, we will remain on Qualifacts Carelogic as our practice management software and Trizetto Gateway EDI as our clearinghouse.
CAHSDOB on 19-Feb-2025 3:38:41 PM CST
Question #5: Does the department require real-time eligibility verification and prior authorization services? Response: The current practice management software is not able to complete real time eligibility due to CAHS using a non-embedded clearinghouse. We are currently using Trizetto Gateway EDI and other payer portals for real time eligibility. The scope of work did include obtaining prior authorizations for services; however, at this time, CAHS has not decided if the service will be needed with the contract.
CAHSDOB on 19-Feb-2025 3:40:04 PM CST
Question #6: Does the department require Coding Services? Response: The department will not require coding services, as the providers code their own service notes. However, an extensive knowledge of behavioral health CPT, HCPCS and ICD-10 coding would be required in benefit verification, charge master maintenance, processing explanation of benefit denials, and correct any failed claims for submission.
CAHSDOB on 19-Feb-2025 3:42:22 PM CST
Question #9: How many locations do you have. Response: CAHSD would have 6 locatons/NPIs that will provide services under the contract.
CAHSDOB on 19-Feb-2025 3:49:05 PM CST
Question #9: How many Providers with NPI numbers do you have. Response: CAHS has approximately 99 providers that are either PT or FT that provides services as CAHS.
CAHSDOB on 19-Feb-2025 3:50:18 PM CST
Question # 10: Are there any specific compliance or state reporting requirements the vendor must adhere to? Response: The vendor must adhere to the CAHS billing SOP and financial policies, Medicare and Medicaid compliancy , third-party commercial payers and any state or federal regulatory entity’s policies.
CAHSDOB on 19-Feb-2025 3:52:42 PM CST
Question #11: What level of customer service support is required? Response: Any client with outstanding self-pay and commercial balances may need to be contacted in order to collect or update payer information.
tamekiamabin on 20-Feb-2025 9:16:12 AM CST
Clarification needed: Contract payers will not be included in this RFP For this BID are you stating you are only requesting for the contract to perform work for out-of-network insurance and self-pay accounts? If so, what is the average monthly volume?
CAHSDOB on 20-Feb-2025 9:38:48 AM CST
2/18/25 Question: Our team is working on completing our proposal and needs clarity on the submission method. The links in the RFP direct up to a portal that requires an account and payment ranging from $99-$899. Are these the correct options for submission? If not, could you provide the submission methods and appropriate link> Response: See Section 1.7 Proposal Submittal, Page 7 of the RFP for the correct options for submission.
CAHSDOB on 20-Feb-2025 10:51:03 AM CST
Question #5: Does the department require real-time eligibility verification and prior authorization services? Response: Yes; the contractor will be required to use the current non-embedded clearinghouse for real time eligibility (Trizetto Gateway EDI) and other payer portals; prior authorization services are included in the RFP.
UPDATE/ADDENDUM HISTORY
All updates/changes are listed below::
12-Feb-2025 9:42:11 AM CST
Changed wording in access description from "download" to "view".
11-Feb-2025 1:37:50 PM CST
Added note about registering with Central Bidding to view/download document.