DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

210.562.6200 | https://uthscsa.edu | https://wp.uthscsa.edu/purchasing/

REQUEST FOR PROPOSAL

OGC Template 0525

REQUEST FOR PROPOSAL

by

The University of Texas Health Science Center at San Antonio for

Selection of a Vendor to Provide

Zero-Balance Audit and Payment Compliance Review Services

RFP No. 745-26-P12

Submittal Deadline:

3:00 PM – Central Prevailing Time –

Wednesday – March 18, 2026

Issued:8:00 AM – Central Prevailing Time – Monday – February 9, 2026 https://uthscsa.edu/ https://wp.uthscsa.edu/purchasing/

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

TABLE OF CONTENTS

SECTION 1: INTRODUCTION

SECTION 2: NOTICE TO PROPOSER

SECTION 3: SUBMISSION OF PROPOSAL

SECTION 4: TERMS AND CONDITIONS

SECTION 5: SPECIFICATIONS AND ADDITIONAL QUESTIONS

SECTION 6: PRICING AND DELIVERY SCHEDULE

ATTACHMENTS:

APPENDIX ONE: PROPOSAL REQUIREMENTS

A01A – Appendix One, Section One – General Information A01B - Appendix One, Section Two – Execution of Offer A01C – Appendix Three, Section Three – General Questionnaire A01D – Appendix Four, Section Four – Addend Checklist

APPENDIX TWO: SAMPLE AGREEMENT

APPENDIX THREE: HUB SUBCONTRACTING PLAN

APPENDIX FOUR: RISK ASSESSMENT

APPENDIX FIVE: TX-RAMP NOTICE

APPENDIX SIX: POLICY DRIVEN ADOPTION FOR ACCESSIBILITY

(PDAA) VENDOR ASSESSMENT

APPENDIX SEVEN: BUSINESS ASSOICATE AGREEMENT (BAA)

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

SECTION 1

INTRODUCTION

1.1 Description of University

The University of Texas Health Science Center at San Antonio — also called UT Health San Antonio (UTHSA) — has a mission to make lives better through excellence in education, research, health care and community engagement. As the largest academic research institution in South Texas, reflected by an annual research portfolio of approximately $413 million, the university is designated as a Hispanic-Serving Institution by the U.S. Department of Education.

UT Health San Antonio’s professional schools of medicine, nursing, dentistry, health professions, graduate biomedical sciences and public health have graduated more than 43,886 alumni who are leading change, advancing their fields and renewing hope for patients and their families throughout South Texas and the world.

One of 14 UT System institutions, UT Health San Antonio has launched the newest of its six schools, the UT School of Public Health San Antonio. Now enrolling students into its Master of Public Health program, this school’s primary focus will be preparing its graduate students for developing and enacting public health policy that serves, specifically, the communities of South Texas.

Another significant reflection of UT Health San Antonio's phenomenal growth is its $472 million UT Health San Antonio Multispecialty and Research Hospital, which opened in December 2024.

The hospital will deliver specialty surgeries and advanced cancer care while focusing on enhancing access to advanced medical care, specialized oncology services and clinical trials for patients throughout South Texas.

For three years in a row, UT Health San Antonio has made Forbes' list of Best-in-State health services employers, and its schools of medicine, nursing and health professions rank in the nation’s top 50 by U.S. News & World Report.

The university employs a diverse workforce of more than 8,500; administers an annual operating budget of $1.46 billion; and stewards’ clinical practices in medicine, cancer, dentistry, nursing and other health professions that provide more than 2.6 million patient visits each year. It is a primary driver of San Antonio’s $44.1 billion health care and biosciences sector. UT Health San Antonio plans to add more than 1,500 higher-wage jobs over the next five years to serve San Antonio, Bexar County and South Texas.

To learn about the many ways “We make lives better®,” visit UTHealthSA.org.

https://www.uthscsa.edu/ https://uthscsa.edu/?utm_source=uthealthsaorg&utm_medium=pageredirect&utm_campaign=uthealthsa

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

1.2 Background and Special Circumstances

The University of Texas Health Science Center at San Antonio (UTHSA) seeks to engage a qualified third-party vendor or consultant to perform a comprehensive zero-balance audit and payer payment compliance review. The objective of this engagement is to identify and recover lost or underpaid revenue by validating payments received from commercial and governmental payers against contracted terms.

UTHSA desires the selected vendor to enter payer contract payment terms into their proprietary or licensed software to model expected payments for services rendered over the preceding twelve (12) months. The analysis should identify discrepancies between expected and actual reimbursement to determine recoverable revenue opportunities.

Because most payers limit retrospective review periods to within twelve (12) months of the final payment or denial, the audit period will begin at the project start date and extend backward twelve

(12) months.

The review will encompass:

• Commercial payers, including national and regional plans.

• Governmental payers, such as Medicare, Medicaid, Tricare, Workers’ Compensation and

VA.

• Managed care organizations, including Medicare Advantage and Medicaid Managed

Care Plans.

Services under review include claims for the newly opened Multispecialty and Research Hospital.

UTHSA’s goal is to ensure compliance with payer contracts, improve payment accuracy, enhance operational transparency, and maximize the recovery of previously unidentified underpayments or missed revenue opportunities.

No Guarantee of Volume. UTHSA does not solicit or guarantee any specific amount of compensation, volume, minimum, or maximum amount of Services under this RFP or any contract or agreement resulting from this RFP.

1.3 Objective of Request for Proposal

The University is soliciting proposals in response to this Request for Proposal RFP 745-25-P12 from qualified proposers to provide operational guidance services (the “Services”) for Zero- Balance Audit and Payment Compliance Review Services are more defined in Section 5 (Scope of Work) of this RFP.

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

1.4 Group Purchase Authority

Texas law authorizes institutions of higher education (defined by §61.003, Education Code) to use the group purchasing procurement method (ref. §§51.9335, 73.115, and 74.008, Education Code). Additional Texas institutions of higher education may therefore elect to enter into a contract with the successful Proposer under this RFP. In particular, Proposer should note that University is part of The University of Texas System (UT System), which is comprised of fourteen institutions described at http://www.utsystem.edu/institutions. UT System institutions routinely evaluate whether a contract resulting from a procurement conducted by one of the institutions might be suitable for use by another, and if so, this RFP could give rise to additional purchase volumes. As a result, in submitting its proposal, Proposer should consider proposing a pricing model and other commercial terms that take into account the higher volumes and other expanded opportunities that could result from the eventual inclusion of other institutions in the purchase contemplated by this RFP. Any purchases made by other institutions based on this RFP will be the sole responsibility of those institutions.

1.5 Transition Plan

As a government entity, UTHSA is obligated by statute to re-solicit, or to leverage eligible Group Purchasing Organization contracts, to continue this service upon expiration or termination of this agreement. Awarded Proposer agrees that if the Signed Agreement expires or is terminated for any reason, then, at University’s option, Awarded Proposer will continue to perform the Zero- Balance Audit and Payment Compliance Review Services in accordance with the terms and conditions of the Signed Agreement until University contracts with a new qualified and experienced contractor(s) to perform the Zero-Balance Audit and Payment Compliance Review Services or is able to perform the Zero-Balance Audit and Payment Compliance Review Services in-house; provided, that, Awarded Proposer will not be required to continue performing the Zero- Balance Audit and Payment Compliance Review Services for more than four (4) months after expiration or termination of the Signed Agreement.

Awarded Proposer agrees to cooperate with, and assist, University’s efforts to transition to another contractor(s) or to perform the Zero-Balance Audit and Payment Compliance Review Services in-house.

1.6 Public Information

All information, documentation, and other materials submitted in response to this solicitation are considered non-confidential and/or non-proprietary and are subject to public disclosure under the Texas Public Information Act (Texas Government Code, Chapter 552.001, et seq.) after the solicitation is completed.

https://uthscsa.edu/ https://wp.uthscsa.edu/purchasing/ http://www.statutes.legis.state.tx.us/Docs/ED/htm/ED.61.htm#61.003 http://www.statutes.legis.state.tx.us/Docs/ED/htm/ED.51.htm#51.9335 http://www.statutes.legis.state.tx.us/Docs/ED/htm/ED.73.htm#73.115 http://www.statutes.legis.state.tx.us/Docs/ED/htm/ED.74.htm#74.008 http://www.utsystem.edu/institutions https://statutes.capitol.texas.gov/Docs/GV/htm/GV.552.htm

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

SECTION 2

NOTICE TO PROPOSER

2.1 Submittal Deadline

University will accept proposals submitted in response to this RFP until 3:00 PM Central Prevailing Time, Wednesday – March 18, 2026 via our e-Procurement Website Euna (formally Bonfire).

2.1.1 When submitting your proposal – follow the directions in Euna.

1. Each document that is required must be submitted individually, completed, and signed (if applicable). DO NOT UPLOAD ALL FILES TOGETHER

2.1.2 If during your submission, you encounter any technical issues – you must contact Euna Support directly for assistance or by calling 1-844-226-3862

1. After contacting Euna, inform the Strategic Sourcing Specialist that you have reached out to Euna due to technical issues.

2.1.3 Euna offers a Help Forum which you can access by clicking here.

2.2 RFP Contact Information and Questions

2.2.1 Interested parties MUST direct questions (ALL QUESTIONS MUST GO THROUGH Euna) about this RFP through Euna Opportunity Q&A.

Located in the Project Details (see below).

https://uthscsa.bonfirehub.com/portal/?tab=openOpportunities https://uthscsa.bonfirehub.com/portal/?tab=openOpportunities mailto:support.bonfire@eunasolutions.com mailto:support.bonfire@eunasolutions.com https://uthscsa.bonfirehub.com/portal/support https://uthscsa.bonfirehub.com/portal/support

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

University instructs interested parties to restrict all contact and questions regarding this RFP to written communications delivered (i) in accordance with this Section on or before 3:00 PM Central Prevailing Time, Tuesday – March 3, 2026 (Question Deadline), or (ii) if questions relate to Historically Underutilized Businesses, in accordance with Section 2.5.

University will provide responses as soon as practicable following the Question Deadline.

University intends to respond to all timely submitted questions. However, University reserves the right to decline to respond to any question.

If submitting multiple questions, submit them in one submission (not multiple submissions).

2.3 Criteria for Selection

The successful Proposer, if any, selected by University through this RFP will be the Proposer that submits a proposal on or before the Submittal Deadline that is the most advantageous to University. Contractor means the successful Proposer under this RFP.

Proposer is encouraged to propose terms and conditions offering the maximum benefit to University in terms of (1) service, (2) total overall cost, and (3) project management expertise.

The evaluation of proposals and the selection of Contractor will be based on the information provided in the proposal. University may consider additional information if University determines the information is relevant.

University reserves the right to award a Contract for all or any portion of the requirements proposed by reason of this request, award multiple Contracts, or to reject any and all proposals if deemed to be in the best interest of the University and to re-solicit for proposals.

Criteria to be considered by University in evaluating proposals and selecting Contractor, will be these factors:

2.3.1 Threshold Criteria Not Scored

A. Ability of University to comply with laws regarding Historically Underutilized Businesses; and

B. Ability of University to comply with laws regarding purchases from persons with disabilities.

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

2.3.2 Scored Criteria

A. Cost of goods and services (25 Points).

1. Evaluation will consider the proposed fee structure, including contingency models, fixed fees, or hybrid approaches. Competitive and transparent pricing that aligns payment with performance outcomes is preferred.

B. Reputation of the Proposer and of the Proposer's goods or services (15 Points).

1. Vendors should demonstrate a proven track record in healthcare zero-balance auditing, payment compliance analysis, and recovery services. References from comparable institutions, particularly academic medical centers or large health systems, are encouraged.

C. Quality of the Proposer's goods or services (20 Points).

1. Proposers must demonstrate quality control methodologies, audit precision, and reporting capabilities that ensure accuracy and compliance with payer and regulatory standards. Proprietary or advanced technology that supports high-volume data analysis and payer contract modeling will be highly valued.

D. Extent to which the goods or services meet the University's needs (20 Points).

1. UTHSA seeks a partner capable of integrating with existing workflows, systems

(including Epic), and payer relationships. The proposer should illustrate how their technology, staff expertise, and methodology address UTHSA’s goals for revenue recovery, compliance, and transparency.

E. Proposer's past relationship with the University (15 Points).

1. If applicable, prior positive experience working with UTHSA or other entities within

The University of Texas System will be considered favorably, reflecting an understanding of system policies, expectations, and institutional standards.

F. Proposer’s exceptions to the terms and conditions set forth in Section 4 (5 Points).

1. Vendors should review and either accept or clearly document any exceptions to the University’s standard contractual terms. Minimal exceptions are preferred to expedite contract execution and compliance review.

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

2.4 Key Events Schedule

Date RFP Issued 8:00 AM Central Prevailing Time, Monday – February 9, 2026

Question Deadline 3:00 PM Central Prevailing Time, Tuesday - (ref. Section 2.2) March 3, 2026

Submittal Deadline 3:00 PM Central Prevailing Time, Wednesday - (ref. Section 2.1) March 18, 2026

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

2.5 Historically Underutilized Businesses

2.5.1 All agencies of the State of Texas are required to make a good faith effort to assist historically underutilized businesses (HUBs) in receiving contract awards. The goal of the HUB program is to promote full and equal business opportunity for all businesses in contracting with state agencies. Pursuant to the HUB program, if under the terms of any agreement or contractual arrangement resulting from this RFP, Contractor subcontracts any Work, then Contractor must make a good faith effort to utilize HUBs certified by the Procurement and Support Services Division of the Texas Comptroller of Public Accounts.

Proposals that fail to comply with the requirements contained in this Section 2.5 will constitute a material failure to comply with advertised specifications and will be rejected by University as non-responsive. Additionally, compliance with good faith effort guidelines is a condition precedent to awarding any agreement or contractual arrangement resulting from this RFP. Proposer acknowledges that, if selected by University, its obligation to make a good faith effort to utilize HUBs when subcontracting any Work will continue throughout the term of all agreements and contractual arrangements resulting from this RFP. Furthermore, any subcontracting of Work by the Proposer is subject to review by University to ensure compliance with the HUB program.

2.5.2 University has reviewed this RFP in accordance with 34 TAC §20.285, and has determined that subcontracting opportunities are probable under this RFP.

2.5.3 A HUB Subcontracting Plan (HSP) is a required part of the proposal. The HSP will be developed and administered in accordance with University’s Policy on Utilization of Historically Underutilized Businesses, attached as APPENDIX THREE.

Each Proposer must complete and return the HSP in accordance with the terms and conditions of this RFP, Including APPENDIX THREE. Proposers that fail to submit the HSP will be considered non-responsive to this RFP as required by §2161.252, Government Code.

Questions regarding the HSP may be directed to:

Contact: Rebecca A. Mendez, HUB Program Manager Phone: 210-562-6300 Email: HUBAdmin@uthscsa.edu

OR

Contact: Mary Minier, HUB Specialist Phone: 210-562-6326 Email: HUBAdmin@uthscsa.edu

Contractor will not be permitted to change its HSP unless: (1) Contractor completes a new HSP in accordance with the terms of APPENDIX THREE, setting forth all modifications requested by Contractor, (2) Contractor provides the modified HSP to University, (3) University approves the modified HSP in writing, and (4) all agreements resulting from this RFP are amended in writing to conform to the modified HSP.

https://texas-sos.appianportalsgov.com/rules-and-meetings?$locale=en_US&interface=VIEW_TAC_SUMMARY&queryAsDate=04%2F22%2F2025&recordId=214411 http://www.statutes.legis.state.tx.us/Docs/GV/htm/GV.2161.htm#2161.252 http://www.statutes.legis.state.tx.us/Docs/GV/htm/GV.2161.htm#2161.252 mailto:HUBAdmin@uthscsa.edu mailto:HUBAdmin@uthscsa.edu

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

2.5.4 At the same time Proposer submits its proposal (no later than the Submittal Deadline (ref.

Section 2.1)), Proposer must submit the following HUB materials (HUB Materials):

(a) One (1) complete electronic copy of Proposer’s HSP through the Euna Procurement Portal.

2.5.5 University may offer Proposer an opportunity to seek informal review of its draft HSP by

University’s HUB Office before the Submittal Deadline. If University extends this offer, details will be provided at the Pre-Proposal Conference (ref. Section 2.6) or by other means. Informal review is designed to help address questions Proposer may have about how to complete its HSP properly. Concurrence or comment on Proposer’s draft HSP by University will not constitute formal approval of the HSP and will not eliminate the need for Proposer to submit its final HSP to University as instructed by Section 2.5.

2.6 Vendor Presentation

University reserves the right to hold Vendor Presentation in person at the University of Texas Health Science Center at San Antonio (or virtual). The dates and times to be determined after the first round of evaluations. Not all vendors may be invited to participate in these presentations, all dependent on first round of evaluation scores.

https://uthscsa.bonfirehub.com/portal/?tab=openOpportunities

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

SECTION 3

SUBMISSION OF PROPOSAL

3.1 Submission

Proposals must be received electronically through the University’s online Procurement Portal via Euna, on or before the Submittal Deadline (ref. Section 2.1 of this RFP). Competitive Bids will be listed on the Procurement Portal, and submissions will only be accepted through the portal.

University WILL NOT accept proposals submitted by paper, telephone, facsimile (“FAX”) transmission, or electronic mail (i.e., e-mail) in response to this RFP.

You can register for a free account by clicking here, which will be required when you prepare a submission. As part of the registration process, you may select Commodity Codes to associate with your account. This will open you up for notifications of opportunities matching your chosen codes.

If you encounter technical issues while preparing and/or submitting your proposal – you must contact Euna directly.

3.2 Proposal Validity Period

Each proposal must state that it will remain valid for University’s acceptance for a minimum of two hundred and forty (240) days after the Submittal Deadline, to allow time for evaluation, selection, and any unforeseen delays

3.3 Terms and Conditions

3.3.1 Proposer must comply with the requirements and specifications contained in this RFP, including the Agreement (ref. APPENDIX TWO) and BAA (ref. APPENDIX SEVEN), the Notice to Proposer (ref. Section 2), Proposal Requirements (ref. APPENDIX ONE) and the Specification and Additional Questions (ref. Section 5). If there is a conflict among the provisions in this RFP, the provisions requiring Proposer to supply the better quality or greater quantity of services will prevail, or if such conflict does not involve quality or quantity, then interpretation will be in the following order of precedence:

A. Specifications and Additional Questions (ref. Section 5).

B. Agreement (ref. APPENDIX TWO).

C. BAA (ref. APPENDIX SEVEN).

D. Proposal Requirements (ref. APPENDIX ONE).

E. Notice to Proposers (ref. Section 2).

https://uthscsa.bonfirehub.com/portal/?tab=openOpportunities mailto:support.bonfire@eunasolutions.com

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

3.4 Submittal Checklist

Proposer is instructed to complete, sign, and return the following documents as a part of its proposal. If Proposer fails to return each of the following items with its proposal, then University may reject the proposal:

3.4.1 Signed and Completed Execution of Offer (ref. Section 2 of APPENDIX ONE).

3.4.2 Signed and Completed Pricing and Delivery Schedule (ref. Section 6).

3.4.3 Responses to Proposer's General Questionnaire (ref. Section 3 of APPENDIX ONE).

3.4.4 Signed and Completed Addenda Checklist (ref. Section 4 of APPENDIX ONE).

3.4.5 Signed and completed General Terms and Conditions (ref. Section 4 of APPENDIX

ONE)

3.4.6 Responses to questions and requests for information in the Specifications and Additional

Questions Section (ref. Section 5).

3.4.7 Signed and completed originals of the HUB Subcontracting Plan or other applicable documents (ref. Section 2.5 and APPENDIX THREE).

3.4.8 Completed Risk Assessment) (ref. APPENDIX FOUR).

3.4.9 Completed and Signed TX-RAMP Notice OR FedRamp (ref APPENDIX FIVE).

3.4.10 Completed Policy Driven Adoption for Accessibility (PDAA) Vendor Assessment (ref

APPENDIX SIX)

3.4.11 Completed Accessibility Conformance Report (ACR) and/or VPAT (ref 5.2 MINIMUM

REQUIREMENTS).

3.4.12 Completed Vendor Accessibility Dev Service Infor Request (VADSIR) (ref. 5.2 MINIMUM

REQUIREMENTS).

3.4.13 Detailed Proposer Quote.

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

SECTION 4

GENERAL TERMS AND CONDITIONS

See Attached in Euna

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

210.562.6200 | www.uthscsa.edu | https://wp.uthscsa.edu/purchasing/

REQUEST FOR PROPOSAL

5.1 General

Minimum requirements and specifications for Work, as well as certain requests for information to be provided by Proposer as part of its proposal, are set forth below. As indicated in Section 2.3, Contractor means the successful Proposer.

5.2 Minimum Requirements

Each Proposal must include information that clearly indicates that Proposer meets each of the following minimum qualification requirements:

5.2.1 Minimum of FIVE (5) years of verifiable experience providing zero-balance audit, payment variance analysis, or healthcare underpayment recovery services for hospitals and/or large physician organizations.

5.2.2 Pursuant to 1 TAC §213.38 (b), UT Health requires documentation providing credible evidence that the products to be included in this bid are accessible for use by persons with disabilities.

1. A completed self-assessment using the Policy Driven Adoption for

Accessibility (PDAA) (APPENDIX SIX) maturity model, using the PDAA template provided by the Texas Department of Information Resources.

2. A completed Vendor Accessibility Development Services Information

Request (VADSIR), using the VADSIR template provided by the Texas Department of Information Resources.

3. Other documentation of vendor’s capability or ability to produce accessible products and services, which may include:

a. Vendor’s internal accessibility policy documents,

b. Contractual warranties for accessibility,

c. Accessibility Conformance Reports (ACRs), based on the VPAT or OpenACR formats, for similar products or services previously provided by the vendor,

d. Accessibility testing documentation, and

e. Other examples of prior work results

5.2.3 Proposer must have, or obtain, a TX-RAMP Level II Certification (APPENDIX

FIVE) from DIR (Texas Department of Information Resources) prior to contract execution. Information on TX-RAMP can be found on the Texas DIR website at:

https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp Please begin TX-RAMP Certification as soon as possible if proposer is not already certified.

file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu https://wp.uthscsa.edu/purchasing/ https://texas-sos.appianportalsgov.com/rules-and-meetings?chapter=213&interface=VIEW_TAC&part=10&title=1 https://dir.texas.gov/resource-library-item/policy-driven-adoption-accessibility-pdaa-vendor-assessment-0 https://dir.texas.gov/resource-library-item/policy-driven-adoption-accessibility-pdaa-vendor-assessment-0 https://prod.dir.texas.gov/resource-library-item/vendor-accessibility-dev-services-info-request https://prod.dir.texas.gov/resource-library-item/vendor-accessibility-dev-services-info-request https://www.itic.org/policy/accessibility/vpat https://www.itic.org/policy/accessibility/vpat https://acreditor.section508.gov/ https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

5.3 Additional Questions Specific to this RFP

Proposer must submit the following information as part of Proposer’s proposal:

5.3.1 If Proposer takes exception to any terms or conditions set forth in APPENDIX TWO and APPENDIX SEVEN), Proposer must submit a list of the exceptions.

The University WILL NOT consider any modifications to the University’s Standard Terms and Conditions AFTER submittal deadline.

5.3.2 UTS165 defines “Information Resources” as any and all computer printouts, online display devices, mass storage media, and all computer-related activities involving any device capable of receiving email, browsing Web sites, or otherwise capable of receiving, storing, managing, or transmitting Data including, but not limited to, mainframes, servers, Network Infrastructure, personal computers, notebook computers, hand-held computers, personal digital assistant (PDA), pagers, distributed processing systems, network attached and computer controlled medical and laboratory equipment (i.e. embedded technology), telecommunication resources, network environments, telephones, fax machines, printers and service bureaus. Additionally, it is the procedures, equipment, facilities, software, and Data that are designed, built, operated, and maintained to create, collect, record, process, store, retrieve, display, and transmit information.

5.3.3 UTS165 defines “Data” as recorded data, regardless of form or media in which it may be recorded, which constitute the original data necessary to support the business of UT System or original observations and methods of a study and the analyses of such original data that are necessary to support research activities and validate research findings. Data includes, but is not limited to printed records, observations and notes; electronic data; video and audio records, photographs and negatives):

5.3.4 UTHSA has determined that this project will require ALL Proposers to complete the Risk Assessment (Appendix Four). The Risk Assessment will establish specifications, representations, warranties, and agreements related to the EIR IT Security that Proposer is offering to provide to the University. Response to Appendix Four will be incorporated into the Agreement and will be binding on Contractor.

5.4 Scope of Work

UTHSA seeks to engage a qualified and experienced partner to conduct a comprehensive zero-balance audit that strengthens revenue integrity, ensures payer compliance, and identifies lost revenue opportunities. Awarded Proposer shall review claims 60 days after zero balance and no biller activity within that timeline.

The successful proposer will combine technical expertise, data analytics capability, and a collaborative approach to deliver a full-scope audit with measurable financial impact. The University’s objective is to establish a sustainable, transparent, and compliant process for continuous improvement in payment accuracy and revenue recovery.

file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu https://wp.uthscsa.edu/purchasing/ http://www.utsystem.edu/board-of-regents/policy-library/policies/uts165-information-resources-use-and-security-policy http://www.utsystem.edu/board-of-regents/policy-library/policies/uts165-information-resources-use-and-security-policy

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

The Awarded Proposer will perform a comprehensive zero-balance audit and payment compliance review that includes, but is not limited to:

5.4.1 Operational and Compliance Standards:

A. Maintain full compliance with HIPAA, state, and federal privacy security regulations.

B. Demonstrate secure data handling capabilities, including encryption, access controls, and audit trails consistent with UTHSA’s data security standards.

C. Possess the ability to transmit and store data in accordance with University IT and cybersecurity policies.

D. Employ staff who are fully trained in payer contract interpretation, reimbursement methodologies, and claim adjudication logic.

E. Provide documentation of staff credentials and training programs ensuring audit personnel are qualified to perform complex payment analyses.

F. Demonstrate the ability to interface with Epic or equivalent EHR and billing systems for data extraction and claim reconciliation.

G. Maintain a dedicated compliance officer or department responsible for regulatory oversight and internal quality assurance.

5.4.2 Technical and Reporting Capabilities:

A. Utilize proprietary or advanced audit software capable of modeling payer contract terms and identifying underpayments at detailed CPT, DRG, or contract-line levels.

B. Produce comprehensive reports summarizing audit outcomes, underpayment findings, payer trends, and financial recovery metrics.

C. Provide data transparency that allows UTHSA to validate findings independently.

D. Offer configurable reporting dashboards or data exports compatible with University analytics systems.

5.4.3 Performance and Service Requirements:

A. Commit to defined turnaround times for audit completion, reporting, and payer recovery actions.

B. Provide a clear escalation process for unresolved claims or payer disputes.

C. Maintain open communication channels with UTHSA’s billing and finance departments, including routine progress meetings and milestone reviews.

file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu https://wp.uthscsa.edu/purchasing/ https://www.hhs.gov/hipaa/for-professionals/special-topics/reproductive-health/index.html https://infosec.uthscsa.edu/policy-and-procedure/

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

D. Adhere to University policies on confidentiality, conflict of interest, and vendor conduct throughout the engagement.

5.5. Reporting and Communication Requirements:

Awarded Proposer must maintain ongoing transparency through structured communication and regular reporting throughout the duration of the engagement.

5.5.1 Regular Reporting Cadence:

A. Provide monthly summary reports detailing audit progress, underpayment findings, recoveries obtained, payer trends, and outstanding issues.

B. Provide ad hoc reports upon request for leadership review, payer escalations, or compliance validation.

C. Supply weekly status updates or dashboards to UTHSA project leadership outlining claims under review, pending recoveries, and aging of active items.

5.5.2 Report Content:

Each report must include, at a minimum:

A. Provide monthly summary reports detailing audit progress, underpayment findings, recoveries obtained, payer trends, and outstanding issues.

B. Provide ad hoc reports upon request for leadership review, payer escalations, or compliance validation.

C. Supply weekly status updates or dashboards to UTHSA project leadership outlining claims under review, pending recoveries, and aging of active items.

5.5.3 Data Transparency and Validation:

A. UTHSA shall have full access to the data supporting all reported findings.

B. The Proposer’s reporting tools or dashboards must allow UTHSA users to view claim-level data, payment comparisons, and supporting documentation.

C. All findings must be traceable and reproducible for validation by UTHSA staff.

5.5.4 Regular Review Meeting:

A. Conduct monthly performance review meetings with Revenue Cycle Leadership

UTHSA stakeholders to review audit results, recovery progress, and next steps.

5.5.5 Access and Data Acquisition:

A. Obtain access to all claims with a zero-balance within the defined 12-month review period, including both hospital-based and professional claims.

file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu https://wp.uthscsa.edu/pao/hop/10-toc/

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

5.5.6 Payment Verification and Modeling:

A. Enter payer contract terms into the vendor’s software or analytical platform to model expected payments and compare these to actual payments received.

5.5.7 Chronological Audit Review:

A. Conduct the review in chronological order, beginning with the oldest claims, to ensure comprehensive coverage of the eligible audit period.

5.5.8 Identification and Reprocessing of Variances:

A. Identify underpayments or misapplied payments and assist in reprocessing claims with payers in coordination with UTHSA’s billing and Revenue Cycle Team.

5.5.9 Recovery Coordination:

A. Collaborate with payers and the University’s Revenue Cycle Team to facilitate the recovery of underpaid claims. All recovered funds will be remitted directly to the University.

5.5.10 Contingency-Based Compensation:

A. The University will remit an agreed-upon contingency fee to the awarded proposer based on verified recoveries. No payment shall be made for unverified findings or non-recoverable claims.

5.5.11 Reporting and Transparency:

A. Provide detailed, transparent reports summarizing audit findings, recovered revenue, payer trends, and root-cause analyses. Reports should enable UTHSA to identify process improvement opportunities, track financial performance, and support compliance initiatives.

B. Monthly, Quarterly, and Yearly Reporting.

C. Reports to be provided to University’s Revenue Cycle Team and/or others as determined upon execution of contract.

5.6 GPO

A. If Proposer is part of any GPO, provide the GPO Name, Contract(s) Number, and other pertinent information.

5.7 Add or Delete Services

UTHSA is continuing to grow clinical, research, and educational services, which may require that additional service locations or facilities be added during the term of this agreement. The agreement that results from this RFP may need to be modified during its term to reflect these new file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

locations. Proposer agrees that the University has the right to add services which are available from the Proposer during the effective period of the contract. The University and the Proposer, prior to execution of services, shall mutually agree upon the scope and price, in writing, for any such additional services. In addition, the University has the right to modify, replace, upgrade, or delete services during the effective period of the contract. The University and the Proposer, prior to modification of services shall mutually agree in writing before modifying services. As well as special notice in Section 1.2 Background and Special Circumstances.

file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu

DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

REQUEST FOR PROPOSAL

SECTION FOUR

TERMS AND CONDITIONS

SECTION SIX

PRICING AND DELIVERY SCHEDULE

APPENDIX ONE

SECTION 1 – GENERAL INFORMATION

SECTION 2 – EXECUTION OF OFFER

SECTION 3 – GENERAL QUESTIONNAIRE

SECTION 4 – ADDENDA CHECKLIST

APPENDIX TWO

SAMPLE AGREEMENT

APPENDIX THREE

HUB SUBCONTRACTING PLAN

APPENDIX FOUR

RISK ASSESSMENT

APPENDIX FIVE

TX-RAMP NOTICE

APPENDIX SIX

POLICY DRIVEN ADOPTION FOR ACCESSIBILITY (PDAA)

VENDOR ASSESSMENT

APPENDIX SEVEN

BUSINESS ASSOCIATE AGREEMENT (BAA)

See Attached in Euna file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu https://wp.uthscsa.edu/purchasing/