Questions and Answers.pdf

Questions and Answers

RFQ 75H71221Q00015

Aging Claim Research Phoenix Indian Medical Center (PIMC) Date: 5/4/2021

Question 1. Under the Pre-Authorization and Out of Network Denials section of the Scope of Work, please clarify if collection notices will also be sent to Private Insurance Payers when warranted based on the IHS Debt Collection Policy.

Answer 1. We will send out a collection notice for the pre-authorizations. We are currently working on a different plan for the Out of Network Denials so we will send out one notice before adjusting these accounts off.

Question 2. Will collection notices be sent by Phoenix Indian Medical Center (PIMC) staff or by the Contractor? If PIMC will send collection notices, will Contractor have access to notices?

Answer 2. The contractor will be provided with a template and will be responsible for sending out the notices.

Question 3. Please clarify under Quality Control who the Contractor analyst is that is referenced. Or, if through the Contractor’s Quality Control measures, that this is information that the Contractor provides to designated PIMC staff.

Answer 3. The contractor should have quality control measures in place to ensure processes are in place and that this information can be provided to PIMC when requested.

Question 4. Is this a new requirement, or if there is a current or previous contractor who has performed similar services? If available, can you please send along the incumbent contract or task order number?

Answer 4. This is a new requirement. We have no record that this requirement is ever contracted out by Phoenix Indian Medical Center.

Question 5. If there are additional payer website access that is needed, will that be provided upon request?

Answer 5. PIMC is not contracted with any PI plan so we have little to no access website access.

Question 6. "Review denial reasons on rejected claims" - Will access to the clearinghouse be provided? What clearinghouse is PIMC currently using?

Answer 6. PIMC has limited access to a clearinghouse to review payment information.

Question 7. "Sends collection notices on certain claims" - Is PIMC utilizing the Debt Management System within RPMS?

Answer 7. Due to the current backlog, PIMC does not utilize the RPMS Debt Management System.

Questions and Answers

RFQ 75H71221Q00015

Aging Claim Research Phoenix Indian Medical Center (PIMC) Date: 5/4/2021

Question 8. "Submits data on denials to PIMC for closeout" - Is PIMC leaving denied balances open on accounts and not posting the denial adjustments per the EOBs when first received?

Answer 8. When follow-up is needed, the balance will sometimes be left open.

Question 9. Is the contractor allowed to correct billing and coding errors in order to resubmit claim for payment?

Answer 9. The contractor will be allowed to correct billing errors; if they have demonstrated experience with coding, they can also make these corrections

Question 10. "The Contractor to provide a summary of claims status on a monthly basis (include amount collected) " What RPMS report(s) is PIMC presently using to provide this data? Or, is the contractor expected to manually track to report status and identify the amounts collected on aged claims that the contractor researches?

Answer 10. The contractor will need to manually track their claims status.