7-RFQ 543509 Third Party Medical Billing Services.docx

CITY OF DETROIT

OFFICE OF CONTRACTING AND PROCUREMENT

REQUEST FOR QUOTE

RFQ No.: 543509 Detroit Health Department - Third Party Medical Billing & Coding Services Buyer: Ashante Booker

All questions must be submitted online in the Supplier Portal

Microsoft Teams Meeting Join: https://teams.microsoft.com/meet/26443306293148?p=wsHOJLYrY810JryuAE

Meeting ID: 264 433 062 931 48 Passcode: 6ay3e57s Dial-in by phone:

+1 469-998-6602,,116544168# (United States, Dallas) Phone Conference ID: 116 544 168#

In the Supplier Portal as specified in this RFQ.

* Vendors must register in Bonfire (EUNA Procurement) to download bid documents and submit bids. The City cannot guarantee the accuracy of any bid documents obtained from outside of Bonfire, and bids submitted outside of Bonfire will not be accepted. Detailed resources about registering and bidding, including video tutorials and live, virtual office hours, are available at www.detroitmi.gov/suppliersupport.

Questions about the specifics of this RFQ must be asked within the Bonfire Messages interface for the bid on or before the date and time indicated above. Questions asked via phone, email, and/or other means will not be answered.

Quotes must be uploaded in Bonfire on or prior to the date and time indicated above. Late and/or emailed quotes will not be accepted.

PROJECT REQUEST

The Office of Contracting and Procurement (OCP), on behalf of the Detroit Health Department, is requesting quotes from qualified firms to provide Third Party Medical Billing Services. The selected Contractor shall provide comprehensive claims processing, billing, revenue cycle management, and related services in support of the Department’s clinical operations. Services shall include electronic and paper claim submission, denial management, accounts receivable management, detailed reporting, and full practice management support designed to maximize reimbursement, improve claim adjudication outcomes, and optimize revenue performance.

BACKGROUND/DESCRIPTION OF ENVIRONMENT

The Detroit Health Department operates multiple clinical programs, including but not limited to Family Planning, Immunizations, Lead Testing, and other public health services. The Department requires a qualified third-party billing provider to manage electronic medical billing, coding, and revenue cycle functions to ensure timely, accurate, and compliant submission of claims to government and commercial payors.

The Department utilizes an electronic health record (EHR) system and requires seamless coordination with that system to support claim generation, coding accuracy, denial management, appeals processing, and accounts receivable oversight. The selected Contractor must demonstrate the ability to improve billing efficiency, enhance first-pass claim success rates, aggressively manage denials, and optimize overall reimbursement performance while maintaining regulatory compliance.

STATEMENT OF WORK

3.1 Contractor shall perform claims billing and services by providing computerized claims, billing and collection services for Detroit Health Department's clinical operations. These services shall include regulation of filing medical insurance claims on behalf of the Detroit Health Department providers with government and commercial companies by electronic and paper means. It shall also provide for billing services directly to patients or for patient's portion of healthcare provider fees not covered by insurance. In addition, this project shall maintain practice management tasks pertaining to accounts receivable within standard acceptable practice guidelines.

3.2 Task List: Each task has been assigned a number for reference throughout the rest of this document and during the commission of the project.

Department medical insurance claims for payment by government and commercial companies by either electronic or paper means. This will include claims requiring processing prior to onboarding Patagonia health record dating back to January 1, 2025.

Detroit Health Department agrees to make available to (name of contractor) all information necessary to properly process the Detroit Health Department client claims and to submit all such billing and insurance information to (name of contractor) daily. In return, (name of contractor) will process and submit all Detroit Health Department clinical claims within seventy-two (72) hours by electronic means wherever possible, and by paper means otherwise. The scope of services provided by (name of contractor) will follow as outlined in the Project Approach Plan included.

Detroit Health

3.3 Key Personnel List

Reproductive Health

Immunizations/ Dir. of Nursing

3.4 Key Contractors/Subcontractors

3.5 Problem Statement

Detroit Health Department is currently unable to efficiently electronically bill for medical services rendered by our clinical providers with the staff and tools available to us. We are seeking assistance from a third-party billing service to help streamline and maintain practice management tasks pertaining to revenue cycle management to includes claims preparation and pre-scrub to ensure successful claim adjudication on first pass with optimal reimbursement. The priority tasks will include claim scrub, billing, processing, and A/R management after claim adjudication and remittance. We also seek for claim denial management and reworking services to optimize claim outcomes.

3.6 Project Approach Plan

As assigned by the Detroit Health Department and in accordance with all applicable policies and procedures. Services shall minimally include:

3.6.1 Complete medical billing and coding services for Family Planning, Lead Testing, Immunizations and other clinical programs.

3.6.2 ICD-10/CPT Coding proficiency/accuracy that is applied unilaterally to all client bills for claim generation and processing.

3.6.3 Thorough and accurate chart reviews to establish appropriate claim coding and timely submission (within 72 hours of completed service) of all billable claims.

3.6.4 Appropriate modifier utilization and incorporation for services rendered to include telemedicine services.

3.6.5 Complete claims management to include follow up with adjudication results, correction and re-submission of denial claims, to include tracking appeal process information, and A/R general management.

3.6.6 Charts Reviewed- within 24 hours of receipt from clinic

3.6.7 Claims Coded- under 24 hours from date of service to the client

3.6.8 Claims Submitted- with 72 hours of receipt from clinic

3.6.9 Denials Appealed- under 120 days post adjudication and denial receipt.

3.6.10 Generation of detailed reporting data to include productivity metrics: total claims filed, total remittances received, denials, appeals, error rates, variance from expected reimbursement to actual, days in A/R per claim, monthly revenue by program, updated payor portal information to ensure first pass success in payment and reimbursement of claims, etc.

3.6.11 Must have ability to link and utilize Detroit Health Department EHR system, Patagonia, for successful management of claims and billing processes related to patient files.

3.6.12 Must assist with filing and following up on claims requiring processing, prior to onboarding Patagonia health record, dating back to January 1, 2025.

3.6.13 All services should maintain HIPPA compliance.

3.7 Project Reports

Scheduled Status Reports

Detroit Health Department Practice Management Report

MINIMUM QUALIFICATIONS

Vendors must meet or exceed the following minimum qualifications to be deemed responsive. Failure to meet any requirement shall result in disqualification.

4.1 The firm must identify at least one (1) staff member who will be assigned to this project that holds a current nationally recognized medical coding certification (e.g., CPC, CCS, RHIT, or equivalent). A copy of the certification must be submitted.

4.2 The firm must provide one (1) reference from governmental or public health entities for which similar medical billing services were performed within the past five (5) years.

4.3 The firm must submit a signed attestation confirming experience processing claims for Medicaid and Medicare payors.

4.4 The firm must submit a redacted sample monthly performance report demonstrating denial tracking, appeals management, and revenue cycle performance metrics. (Submission required as part of proposal package.)

4.5 The firm must submit a signed HIPAA compliance attestation confirming adherence to applicable federal HIPAA regulations and willingness to execute a Business Associate Agreement (BAA).

TECHNICAL INFORMATION

The City of Detroit is committed to centralizing and warehousing data for the purpose of improving service delivery and enabling cross departmental analytics. For this reason, we expect Contractors, contractual relationships, and resulting software platforms to enable data access, data interoperability, warehousing of resulting data, and adherence to City data standards.

Specifically, the City minimally requires:

· Access to any data via APIs in a machine-readable format.

· Full documentation of APIs (including field names and objects) and the database schema used by the application.

· Ability for City to push data as needed to these software systems to update base datasets.

· Any location-based data or platform utilizes the City’s Base Units geocoder, Base Units Database, and/or address data standards as applicable. For more information see: https://base-units-detroitmi.hub.arcgis.com/pages/about-base-units

· The ability for the City to use and govern this data as it deems necessary-- centralizing it, porting it into other systems, and using it for additional and future organizational needs.

The City prefers:

· System or platform has the capacity to store field-level metadata and display it in the user interface when appropriate. API is able to provide data in a JSON format. Data systems or data exports integrate easily with ESRI products including feature services.

· Systems or platforms that support data exchanges (pushes and pulls) that can happen dynamically.

· Specifications, Change of Specification, and Errors or Omission. Specifications which refer to brand names are given for reference. Vendors may quote on equivalent articles, provided that brand name and catalog number(s) and any deviations are noted on the bid form and complete descriptive literature is furnished. Exceptions will state “Do Not Substitute.” The decision of the City shall be final.

QUESTION DEADLINE

All questions regarding the RFQ shall be submitted through the Supplier Portal no later than the time and date specified on the Cover Page. In the interest of transparency, only written questions will be accepted. Answers to questions will be posted within the Supplier Portal. The City of Detroit does not guarantee a response to questions not submitted after the question deadline.

Should a Vendor be in doubt as to the true meaning of any portion of this RFQ or find any patent ambiguity, inconsistency, or omission herein, the Vendor must make a written request for an official interpretation or correction in accordance with the instructions for submitting questions as specified in this RFQ.

Vendors are advised that no oral interpretation, information or instruction by an officer or employee of the City of Detroit shall be binding upon the City of Detroit.

Vendors requesting changes to the RFQs terms and conditions, specifications, quantities, etc.; or if clarifications are needed, must make the request in writing by the stated bid submission deadline.

REJECTIONS, MODIFICATIONS, CANCELLATIONS

The City of Detroit expressly reserves the right to:

1) accept or reject, in whole or in part, any and all quotes received;

2) waive any non-conformity;

3) re-advertise for quotes;

PROTESTS

Protests can be filed with the Office of Procurement. Interested parties aggrieved by a solicitation or the award of any resulting contract, may file written notice of protest to the following:

City of Detroit Attention: Chief Procurement Officer 2 Woodward Avenue, Suite 1008 Detroit, MI 48226 Re.: “Procurement Protest”

At a minimum, such protests shall include:

1) name of protestor.

2) solicitation/contract number and description; and

3) statement of grounds for protest (reference specific text in the solicitation, bid or contract document that is at issue).

The decision of the Chief Procurement Officer and/or the Department Director are final and is not subject to appeal.

INVOICES

Vendors must be registered in City of Detroit Vendor Portal and be a registered vendor with the City of Detroit to submit invoices and receive payments. Go to http://www.detroitmi.gov/Supplier to register.

Authorization to commence work or ship goods – read carefully.

Contractors may begin work or ship goods upon receipt of the required authorization, which is the CPA (Contract Purchase Agreement), in addition to SPO (Standard Purchase Order), from Procurement.

PREVIOUS EXPERIENCE

The City’s experience with the Vendor on previous contracts will be considered in determining the award.

MISCELLANEOUS

It shall be the responsibility of the Vendor to thoroughly familiarize themselves with the provisions of these specifications. After executing the contract, no consideration will be given to any claim of misunderstanding.

The Vendor agrees to abide by the rules and regulations as prescribed herein by the City as the same now exists or may hereafter from time to time be changed in writing.

Contractors are encouraged to contract with small and minority businesses, women's business enterprises, labor surplus area firms and Detroit businesses. The City strongly encourages the hiring of Detroit residents whenever possible by contacting Detroit At Work for your hiring needs. Visit the Detroit At Work website at www.detroitatwork.com for specific contact information regarding these opportunities.

GENERAL CONDITIONS:

It is the responsibility of the Vendor to review General Conditions located on the City of Detroit’s website.

12.1 Responsibilities

In your quotation a distinction between dollars and cents must be made. Also, illegible bids may be grounds for rejection of your bid. All changes made to the bid form altering, price, terms, quote and/or conditions. MUST be crossed out and initialed. Failure to make any initial changes will be grounds for rejection of your bid. CORRECTION FLUID IS NOT ACCEPTABLE.

12.2 Local Preference Conditions

It is the responsibility of the Vendor to review the Local Preference Conditions attached to this bid and comply with all requirements therein.

12.3 Minor Deviations

Specifications referred to herein are used to indicate desired type, and/or construction, and/or operation. Other products and/or services may be offered if deviations from specifications are minor and if all deviations are properly outlined and stated in the bid document. Failure to outline all deviations will be grounds for rejection of your bid.

The decision of the City of Detroit, acting through the Chief Procurement Officer, shall be final as to what constitutes acceptable deviations from specifications.

12.4 Extension

The Contract Purchase Agreement’s period of performance may be extended per contract terms. Both parties must agree to an extension with the same terms and conditions of the current contract.

12.5 Termination of Contract (Cause)

At any time during the contract the City may terminate the agreement for reason of poor or deficient work performance, inability of the Contractor to show cause of poor or deficient work performance, inability of the Contractor to supply trained competent technicians, or lack of service as described in this agreement by giving a 10-calendar day notice in writing. EITHER party may terminate the agreement by giving a 30-calendar day written notice to terminate.

12.6 Termination of Contract (Convenience)

The City reserves the absolute right to terminate this contract in whole or in part, for the convenience of the City at its sole discretion on thirty (30) days written notice to the Vendor.

12.7 Equalization Factor

Per Section 17-5-12 (c)(1) of the Detroit City Municipal Code, “The Vendor that makes the lowest bid, as evaluated or scored, shall be deemed the lowest equalized Vendor. If the lowest equalized bid is evaluated or scored below the lowest responsible bid submitted, the lowest equalized Vendor shall be awarded the contract, provided that, the contract awarded to such Vendor shall not exceed, more than 12 percent above the lowest responsible bid submitted, or $100,000.00, whichever is less.”

The firm making the lowest responsive, responsible bid evaluated according to the Equalization Allowance Table* shall be deemed the lowest Vendor. (see Equalization Credit Statement).

Vendors who wish to receive Equalization credit for bids submitted must submit their CRIO-issued Detroit Based Business certificate with their bid document to substantiate eligibility. The CRIO certificate must be submitted with each and every bid response submitted by the vendor. Failure to submit the CRIO certificate will result in equalization credit not being applied to your bid.

12.8 Bid Withdrawal

No bid shall be withdrawn for 120 days from submission deadline. Vendors may reduce this period if stated on bid, but such bids may be rejected on the basis of the reduced time period.

12.9 Insurance

The Contractor shall maintain at its expense during the term of this contract, the following insurance:

12.9.1 Worker’s Compensation insurance with Michigan statutory limits and Employer’s Liability insurance with limits of $500,000.00 each accident, $500,000.00 each disease, $500,000.00 each disease/each employee. For Federal and State Funded Training Programs and etc., is required to secure insurance for worker’s compensation for all of its participants and The City of Detroit should also be listed as an additional insured.

12.9.2 Commercial General Liability insurance with a combined single limit of $1,000,000.00 per occurrence subject to a minimum aggregate limit of $2,000,000.00

12.9.3 Errors and Omission Cyber Liability Insurance, $1,000,000.00 per claim when applicable $5,000,000.00 aggregate

12.9.4 If during the term of this contract, changed conditions or other pertinent factors, should in the reasonable judgment of the City, render inadequate the insurance limits, the Contractor will furnish on demand such additional coverage as may reasonably be required under the circumstances. All such insurance shall be affected at the Contractor's expense, under valid and enforceable policies.

12.9.5 All policies shall name the Contractor as the insured and shall be accompanied by a commitment from the insurer that such policies shall not be canceled or reduced without at least thirty (30) days' prior notice to the City. The Commercial General Liability insurance policy shall name the City as an additional insured. Certificates of insurance evidencing such coverage shall be submitted to the Finance Department, Office of Contracting and Procurement, prior to the commencement of performance under this contract and at least fifteen (15) days prior to the expiration dates of expiring policies.

12.10 Operational Information

Awarded Contractor(s) will work closely with City agency staff.

The Vendor is expected to provide service in accordance with the terms of the contract executed under the rules, regulations, and supervision of the City.

12.11 Order Quantities

Actual quantities ordered will be contingent on funds available at time of purchase. The City of Detroit reserves the right to reduce quantities if price quoted exceeds budgetary limitations or to increase quantities if funds are available.

BASIS FOR AWARD

This procurement shall be evaluated on a price-only basis. Award will be made to the lowest responsive and responsible Vendor whose submission meets the Minimum Requirements set forth in this RFQ.

Revised 12/2/2025