IHS, Alaska Area Native Health Service, Division of Extramural Awards and Agreements, 250 Gambell Street, Anchorage, Alaska 99501

R -- PROGRAM MANAGEMENT/SUPPORT SERVICES Sol 243-RFP-96-4003, Due 021296, POC William Knox, Contract Specialist, (907) 257-1430. The Alaska Native Medical Center in Anchorage, Alaska is seeking business office enhancement services for the hospital. Contractor shall perform the following: (a) Analyze and evaluate the existing health care cost recovery system and provide the agency with a report outlining the strengths and weaknesses of the current program, including recommendations for improvement; (b) Perform a monthly analysis of funds recovered from third party payers; (c) Review and analyze, by insurer, claim denials or partial payments; (d) Perform computer data matches of eligible beneficiaries with other data sources to identify insurance sources; (e) Determine insurance coverage and verification of beneficiaries through interviews and follow-up; (f) Gather all required and appropriate information needed from the medical record and/or physician to obtain pre-certification approval from third party payers; (g) Prepare claims to include establishing a process to properly code medical records and other related forms; (h) Receive explanation of benefits from insurance company, post accounts receivable and prepare financial reports; (i) code medical records for all those which are identified as having third party coverage; (j) Provide interface between commercially available software and the current computer information system; (k) Initiate recovery or repayment from conditional or mistaken payments to other governmental agencies; and (l) Provide Medicare and Medicaid annual cost reports. It is anticipated that a one year contract with four one-year option periods will be awarded. The request for proposal 243-RFP-96-4003 may be obtained by written request only at the above address or by Faxed request at (907) 257-1144. The anticipated closing date is COB 4:30 p.m., local time, February 12, 1996. This acquisition is a total set aside under the Authority of the Buy Indian Act for firms which are 100% Indian owned and operated. Joint ventures with non-Indian owned firms are authorized as long as the Indian owned firm is the managing partner. (356)

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