Medical Clearinghouse Solution

The Vendor is required to provide healthcare claims clearinghouse solution that supports behavioral health operations, enhances revenue cycle performance, and ensures compliance with federal and state regulations.
- Requirement:
•    The agency operates six hospitals and three outpatient centers using epic as the enterprise EHR and billing system.
•    Clearinghouse vendors capable of seamless epic integration using certified interfaces or APIs. The solution should support high-volume transactions, automated eligibility checks, payer routing logic, and real-time claim validation. 
•    The clearinghouse should also provide reporting, denial analytics, payer performance tools, and administrative dashboards to assist operational decision-making.
- Functional and technical needs
•    Perform real-time insurance eligibility verification (270/271) for hospital and outpatient encounters.
•    Transmit institutional and professional claims (837i/837p) and receive payer acknowledgments.
•    Provide 835 remittances, denial mapping, and automated posting compatibility with epic.
•    Support eft and era enrollment services and payer-specific enrollment workflows.
•    Integrate seamlessly with epic using certified connections or APIs.
•    Offer configurable work queues, edit checks, and proactive error correction tools.
•    Maintain strict HIPAA-compliant security, uptime guarantees, and disaster recovery capabilities.
•    Accessing the Medicare DDE system for Medicare claims submissions and corrections.