Accounts Receivable Credit Balance Cleanup Services

The Vendor is required to provide accounts receivable (AR) credit balance cleanup services for hospital/facility accounts.
- Services include:
•    Identify, validate, and resolve existing facility AR credit balances;
•    Support compliance with federal and state regulations governing credit balance reporting and refunding; and
•    Provide process recommendations to reduce future accumulation of inappropriate credit balances.
- Finalize data layout, file transfer protocols, and security requirements (HIPAA-compliant).
- Stratify credit balances by:
•    Payer type (e.g., Medicare, Medicare Advantage, Medicaid, Medicaid Managed Care, commercial, workers’ comp/no-fault, self-pay);
•    Aging (e.g., 0–90, 91–180, 181–365, >365 days);
•    Balance amount ranges (e.g., <$25, $25–$250, >$250);
•    Root cause categories (e.g., overpayment, duplicate payment, coordination-of-benefits, contractual variance, posting error, etc.).
- Account-Level Research and Validation
•    Review billing and payment history, remittance advice, and posting/adjustment activity.
•    Validate the legitimacy of the credit balance (true credit vs. system or posting error).
•    Determine appropriate disposition:
o    Refund to payer or patient;
o    Internal adjustment (e.g., reversal of incorrect posting);
o    Application or transfer to another valid liability where permitted;
o    Removal of erroneous credit resulting from system or configuration issues (with documentation).
•    Document research steps and final disposition in an agreed format.
- Resolution and Processing Support
•    Prepare refund requests and/or adjustment transactions in accordance with agency policies and system requirements.
•    Work within agency defined approval workflows for refunds and adjustments.
•    Provide files or transaction-level detail needed for agency to post or execute refunds/adjustments if the vendor does not have direct system access.
•    Support agency in meeting any applicable payer or regulatory timelines for credit balance resolution and reporting. 

- Questions/Inquires Deadline: December 29, 2025