Billing Clearinghouse Services

The Vendor is required to provide an electronic submission of medical documentation system that supports the electronic transmission of healthcare claims and remittance information between department and various payers. 
- The system must comply with all federal and state electronic data interchange (EDI) standards and support integration with department billing applications.
- Requirement:
1. Claim submission and processing
•    Support both batch and real-time claim submissions up to 6,000 annually.
•    Perform pre-submission validation and edit checks to ensure claim accuracy.
•    Provide detailed error reports for rejected claims.
•    Allow resubmission of corrected claims through the same interface.
2. File transfer service
•    Submit, edit, and receive claims and remittances for Medicare, Medicaid, and commercial insurances up to 3,000 annually.
•    View a snap shot of all the transmissions
•    Provide immediate snap shot of 837 responses received by Medicare
3. Medicare analytics
•    Compare revenue cycle metrics against the nationally published standards.
•    Track key financial indicators and trend data over a rolling 12-month view.
•    Options to review and analyze Medicare data.
4. Medicare direct data entry verification
•    Provided based on delivery method, unit of measure, and volume limit.
5. Claims management
•    Submitting, editing, and receiving claims and remittances for Medicare, Medicaid and commercial insurances.
•    Provide advanced reporting options including top payer activity, payment activity by day, and failed deposit conversions.
•    Audit and appeal documentation workload to support claim reimbursement and payment activities.
6. Remittance and reconciliation
•    Support automated retrieval of 835 remittance files from payers.
•    Provide detailed reconciliation of payments and adjustments.
•    Generate summary and detailed financial reports for accounting use.
7. System integration and compatibility
•    Support standard EDI formats (837, 835, etc.).
•    Provide secure data exchange interfaces compatible with department systems.
•    Allow automated data import and export from department databases or third-party systems.