SOLICITATION NOTICE
R -- Denials Management Services
- Notice Date
- 8/1/2007
- Notice Type
- Solicitation Notice
- NAICS
- 561110
— Office Administrative Services
- Contracting Office
- VA SALT LAKE CITY HEALTH CARE SYSTEM;500 FOOTHILL DRIVE (04A);SALT LAKE CITY, UT 84148
- ZIP Code
- 84148
- Solicitation Number
- VA-259-07-RP-0157
- Response Due
- 9/3/2007
- Archive Date
- 11/2/2007
- Small Business Set-Aside
- Total Small Business
- Description
- The Salt Lake City Health Care System (VASLCHCS) is soliciting for the following tasks: a. A contractor to review insurance carriers Explaination of Benefits (EOB) for non payment of charges submitted by the VASLCHCS. b. A contractor to review insurance carriers Explaination of Benefits (EOB) for under payment of charges submitted by the VASLCHCS. c. A contractor that is able to track trends of the insurance denial codes from the VISTA data base and submit reports to the VASLCHCS. The SLCHCS intends to award a Firm Fixed Price, Indefinite Quantity Indefinite Delivery Blanket purchase Agreement to a qualified firm with the capability and capacity to provide the services listed herein. The overall scope of services is the establishment of an off-site denials management unit. Its purpose shall be to identify those claims that meet payment criteria but: a) the individual insurance carrier denies payment without valid cause. b) or the insurance carrier pay the VASLCHCS less than the policy contracted amount or usually and customary carriers. The contractor must have the ability to compare VASLCHCS claims to insurance carriers EOB's and have access or knowledge of the various policy restrictions. The contractor will provide the following services: Appealing denied insurance claims by reviewing: " Full bill charges " Line item denials " Analyzing account for fair and equitable compensations for procedures paid where insurance companies have used the reason " usual and customary charges" payment rationale " Analyzing all accounts that have been closed/collected where reimbursement is less than 60% of total charges " Non-covered charges " Administrative adjustments " An audit review of VASLCHCS insurance claims to determine the type, quantity and suggest avenues for revenue recoveries. " Provide employees that know and work directly with VASHCLHCS accounts receivable program with full interface for gathering pertinent data for patients as well as making comments and updates for each account worked by the vendor. " If an account requires a formal legal appeal hearing after approval from VASLCHCS the vendor will bear the burden of all legal costs, but receive and additional 10% of the recovered charges. The contractor will receive an initial extract of all non-paying or underpaid claims sent to the carrier in the past 12 months. The file extract data source will be VISTA. The VASLCHCS will create the extract to send to the contractor based on criteria agreed on by both the contractor and the VASLCHCS. The files will be transferred to the contractor using a secure FTP (File Transfer Protocol). The contractor will establish a shared drive to which files will be transferred. In order to protect the data, the VASLCHCS and the contractor will employ encryption software and the contractor shall not release data except for the purposes of their contract without written authorization of the VASLCHCS. Patient confidentiality (HIPPA compliance) and overall data security are vitally important and will be maintained at all times. All contractor personnel shall observe the requirements imposed on sensitive data by the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and all applicable VA policies and procedures. Violation of the Act may involve imposition of criminal penalties. The contractor shall complete appropriate screening of their employees. Contractor must obtain One VA VPN access for staff assigned to this project.
- Place of Performance
- Address: VA SALT LAKE CITY HEALTH CARE SYSTEM;500 FOOTHILL DRIVE (04A);SALT LAKE CITY, UT 84148
- Zip Code: 84148
- Country: USA
- Zip Code: 84148
- Record
- SN01358747-W 20070803/070801221038 (fbodaily.com)
- Source
-
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