The vendor required to provide forensic medical billing services for physical health, mental health, substance use treatment, pharmacy, durable medical equipment, pre-release services, and other medical covered benefits.
- Objectives
• Forensic billing and revenue cycle management services, demonstrating experience and qualification for processing medical outpatient, pharmacy, and other medical covered benefits and services.
• Ensure the billing and revenue cycle management services are operated in a professional, ethical, efficient, and cost-effective manner with full reporting and accountability to county.
• Ensure that the health care services operate at full staffing.
• Implement a utilization review program.
• Implement a consistent, accurate, complete, and timely claims adjudication process.
• Ensure that federal, state, and county requirements are met.
- Medical billing and revenue cycle management
• Administer billing and revenue cycle management services for the county agency, department, and the probation related to billing for medical pre-release services including, but not limited to:
o Coding of the service encounters for services rendered inside of the detention facilities and service encounters related to the claim pre-release services.
o Creation of a ub-04, cms-1500, pharmacy, and other claims formats as required.
o 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.
o Editing the claims to ensure accuracy.
o Credentialing of medical providers in the facility as required.
o Management of medical denials and appeals for fee-for-service and short Doyle claims, including medical Rx.
o Underpayment recovery functionality to ensure optimal revenue integrity.
o Monthly and quarterly payment reconciliation with county, department of corrections, and the probation department.
• The service encounter data in an industry-standard format to county within one (1) week of services being rendered in the adult and juvenile detention facilities.
• County staff to access to the vendor’s electronic health record system and collaborate on solutions to interface and exchange data with the county’s electronic health record system.
• Integrate the electronic health record system into the embedded health provider’s electronic health record system.
• Include all service encounters related to medical eligible adults and juveniles, and transition aged youth housed in the juvenile facility, including but not limited to authorized medical pharmaceuticals; international classification of diseases (icd-10) for diagnoses and outpatient-based procedures; current procedural terminology (CPT) codes for services and procedures; and healthcare common procedure coding system (HCPCS) level ii codes for supplies, equipment, and other services not covered by procedural.
- Contract Period/Term: 1 year
- Pre-Proposal Meeting (Mandatory) Date: December 29, 2025
- Questions/Inquires Deadline: January 7, 2026
