Health Insurance Discovery of Eligibility Software Platform

The Vendor is required to provide a health insurance discovery and eligibility verification platform for the purpose of identification of and verification of known medical insurance for program eligibility, reimbursement, and reporting.
- To support eligibility determination and billing, the County uses insurance verification and discovery tools to confirm coverage and identify the appropriate payer, typically a health insurance company.
- The programs average 4,300 active patients, 1,000 medical encounters, and 500 new or renewing applicants per month, all requiring insurance verification.
- These platforms streamline the administrative process, reduce billing errors, and improve reimbursement rates.
- The County intends to implement the most streamlined approach to insurance discovery and eligibility verification through workflow automation to minimize manual discovery initiation, manual or duplicate data entry, and data validation.
- Additional information on agency Application Programming Interface (API) documentation on necessary endpoints (demographics, appointments, insurance updates).
- Solution must be cloud-based, either SaaS or hosted by the vendor.
- Solution must include access to production and at least one non-production environment for integration development and testing.
- SSO (SAML/OAuth) is strongly preferred for any end user authentication into user facing websites or web portals, using County's existing Microsoft Entra SSO solution.
- For self-pay, uninsured, unknown insurance clients, use real-time query of national databases (e.g., CMS, clearinghouses) to search for primary and/or secondary health insurance coverage for Florida Medicaid, Medicare, and Commercial plans using limited demographic (name, DOB, SSN, address) information
- Documented audit trail within agency EHR to document changes made to a patient's record
- Ability to automate insurance discovery during initial eligibility screening and determination at the point of application.
- Must allow for multiple users with individual logins and the ability to track historical searches by user.

- Contract Period/Term: 5 years
- Questions/Inquires Deadline: December 30, 2025