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BILLING-1143 - USA (Fredericksburg, Virginia) - RFI for Consolidated Payment Services - Deadline October 23,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: BILLING-1143

Government Authority located in Fredericksburg, Virginia; USA based organization looking for expert vendor for consolidated payment services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide consolidated payment services to align its current non-network claims adjudication and payment process with its in-network claims process, realignment of government activities by shifting the processing and payment of non-network claims to a contracted claims processor, in order to reduce fragmentation, overlap, and duplicative work to the government authority located in Fredericksburg, VA.
- Component needs are as follows: All non-network claims submitted on industry standard EDI or paper claims will be processed by the claims processor, Capability to ensure that duplicate billing does not occur, Claims processor must be able to access all VA referrals and approvals to validate and approve claims, Claims processor must be able to receive the fee schedule from VA and locally contracted referral or negotiated Veteran Care Agreement (VCA) rates to accurately process claims reimbursements correctly per the CMS fee schedule reimbursement hierarchy depending on program authority that care occurred under, Ability to adjudicate approval for claims based on the standardized episode of care (SEOC) that was approved on the referral, Ability to deny claims if the timeframe of the care falls outside of the window of the referral of if the care provided falls outside of the scope of the SEOC, A centralized billing and provider reimbursement system that effectively and accurately auto-adjudicates claims and pays providers in accordance with industry standards and provides VA with full industry standard EDI HIPAA compliant claims that include with the full HIPAA required data elements for all populated fields from the original 835/837/NCPDP/Dental claim types for each transaction, ability to process recoupments for inappropriate provider claims payment; this is to include instances where the fee schedule changes, Full 837 COB claims data and invoice submission to the VA through VA’s approved submission system, including those in pre-payment status, on a daily basis, Claims processing status reports on a weekly basis, quarterly claims audit reports, and ad hoc reporting capability, Coordination of Benefits - Identification Veteran’s OHI when applicable, Fraud, waste and abuse protection and mitigation processes, Meet operational, availability and recovery time objectives, Capability to pilot claims process and proceed with national rollout in a phased manner.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location

[E] Proposal Submission:

Response should be submitted physically (courier or post).

Expiry Date : Friday, 23 October, 2020

Category : Billing Services, Medical Billing and Coding

Country : USA

State : Virginia

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