Chief A&MMS (90C), Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23249

R -- AUTOMATED ELIGIBILITY VERIFICATION SYSTEM SOL RFQ 652-58-98 DUE 120297 POC Dolores Quarles, 804) 675-5476 This medical center intends to negotiate a sole source procurement with Health Communication Services, 10128 West Broad Street, Glen Allen, Va for software for an Automated Eligibility Verification System. The software is known as KeyConnect Automated Eligibility Verification System. This function access payors' electronic remittance information, reformats the data and posts payment information to the appropriate patient account. It provides control reports, duplication detection and retains work-flow decisions for the operator. It also provides contractual adjustment calculation and posting, which extracts and calculates the adjustment appropriate for the payor source. The adjustment considers applicable deductibles and coinsurance and separately calculates fee-schedule items, such as Medicare and Laboratory fees. It then posts contractual adjustments to a patient's account. The System receives electronic payment advice from Medicare, retrieves the appropriate UB92 on which claim was billed, updates the payment amounts and prints out the Explanation of Medicare Benefits and UB92 on a printer. It allows the user to automate the retrieval of eligibility status and benefits information. It pools the facility's admissions system for new patients receiving inpatient or outpatient services, logs on the specified carrier's inquiry system, extracts customer-defined eligibility and benefit information then posts this data back to the user's admissions system. This system will allow for verification of the eligibility of most government insurance intermediaries (Medicare, Medicaid, Champus), Blue Cross Plans and a small number of leading commercial insurer through NEIC access. Carriers currently offered through NEIC are Aetna, Cigna National and Managed Care, Cigna Virginia, MetraHealth, Prudential, US Healthcare, and other insurers predominantly on the west coast. SIC Code 7376. Contract award will be subject to availability of funds. Interested persons may identify their interest and capability to respondto the requirement or submit proposals. All requests must be in writing. Issue o/a November 17, 1997 and the closing date is o/a December 2, 1997. (0308)

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