Medical Billing for Forensic Services

The Vendor is required to provide medical billing and revenue cycle management services.
- The facility houses up to 85 youth and young adults ages 12 to 25, and daily averages range from 60 to 65; all health-related services in the youth facility are rendered by a team of clinical and non-clinical professionals 24 hours per day, 7 days per week.
- Coding of the service encounters inside of the agency facility
- Creation of a UB-04, CMS-1500, pharmacy, and other claims formats as required
- Management of medical prior authorizations for all medical, pharmacy, and other services required by the medical program; includes non-urgent, concurrent, pre-service requests, and post-service requests
- Editing the claims to ensure accuracy
- Credentialing of medical providers in the facility as required by the agency
- Management of medical denials and appeals
- Underpayment recovery functionality to ensure optimal revenue integrity
- Administration of medical Notices of Action (NOAs) as required by the Department of Health Care Services.
- The medical fee-for-service services are divided into two parts, including fee-for service incremental rates and bundled rates.
- Medical Fee-For-Service incremental rates includes the following service categories, and are based on the standard agency medical rate codes:
1. Clinical consultations (physical, mental health, substance use)
2. Laboratory and radiology services performed offsite
3. All medications administered inside the facility, including physician administered drugs and long-term injectable
4. Medication Assisted Therapy (MAT), including treatments and counseling
5. Reimbursements for in-reach providers working in the facility medical Bundled rates include the following service categories:
1. Health Risk Assessment
2. Care Coordination
3. Care Manager Warm Handoff
4. Development of a Reentry Care Plan
5. Post-Transition Support

- Contract Period/Term: 2 years