Central Bidding - Revenue Cycle Management/Billing Services (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

Inquiries and responses can be emailed to [email protected] INTERESTED PARTIES MUST REGISTER WITH CENTRAL BIDDING FOR ACCESS TO VIEW DOCUMENT VIA THIS WEBSITE. THERE IS NO CHARGE ASSOCIATED WITH REGISTERING.

BID 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 ( Expired )
History:	599 Views, 51 Messages
Event Status:	Vendor Awarded; bidding for event closed
Actions:	Sign-In to Bid Username: Password:
Visitors:	Visitors/Central Bidding Plan Holders

DOWNLOAD BID DOCUMENTS

RFX #3000024275_RCM_Billing_Services02102025.pdf (1.0 MB)

Addendum #01 RFX #3000024275 RCM Billing Services.pdf (121.8 KB)

Join Zoom Meeting RFX.pdf (98.6 KB)

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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.

CAHSDOB on 24-Feb-2025 9:20:43 AM CST

Question #7: Does the department require Credentialing Services?
Response: No.

CAHSDOB on 24-Feb-2025 10:08:59 AM CST

Question #8: What are the top denial reasons currently faced by your department?
Response: CO-22, MA07, PR-27, CO0109, N767, No Authorization.

CureMD on 24-Feb-2025 10:19:52 AM CST

. What is the estimated annual claim volume and revenue?
CureMD on 19-Feb-2025 7:41:41 AM CST

CAHSDOB on 25-Feb-2025 8:39:41 AM CST

Question: What is the estimated claim volume and revenue?
Response: CAHSD has an average of $425,000 per month on self-generated revenue from third-party insurance, Medicare and Medicaid. CAHS processes an average of 8,000 claims per month.

CAHSDOB on 25-Feb-2025 8:49:09 AM CST

Question: Are there any specific compliance or state reporting requirements the vendor must adhere to?
Response: Yes; CAHS billing SOP and financial policies; Medicare and Medicaid compliancy; 3rd party commercial payers; state and federal regulations.

CAHSDOB on 25-Feb-2025 8:58:45 AM CST

Question: 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?
Response: No, the contract includes in and out of network payers. CAHS processes an average of 8,000 claims per month.

CAHSDOB on 25-Feb-2025 9:32:37 AM CST

Question: What is CAHSD's daily average claims volume?
Response: 300

CAHSDOB on 25-Feb-2025 9:33:34 AM CST

Question: What is CAHSD's monthly average claims volume?
Response: 8,000

CAHSDOB on 25-Feb-2025 9:39:52 AM CST

Question: Performance: What is your definition of error rate? How is this measured?
Response: The percentage of medical claims submitted by a provider that contain errors. Formula: The total number of claims submitted without error divided by the total number of claims submitted.

CAHSDOB on 25-Feb-2025 9:42:02 AM CST

Question: Performance: What is your definition of bad debt? How is it currently measured?
Response: The portion of receivables that can no longer be collected from the payer or client (timely filing limit, non-covered services, outstanding client balance over 120 days).

CAHSDOB on 25-Feb-2025 9:42:55 AM CST

Question: Performance: What is the average national bad debt percentage? What is the source of this metric?
Response: < 5%, Source- Healthcare Financial Management Assoc. HFMA, Medical Group Management Assoc, MGMA

CAHSDOB on 25-Feb-2025 9:43:39 AM CST

Question: Contractor shall have an annual audit conducted by an independent certified public accountant, and it must be submitted within six (6) months of the end of the contractor’s business year. IS THIS REQUIRED?
Audit of what?
Response: See 2.8 of the RFP. It will be determined if the successful proposer falls under the guidelines of Louisiana State law as needing an independent financial audit of its organization.

CAHSDOB on 25-Feb-2025 9:44:28 AM CST

Question: Use of Sub-contractor: Our company uses an overseas sub-contractor who exclusively performs work for our company only for the last 15 years. Are we allowed to use a sub-contractor in India?
Response: See 1.8 of the RFP "Have it's principal place of business be located in the continental Unites Staes." and 1.23 "The Agency shall have a single prime Contractor…….."

CAHSDOB on 25-Feb-2025 9:45:11 AM CST

Question: Insurance: Should this include the subcontractor or subcontractor should get their own insurance?
Response: See 1.31.1 of the RFP 'Contractor's Insurance' and 1.31.7 of the RFP 'Subcontractors'

CAHSDOB on 25-Feb-2025 9:46:11 AM CST

Question: Billing audit guideline RS22 1825: Does this require that we need to audit the work that we do?
Response: Compliance with this State Law (RS 22:1825) is a requirement https://www.legis.la.gov/legis/Law.aspx?d=509000

CAHSDOB on 25-Feb-2025 10:52:26 AM CST

Question: Billing audit guideline RS22 1825: Does this require that we need to audit the work that we do?
Response: NO. Compliance with this State Law (RS 22:1825) is a requirement https://www.legis.la.gov/legis/Law.aspx?d=509000

CAHSDOB on 25-Feb-2025 11:17:14 AM CST

Addendum to Question: Contractor shall have an annual audit conducted by an independent certified public accountant, and it must be submitted within six (6) months of the end of the contractor’s business year. IS THIS
REQUIRED? Audit of what?
Answer: See 2.8 of RFP. "When required by state law". Financial audit.

CAHSDOB on 25-Feb-2025 11:38:50 AM CST

Question: 1.How does CAHS schedule appointments, is it handled within a central location or is it set up at each location?
Response: Each location is responsible for scheduling their own appointments.

CAHSDOB on 25-Feb-2025 11:39:39 AM CST

Question: 2. Please provide scope of the integration with your existing system and what data is required in the interface to send and or receive data. Is this bi-directional or uni-directional in the integration? API, HL-7,
etc?
Response: Our existing EMR sends and receives data through a HIPPA secure portal. The transfer of data is bi-directional between the clearinghouse and EMR. We do not use a HL-7 interface to transfer and receive
claim data.

CAHSDOB on 25-Feb-2025 11:40:26 AM CST

Question: 3. If possible to interface between the billing and your existing system, what are the capabilities of your system to connect with another system? What are CAHS expectation around an interface of the two
systems.
Response: The billing module is embedded in our EHR. The EMR does not interface to another claim system. The clearinghouse uses a secure portal to receive and transfer client claim data.

CAHSDOB on 25-Feb-2025 11:41:09 AM CST

Question: Is the Authorization mandatory, if an organization responding is unable to support this due to workflows at CAHS is this a disqualification?
Response: See 1.8 first bullet of the RFP (Proposer must be willing to work with the Agency to develop processes that allow the fulfillment of the agency needs.) See Part 3: Evaluation of the RFP.

CAHSDOB on 25-Feb-2025 11:42:02 AM CST

Question: What is the average claim volume per month or over a year?
Response: Approx 8,000 per month.

CAHSDOB on 25-Feb-2025 11:42:54 AM CST

Question: How many billable NPI's are there within CAHS?
Response: 99 FT or PT FTEs

CAHSDOB on 25-Feb-2025 11:44:06 AM CST

Question: Number or authorizations per month or over a year?
Response: 1001

CAHSDOB on 25-Feb-2025 11:44:43 AM CST

Question: Is the billing done in house or with a third party, if a third party who is the organization?
Response: In-house

CAHSDOB on 25-Feb-2025 11:45:39 AM CST

Question: Are the authorizations done in-house or with a third party, if a third party who is the organization?
Response: In-house

UPDATE/ADDENDUM HISTORY

All updates/changes are listed below::

13-Mar-2025 11:58:23 AM CDT

Added hyperlink information for Zoom Meeting bid opening for RFX# 3000024275.

13-Mar-2025 11:24:06 AM CDT

JoinRFX 3000024275 Zoom Meeting

13-Mar-2025 11:16:13 AM CDT

3/13/25 11:15 Join BID OPENING RFX#3000024275 Zoom Meeting https://capitalareahumanservicesdistrict.zoom.us/j/7650653763?pwd=BDraDCAw6lab7QT7HBiIVWZ6fFbqnT.1&omn=99408022360 Meeting ID: 765 065 3763 Passcode: CAHSD --- One tap mobile +14042012656,,7650653763# US +13097403221,,7650653763# US --- Dial by your location ? +14042012656 US ? +1 309 740 3221 US ? +12122258997 US ? +16462551997 US ? +14805624901 US Meeting ID: 765 065 3763 Find your local number: https://capitalareahumanservicesdistrict.zoom.us/u/abInCuj9qS

27-Feb-2025 1:05:48 PM CST

Addendum correcting bad debt percentage requirement.

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.