The vendor is required to provide medical billing and credentialing services which includes a practice management system for the university’s center for speech, language, and hearing (CSLH), and university psychology clinic (PC), and to provide an electronic health record (EHR) for the center for speech, language, and hearing.
- Medical billing
• Medical billing service provided shall be compatible with electronic health record systems and related practice management systems designed to support speech, language, and hearing; and applied behavior analysis clinics.
o Medical billing service shall be compatible with offeror’s proposed EHR for CSLH.
o Medical billing service shall be compatible with the PC’s EHR – rethink autism.
• Contractor will provide assistance and guidance to the university to maintain medicare and Medicaid eligibility and support. this includes completing and submitting applications and all other required paperwork for medicare and Medicaid.
• University will provide all necessary information needed to ensure accurate and timely completion of required forms and related paperwork, e.g., required signatures from an authorized representative of the university CSLH or university PC respectively.
o Electronic filing is the required method of filing primary medicare and Medicaid claims.
o Electronic filing is the preferred method of filing to all other guarantors, as applicable. otherwise, paper invoices may be issued directly to appropriate patient guarantors.
o On-line portal for clients to review their records and to make credit or debit card payments preferred.
• Contractor will submit all “completed claims” to the applicable third-party payer. a “completed claim” is a claim for clinical services that
o Is received by contractor and supported by a record that contains all necessary and accurate information
o Has been reviewed and any identified issues sent to university for remediation have been rectified
o Is for a client encounter that has been electronically signed off by the university.
o Has been reviewed by the university and deemed ready for billing; and
o is Not subject to a billing hold.
• Contractor will not have responsibility for any adverse impact to client that may result from any university delay in completing claims.
• Accounts with outstanding balances after the insurance and/or third-party payer has determined benefits due will be billed by contractor to the client.
• Contractor will send up to three client statements to the client or responsible party, except as to those accounts on which an insurance carrier or third-party payer has accepted responsibility to pay.
• The university has submitted all necessary information; contractor will bill all uninsured patients directly.
o An account will be considered uncollectable if three separate attempts by the contractor to collect payment is unsuccessful.
o Contractor shall notify the university of all uncollectable accounts.
• Contractor is responsible for ensuring that collection activity conforms with the requirements of all applicable laws or regulations.
• Contractor shall notify university of
o All client complaints about clinical services within two (2) business days of receipt;
o All client complaints about billing within ten (10) business days of receipt; and
o All notices of audit, requests for medical records or other contacts or inquiries out of the normal course of business from representatives of medicare, Medicaid or private payers with which the university contracts or any law enforcement or government agency ("payer inquiries") within ten (10) business days of receipt, unless such agency prohibits contractor from disclosing its inquiry to client.
o Billing will not begin for above scenarios until contractor has provided university with five (5) business days written notice of an issue described in 1 and or 2 above and an opportunity to correct.
- Electronic health record for center for speech, language, and hearing
• Able to import existing records from the university’s current EHR – advanced.
• Develop, code, and migrate all existing records from the university’s current EHR-advanced md application to the new EHR.
• Automated billing for streamlining the billing process and ensuring accuracy of insurance claim submissions.
• Compatibility with offeror’s proposed medical billing solution.
• Task management
o Auto creates tasks and reminders for documentation, authorizations, and verifications.
• Control workflows for
o Documentation
o Authorizations
o Verifications
• Able to provide reports and analytics that will allow clinic to view detailed elements of records.
• Contain pre-made forms that include referrals, evaluations, and progress notes.
o Forms shall be capable of feeding into each other, e.g., goals to carry over from plan of care to progress notes.
o Service types and minutes should feed to charge slips to minimize billing errors.
• EHR shall include a practice management tool supporting:
o Scheduling of the clinic
o Scheduling by individual clinician,
• Customer support
o Support for application of EHR shall be available during and after implementation
o Availability on weekdays by phone at a minimum between hours of 8:00 am to 5:30 pm
o Availability via online chat highly desired.
o Availability via e-mail with response no later than 24 hours during business hours/days e.g., email Friday of a non-holiday weekend at 3:00 pm, response no later than 3:00 pm on the following Monday.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: June 16, 2025