Autonomous Coding Solution

The vendor is required to provide autonomous coding solution for include:
- General requirements
1. Software criteria
•    Use artificial intelligence (AI) and machine learning (ML) to make accurate code assignments while reducing revenue leakage and denials to promote a clean claims process.
•    Provide accurate and compliant autonomous coding consistently with a high level of confidence by reading structured and unstructured medical documentation and have ability to extract data such as diagnoses procedures, lab data, patient demographics, SDOH, etc.
•    Provide technology that uses clinical intelligence to identify codes by applying coding guidelines, payer rules, lcd, NCD, CCI and NCCI edits, medical necessity and other policies that support accurate coding
•    Uses ama (american medical association) licensed CPT data for higher levels of coding compliance.
•    Quickly adjust to regulatory changes to ensure accurate billing
•    Have the ability to create custom edits
•    Have the ability to cover and support the spectrum of him coding areas for hospital and professional records on a single platform to include emergency room, outpatient clinic and procedure accounts, day surgery and professional clinic accounts.
•    Include quality assurance auditability with extensive reporting and analytics.
•    Provide on-going engine training and learning based on historical and current coded data to identify improvements in performance over time.
•    Include no touch coding with a direct to bill option
•    Identify when manual intervention is needed by flagging accounts for human review based on pre-determined confidence threshold
•    Support hl7v2 and FHIR standards for admission, discharge, transfer (ADT), clinical documentation, orders and results, and financial transactions.
•    Implement bidirectional coding interfaces for account-level updates, especially for facility coding workflows
•    Support charge router integration with message types: new charge, update charge, delete charge, and acknowledge charge
•    Support simple visit coding (svc) workflows to pull diagnoses from charge.
- Technology
•    The ability to integrate with epic electronic medical records (EMR), epic billing system, and CAC (computer assisted coding) professional application.
•    The ability to recognize and account for patients that may have multiple contacts, such as ed, clinic or ancillary encounters on a given date. 
•    A hospital account record for any given date may contain multiple clinics, departmental or ancillary contacts that must be coded and billed on the same claim for that date.
•    The ability to recognize and account for patients that may have multiple contacts, such as ed, clinic or ancillary encounters on a given date. 
•    A hospital account record for any given date may contain multiple clinics, departmental or ancillary contacts that must be coded and billed on the same claim for that date.
•    The ability to map and validate clinical documentation sources, such as epic care inpatient and document management systems
•    Identify specialty-specific documentation elements for interface transmission.

- Contract Period/Term: 3 years
- Questions/Inquires Deadline: October 07, 2025