Claims Coding Billing and Collection Services ARFQ Specifications.pdf

PDF 364 KB Posted

Attached to
Claims Coding, Billing and Collection Services
Solicitation number
ARFQ 0512 OHF2700000001 1
Issued by
Kanawha County, West Virginia

About this file

This document contains the specifications and requirements for an ARFQ (Automated Request for Quote) issued by the State of West Virginia for Claims Coding, Billing and Collection Services. The solicitation seeks a qualified vendor to provide comprehensive claims coding, billing, and collection services, including processing of medical claims, coding verification, billing operations, and collection activities. The state requires detailed responses addressing service capabilities, staffing qualifications, quality assurance procedures, technology systems, and implementation timelines. The contractor must demonstrate experience with healthcare claims processing, knowledge of relevant coding standards (ICD-10, CPT, HCPCS), and proficiency with billing software systems. The contract term and specific response deadlines, site visit requirements, and bidders' conference details are outlined within the solicitation documents.

The specifications emphasize compliance with state regulations, HIPAA requirements, and data security standards for handling sensitive healthcare information. Pricing shall be submitted according to the ARFQ format, with evaluation criteria including cost competitiveness, vendor experience, system capabilities, and proposed service level agreements. The state will assess the incumbent's performance if applicable and evaluate how the proposed solution integrates with existing state systems and processes. Vendors must provide detailed cost proposals for claims processing volumes, monthly service fees, and any transaction-based pricing structures. Additional requirements include liability insurance, bonding, disaster recovery capabilities, and 24/7 customer support services to ensure continuity of claims operations for the state.

View the file

Other files

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

REQUEST FOR QUOTATION

Claims Coding, Billing and Collection Services

ARFQ OHF27*1

SPECIFICATIONS

1. PURPOSE AND SCOPE: The West Virginia Office of Shared Administration

Purchasing Division is soliciting bids on behalf of the Department of Health Facilities (DHF), to establish an open-end contract for Comprehensive Inpatient and Outpatient Claims Coding Services, Billing Services and Collection Services for the State owned and operated hospital facilities. The services will complete abstracting of claims data from the clinical system inside of the facilities data systems prior to submitting to the clearinghouse.

Services are to be performed remotely (off-site), therefore, it will be necessary for the vendor to provide their own staffing, facility and operational resources and to demonstrate a secure ability to interface with the Facilities Electronic Health Records currently (Medsphere’s CareVue) and ADT/Billing systems (Optimum). The Clearinghouse currently being utilized is Availity. All systems are cloud based and are accessible via URL, with interfaces built between them for 835/837 file exchange.

The West Virginia Department of Health Facilities (DHF) is a multi-specialty organization currently offering services at three different locations throughout the State of West Virginia.

● Mildred Mitchell-Bateman Hospital is located at 1530 Norway Ave., in Huntington, WV 25709-0448. The Facility is a 110-bed, state-supported acute psychiatric hospital with acute, forensic and long-term patients. The hospital is accredited by the Joint Commission and certified by the Center for Medicare & Medicaid Services (CMS).

● William R. Sharpe, Jr. Hospital is located at 936 Sharpe Hospital Road off Route 33 West, in Weston, WV 26452. The Facility is a 200-bed, state-supported acute psychiatric facility with full accreditation from The Joint Commission on Accreditation of Healthcare Organizations and certified by the Center for Medicare & Medicaid Services (CMS).

● Welch Community Hospital is located at 454 McDowell St., in Welch, WV 24801.

The Facility has 55 licensed beds. Of the 55, there are 45 medical/surgical beds, 8 intensive care beds; 2 pediatric beds. The Hospital serves the counties of McDowell, Wyoming and Mingo with a total market population of approximately 80,000.

2. SPECIAL BILLING INFORMATION:

2.1.PSYCHIATRIC FACILITIES: DHF is responsible for patient care whether or not coverage is available. Patients are admitted to the psychiatric facilities by judges when the patient is found to be incompetent to stand trial, or by mental hygiene commissioners for evaluation. Often these patients do not

Page | 1Revised 08.26.2026 have coverage; however, the patient accounts still need to be written off and “touched” even though no payment will be received. Also, Medicaid Fee-for-Service does not cover those who are over the age of 21 years.

However, if the patient is a member of a Medicaid MCO, 15 calendar days may be covered, and sometimes up to 30 calendar days depending on the admission date, but after the initial coverage, no payments will be received.

The accounts in this situation will also require posting and write-offs as well.

2.2.SYSTEMS, PAYER AND UTILIZATION INFORMATION

2.2.1. SYSTEMS: The State-owned facilities utilize Medsphere’s

CareVue for their Electronic Medical Record (EMR). The general acute care hospital, the psychiatric hospitals, and outpatient services utilize Optimum RCM for Admission Discharge Transfer (ADT), for billing claims, for tracking accounts receivable (AR) and all other features related to a Revenue Cycle Management system. The Acute Care facility utilizes Experience Care/NetSolutions for ADT, Minimum Data Set (MDS), care plans, billing and tracking AR. Patient statements are sent from Optimum; however, patient statements at the Acute Care level shall be sent by the claims and billing vendor for any amounts due not covered by the payer.

2.2.2. FACILITIES’ CURRENT CENSUS and PAYER MIX:

2.3.CURRENT ESTIMATED PAYOR MIX FOR ACUTE CARE

FACILITIES FROM 01/01/2021-04/30/2022 BASED ON CENSUS DAYS:

Page | 2Revised 08.26.2026

Facility Licensed Beds Current Census (6.30.2022)

Welch 55 12

ACUTE CARE FACILTY PAYERS RECEIPT FROM PAYER %

WELCH MEDICAID 98.9%

MEDICARE 0

PRIVATE 0

COMMERCIAL 1.06%

2.3.1. SERVICE UTILIZATION BY FACILITY: Sharpe, Bateman and Welch

PAYER SERVICES NUMBER

COMMERCIAL 99211 4

99211 GT 78

99212 GT 14

99213 GT 2

99308 1 99441 187 99442 53 99443 6

GUARANTOR 99212 GT 1

99213 1 99441 99 99442 17 86580 4

MEDICAID 99211 GT 1

99212 1

99212 GT 4

99213 GT 1

99441 1 86580 1

MEDICARE 99211 GT 8

99212 5

99212 GT 92

99213 1

99213 GT 7

99308 1 99441 16 99442 1

3. DEFINITIONS: The terms listed below shall have the meanings assigned to them below. Additional definitions can be found in section 2 of the General Terms and Conditions.

Page | 3Revised 08.26.2026

3.1. “Contract Services” means Comprehensive Professional, Inpatient and Outpatient Claims Coding Services, Billing Services and Collection Services as more fully described in these specifications.

3.2.“Pricing Page” means the pages, contained wvOASIS or attached hereto as

Exhibit A, upon which the vendor should list its proposed price for the Contract Services.

3.3.“Solicitation” means the official notice of an opportunity to supply the State with goods or services.

4. QUALIFICATIONS: Vendor’s staff shall have the following minimum qualifications:

4.1.Vendor must have extensive knowledge of professional, inpatient, outpatient, general acute, and psychiatric billing, modifiers, coding, coverage guidelines, fee schedules, Health Insurance Portability and Accountability Act (HIPAA) compliance, Office of Inspector General (OIG), Healthcare Reform Act and contract compliance and will provide proof of a formal corporate compliance Program aligned with OIG guidelines.

4.2.Vendor must ensure all staff assigned to this contract are qualified and receive the appropriate training and certifications regarding billing practices, protection of patient information, Health Insurance Portability and Accountability Act, and any other necessary compliance training as needed to complete the services contained within the contract. vendor will provide proof of coder credentials (AHIMA/AAPC) and annual competency assessments.

4.3.Vendor must have a minimum of five (5) years’ experience in hospital billing for Acute Care Hospitals, Psychiatric, and Outpatient Clinic Billing.

4.4.Vendor must maintain an up-to-date knowledge of Medicare, Medicaid, Public Employee Insurance Agency (PEIA) and third-party insurance company billing rules.

4.5.Vendor will utilize all computer and software systems contracted by DHF.

4.6.Vendor will ensure a staffing continuity plan is in place to address turnover without service interruption.

Page | 4Revised 08.26.2026

4.7.Vendor must ensure all patient information and data provided by the facilities to the vendor is kept confidential and shall not be disclosed to anyone outside of the vendor other than to the extent necessary for the vendor to process and submit claims for the hospitals.

4.8.Vendor must have processes in place to secure protected patient health information to include:

4.8.1. Network encryption

4.8.2. Document disposal

4.8.3. Cyber Security Accreditation (SOC 2 Type II, HITRUST)

4.8.4. IT Security risk assessment annually

5. MANDATORY REQUIREMENTS:

5.1.Mandatory Contract Services Requirements and Deliverables: Contract

Services must meet or exceed the mandatory requirements listed below.

5.1.1. Vendor must be able to begin service provision within thirty

(30) calendar days from award of the contract, including milestones, resource allocation, and downtime planning.

5.1.2. Vendor must maintain the staffing levels needed to perform the services for the duration of the contract and provide monthly staffing reports.

5.1.3. Vendor must comply with all Federal and State regulations as well as Bureau policies related to revenue cycle coding, billing and collection.

5.1.4. Vendor must have access to the Medicare intermediary

systems.

5.1.5. Vendor must supply viewing and report performance access to DHF administration for the vendor’s chosen claims clearinghouse electronic eligibility system. The vendor must

Page | 5Revised 08.26.2026 maintain their own independently registered accounts, as the vendor will not be permitted to share or “piggyback” on state administered portal credentials, for:

5.1.5.1. Claims Clearing House

5.1.5.2. Medicare portals

5.1.5.3. Medicaid portals

5.1.5.4. All Medicaid MCO portals

5.1.5.5. All commercial payer portals

5.1.5.6. All eligibility and remit portals

5.1.6. Vendor shall be given appropriate access and use of the Electronic Health Records (EHR) system to view medical records and documentation as necessary for outpatient coding, inpatient coding, psychiatric coding and billing.

5.1.7. Vendor must establish and maintain access to the facility data systems. The facilities will provide the vendor with the required access and information from the facilities data system;

however, the vendor will assume responsibility for any associated developmental and equipment costs to establish such a connection.

5.1.8. Vendor shall maintain audit logs for all portal actives and must maintain a credential lifecycle plan (creation, termination, password rotation).

5.1.9. Vendor must be able to accept and transmit Health Level

Seven (HL7) transactions and meet the requirements to ensure HIPAA-compliant electronic data interchange (EDI) transactions within the current system and with communications with payers and providers.

5.1.10.Vendor shall assume responsibility for producing and mailing all applicable patient statements and letters.

5.1.11.Vendor shall invoice DHF monthly for services rendered based on a percentage of monies collected during the previous month excluding any up-front collections from the facilities.

This does not include monies collected from cost settlements.

For any outstanding AR, if dollars are collected, the vendor may also invoice. Invoices should include a listing of all

Page | 6Revised 08.26.2026 charges for the applicable period and must address the following:

5.1.11.1. Vendor shall be responsible for any reimbursements, fines and penalties resulting from assigning improper coding or billing not supported by proper provider documentation except for instances where the facilities provided inaccurate medical information.

5.1.11.2. Vendor shall refund any coding costs which result in a “take back” of dollars from the Facilities due to revision/rejection of the codes assigned by the vendor.

5.1.11.3. Vendor shall deduct on a dollar-for-dollar basis from the current month's invoices any amount deemed unbillable due to a late submission of billing caused by the vendor, i.e., timely filing.

5.1.12.Vendor Director or designee shall attend monthly DHF status meetings including but not limited to: Biweekly meetings for the first 90 calendar days after contract award, during normal working hours at the discretion of DHF. DHF may cancel meetings at their discretion.

5.1.13.Vendor shall provide a toll-free customer service number and staffing for individuals who have questions related to patient account information. The customer service numbers must be staffed Monday through Friday, during normal business hours (8:00 AM through 5:00 PM), excluding the following holidays:

5.1.13.1. New Year’s Day

5.1.13.2. Memorial Day

5.1.13.3. 4th of July

5.1.13.4. Labor Day

5.1.13.5. Thanksgiving Day

5.1.13.6. Christmas Day

5.1.14.Vendor shall be responsible for providing all materials and resources required for the performance of the contract including, but not limited to, third party audit compliance, facilities, equipment, cyber liability insurance, errors and omissions insurance, statements, postage and personnel.

Page | 7Revised 08.26.2026

5.1.15.Vendor shall provide and maintain a compliance log accessible to DHF, this shall include a shared project management tool for issues and work log.

5.1.16.Vendor shall notify DHF of any contact by attorneys, investigators or patient complaints within twenty-four (24) hours of receipt.

5.1.17.Vendor shall notify DHF of any real or suspected breach of patient medical or financial information immediately upon identification of the breach.

5.1.18.Vendor shall provide a formal breach response plan with timelines aligned with HIPPA and complete an annual review of Corrective action plans for compliance risk.

5.2.Vendor shall provide certified professional coding services to include:

5.2.1. Identification and coding of principal, secondary and all diagnoses and procedures shall be up to date (CD, ICD 10, HCPCS, CPT) and accurate using the applicable criteria to include:

5.2.1.1. International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-CM/PCS).

5.2.1.2. Current Procedural Terminology (CPT) as administered by the

AMA (American Medical Association). Healthcare Common Procedural Coding System (HCPCS).

5.2.1.3. American Health Information Management Association

(AHIMA) Standards of Ethical Coding and/or American Academy of Professional Coders (AAPC).

5.2.1.4. Centers for Medicare and Medicaid Services (CMS) Rules &

Regulations.

5.2.1.5. Uniform Hospital Discharge Data Set (UHDDS) guidelines.

5.2.1.6. National Uniform Billing (NUBC) specifications.

5.2.1.7. Any other federal, state or insurance procedural and hospital billing specifications and requirements for payment of claims.

Page | 8Revised 08.26.2026

5.2.2. Utilizing encoder and other related databases and references to minimize coding errors and ensure ongoing internal audits of minimum 5% random samples annually.

5.2.3. Vendor shall submit an audit report monthly listing any coding errors.

5.2.4. Meeting the standard for compliance of Continuing

Education (CE) as defined by American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC).

5.2.5. Vendor shall represent and provide rationale to a third party or audit response related to the accuracy of the coding of any record for which the vendor has assigned diagnosis and/or procedure codes for inclusion in the appeal of such challenge.

5.3.Vendor Shall provide professional billing services to include:

5.3.1. Preparing and submitting complete and accurate insurance claims electronically to Medicare, Medicaid and any other applicable carriers including both commercial and private insurances.

5.3.2. Ensuring claims contain complete and accurate information and will be filed with third party entities in a timely manner through the facilities billing system as soon as service is complete (e.g. 24-48 hours outpatient, 72 hours inpatient).

5.3.3. Work Queues in the clearinghouse and the RCM billing

system will be worked daily.

5.3.4. Ensuring all government payor and private insurance timely filing requirements are met.

5.3.5. Preparing and mailing invoices to patients responsible for co-pays and/or deductibles, private pay, and uninsured patients at thirty (30), sixty (60), ninety (90) and one hundred and twenty (120) calendar days for outstanding accounts receivable for Acute Care patients.

Page | 9Revised 08.26.2026

5.3.6. Handling in/out-bound correspondence which may include patient, third party payer, attorneys, and vendors' calls or mail (electronic or hard copy). The facilities must approve all letters and communication formats related to facility accounts prior to being sent out by the vendor.

5.3.7. Supporting, discussing and explaining the primary, secondary and tertiary billing, collection and resolution of Medicare, other government and non-government accounts with internal and external contacts.

5.3.8. Reviewing all claims to determine accuracy and compliance with payer specifications so that claims are paid on the first submission. All denials and remittance advice where claims have not been paid will be worked and resubmitted according to the denial reason using the Availity Denial Management system if remittance is electronic. Denials shall be worked daily.

5.3.9. Vendor shall ensure that all denials are posted with a denial code for tracking purposes.

5.3.10.Vendor shall report all denials monthly to the facility.

5.3.11.Collaborating and communicating with multiple departments to identify needs and fact-find to obtain necessary information to resolve a claim including charging, coding, and billing.

5.3.12.Collecting missing patient information by, including but not limited to, gathering electronic patient information from the facilities, searching the billing service provider’s billing database, interfacing with insurance provider’s data systems, or by direct patient, family member or responsible party contact via phone, mail, and electronic communications.

5.3.13.Reporting to the facilities any identified updated insurance/demographic information as appropriate to ensure all facility data is up to date.

5.3.14.Reviewing all insurer payment transactions and remittance advice received to ensure they match the claim.

Page | 10Revised 08.26.2026

5.3.15.Performing any necessary account system changes such as financial class change, eligibility updates, re-bills or payer follow up/contact and documenting in the patient accounting system notes.

5.3.16.Posting and processing all payments and denials based on remittance advice or any other payment or correspondence within five (5) business days of receipt of notification. This will include, but is not limited to, all necessary secondary billing and adjustment of accounts. This includes any credit balance as well as any debit balances listed with denial code for tracking purposes.

5.3.17.Medicare and Medicare secondary accounts must be completed within five (5) business days of the date of billing, rebilling or additional submission. All accounts that remain pending will require a phone call to the Medicare Intermediary every thirty (30) calendar days until account resolution.

5.3.18.Medicaid and Medicaid secondary accounts forms must be completed online within five (5) business days of the date of billing, rebilling or additional submission. All accounts that remain unpaid require a phone call to the Medicaid Intermediary every twenty-eight (28) calendar days until account resolution.

5.3.19.All accounts with secondary payor sources will be billed within 5 business days of receipt from the primary payor.

5.3.20.All Managed Care Organization (MCO) accounts that remain open for thirty (30) calendar days from the date of submission or resubmission will require a follow-up phone call. These accounts will follow a thirty (30) calendar day phone follow-up schedule until account resolution.

5.3.21.All commercial accounts that remain open for thirty (30) calendar days from the date of submission or resubmission will require a follow-up phone call. These accounts will follow a thirty (30) calendar day phone follow-up schedule until one hundred and twenty (120) calendar days from original submission to the carrier. In the event that the account remains unresolved for one hundred and twenty (120) calendar days

Page | 11Revised 08.26.2026 from the date of the original submission to the carrier the account will then be automatically transferred to self-pay.

5.3.22.The vendor should check to see if all procedures listed on insurance claims sent out by the hospitals also appear on the statement received from the insurance company. Similarly, all codes included in the claim must also appear identical in the insurer’s payment transaction. If all procedures match, and the codes for these procedures are identical, the medical biller reviews the payments for each procedure. Each payment should be in accordance with the contract between healthcare provider and payer.

5.3.23.If the insurance provider opted not to pay for certain procedures, these unpaid charges should be explained in full. If the insurance provider decides not to cover the entire bill, the vendor will determine if there is a secondary insurance available for the patient. If the patient is covered by additional insurance plans, the vendor will submit a claim for the remaining bill to the secondary payer. If the claim is denied and requires correction, the correction shall be made and resubmitted in a timely manner using the denial management system.

5.3.24.If the procedures and codes listed in the insurance provider’s transaction report match those sent by the hospital, all charges are compliant with the financial agreement between both parties, and the healthcare provider has received appropriate reimbursements for their medical services, these payments and adjustments are then posted to the patient’s account.

5.3.25.If the patient fails to pay a bill in the required timeframe, the vendor is responsible for following up with the patient and handling any additional billing issues. If the balance remains unpaid beyond one hundred and twenty (120) calendar days, a collections process is initiated in order to receive reimbursement for the overdue bill.

5.3.25.1. Vendor is responsible for mailing three (3) monthly letters requiring payment or offering a payment arrangement. If no payment or payment arrangement is made, the vendor will be responsible for initiating the collection process with phone calls and letters for each facility.

Page | 12Revised 08.26.2026

5.3.26.Vendor shall rectify and document any issue preventing the claim from being paid in a timely manner and provide a monthly report to the facility explaining why the claim was not paid due to timely filing.

5.3.27.Vendor shall document in RCM system notes all activities performed on the account so DHF and others can determine the progression of activities, issues encountered, who was contacted, discussions about the account, attempts at collections, and all other activity that documents account activity.

5.3.28.Vendor shall be responsible for verifying all charges, to include the late charges are posted automatically by the facility, that they are correct before billing to eliminate late charges.

5.3.29.Vendor shall be responsible for billing late charges immediately with correct claim to insurance and submit a monthly report to the facility that documents late charges and the date the billed or adjusted.

5.4.Upon award of the contract, the vendor will review all claims that have not been previously billed, denials received from payers in the past year and claims the facility has identified as bad debt to determine which of those claims should be billed or rebilled for the purposes of recovering any unpaid revenues.

5.5.Vendor shall process payments and adjustments to include:

5.5.1. Utilizing DHF’s electronic billing system.

5.5.2. Vendor shall accept payment from any patient that calls regarding their account or wants to pay using DHF payment systems provided. In the case payment systems are not available, patients will be referred to the hospital’s billing department.

5.5.3. Ensuring all payments are remitted for processing.

5.5.4. Adjusting for any and all contractual allowances and client approved adjustments, as well as any and all subsequent billings, to be completed within five (5) business days of receipt.

Page | 13Revised 08.26.2026

5.5.5. Processing any and all credit balances within five (5) business days. All payers that accept a voided claim or a notice of take back will have one submitted directly to the payer. All other refunds will be prepared by the vendor with the paperwork and supporting documentation submitted to facilities for refund processing.

5.5.6. Utilizing the facility policies and procedures for

administering uncollectible accounts. Vendor shall report monthly to the facility of all uncollectable accounts.

5.5.7. If any discrepancies are found in the transaction and a payer denial is received, the vendor must enter into an appeal process via the Denial Management system/or manually. The vendor will submit the first level of appeal. If the first level of appeal is denied by the insurance provider, then a second appeal must be submitted by the hospital. The vendor will ensure that the hospitals receive the maximum appropriate reimbursement as agreed upon between the hospitals and the payer.

5.5.8. Vendor shall monitor the Day End Reports to determine the work necessary to be performed daily to expedite the movement of claims to the clearinghouse that includes, but is not limited to, all work queues, suspended claims, credit balances, bill holds, zero pay report, etc.

5.5.9. Vendor shall provide the industry rate First-Pass Resolution Rate target of 92-95% and use an automated eligibility verification wherever possible.

5.5.10.Vendor shall ensure all claims are accurate and bill all claims within ten (10) calendar days of discharge for both inpatient and outpatient claims if documentation is complete.

5.6.Vendor shall provide monthly quality assurance services to include:

5.6.1. Reviewing documents and utilizing coding compliance

knowledge to identify inefficient documentation and coding quality deficits.

5.6.2. Reviewing and validating coding methods.

Page | 14Revised 08.26.2026

5.6.3. Assisting in developing key performance indicators for overall coding and billing accuracy and productivity.

5.6.4. Maintaining a 98% level of accuracy for all coding and billing services using inter-rater reliability practices or other agreed upon processes.

5.6.5. Performing routine, probe, validation and focused audits of coding and billing activities.

5.6.6. Collaborating with hospital staff to design effective

corrective action to achieve ongoing compliance.

5.6.7. Assisting in the resolution of provider reimbursement

configuration or claim payment issues.

5.6.8. Implement daily cash reconciliation between clearinghouses, bank deposits, and RCM systems.

5.6.9. Providing technical assistance to the facilities for configuring coding within the State’s systems.

5.6.10.Providing updates and guidance on changes to Federal and State regulations impacting service provision.

5.6.11.Providing updates and guidance to DHF on hospital improvement requirements that are affecting claims and revenue.

5.6.12.Vendor must maintain a 94-97% or higher clean claim rate, which will be reported from the clearinghouse; the error rate shall be less than 11%; business days to submission must be ten

(10) business days or less. If these standards are not maintained, an improvement plan must be submitted on how the vendor plans to meet the requirements. If the clean claims rate and error rate are determined to be caused by provider errors or issues, the vendor will assist and educate providers on the corrections needed to accomplish.

5.7.Vendor must provide monthly reports by the 5th day of the subsequent month to include the following, but not limited to:

5.7.1. Itemized reports of all invoices and claims billed, monies collected and outstanding balances.

Page | 15Revised 08.26.2026

5.7.2. Report of all accounts that have been denied due to untimely filing, with an explanation of the billing delay or proof of timely filing.

5.7.3. An aging summary based on discharge date utilizing facility defined payer categories, and an aging breakdown of every 30 calendar days through 270 calendar days with the final category being greater than 270.

5.7.4. A collection/liquidity report.

5.7.5. A top 0 Denial categories report with root cause analysis.

5.7.6. A summary of payments received by payers, with prior

period comparisons.

5.7.7. Any additional reports that are necessary to accurately report on the account activity of the outpatient accounts receivable:

5.7.7.1. Cash forecasting projections for next 30/60/90 calendar days.

5.7.7.2. Variance analysis month over month and year over year.

5.7.7.3. Daily report package for real-time oversight.

5.7.8. Unbilled claims volume and gross charges.

5.7.9. First pass clean claims rate for paid claims.

5.7.10.Denial rate, resolution process and prospective avoidance processes.

5.7.11.Lag time analysis from date of documentation receipt to coding, charge entry, bill date, payment receipt date and payment posting date.

6. CONTRACT AWARD:

6.1.Contract Award: The Contract is intended to provide the Agency with a purchase price for the Contract Services. The Contract shall be awarded to the vendor that provides the Contract Services meeting the

Page | 16Revised 08.26.2026 required specifications for the lowest grand total cost as shown on the Pricing Pages.

6.2.Pricing Page: Vendor should complete the Pricing Page by WV DHF monthly collections estimate of 2,000,000.00 x Vendor Percentage for recovery which will equal the 12 monthly fees. The 12 monthly fees will then be multiplied by 12 to obtain the annual fee. Vendor should complete the Pricing Page in full as failure to complete the Pricing Page in its entirety may result in the vendor's bid being disqualified.

Vendor should type or electronically enter the information into the Pricing Page, see Exhibit A.

7. PERFORMANCE: Vendor and Agency shall agree upon a schedule for performance of Contract Services and Contract Services Deliverables, unless such a schedule is already included herein by Agency. In the event that this Contract is designated as an open-end contract, the vendor shall perform in accordance with the release orders that may be issued against this Contract.

8. PAYMENT: Agency shall pay Monthly or Annual Fee, as shown on the Pricing Pages, for all Contract Services performed and accepted under this Contract. A 2% reduction in payment fees will be charged based on the SLA achievement falling below 94%. Vendor shall accept payment in accordance with the payment procedures of the State of West Virginia.

9. TRAVEL: Vendor shall be responsible for all mileage and travel costs, including travel time, associated with performance of this Contract. Any anticipated mileage or travel costs may be included in the flat fee or hourly rate listed on vendor’s bid, but such costs will not be paid by the Agency separately.

10.FACILITIES ACCESS: Performance of Contract Services may require access cards and/or keys to gain entrance to Agency’s facilities. In the event that access cards and/or keys are required:

10.1. Vendor must identify principal service personnel which will be issued access cards and/or keys to perform service.

10.2. Vendor will be responsible for controlling cards and keys and will pay a replacement fee, if the cards or keys become lost or stolen.

Page | 17Revised 08.26.2026

10.3. Vendor shall notify the Agency immediately of any lost, stolen, or missing card or key.

10.4. Anyone performing under this Contract will be subject to Agency’s security protocol and procedures.

10.5. Vendor shall inform all staff of Agency’s security protocol and procedures.

11.VENDOR DEFAULT:

11.1.The following shall be considered a vendor default under this Contract.

11.1.1.Failure to perform Contract Services in accordance with the requirements contained herein.

11.1.2.Failure to comply with other specifications and requirements contained herein.

11.1.3.Failure to comply with any laws, rules, and ordinances applicable to the Contract Services provided under this Contract.

11.1.4.Failure to remedy deficient performance upon request.

11.2.The following remedies shall be available to the Agency upon default.

11.2.1.Immediate cancellation of the Contract.

11.2.2. Immediate cancellation of one or more release orders issued under this Contract.

11.2.3.Any other remedies available in law or equity.

Page | 18Revised 08.26.2026

12.MISCELLANEOUS:

12.1.Contract Manager: During its performance of this Contract, the vendor must designate and maintain a primary contract manager responsible for overseeing vendor’s responsibilities under this Contract. The Contract manager must be available during normal business hours to address any customer service or other issues related to this Contract. Vendor should list its Contract manager and his or her contact information below.

Contract Manager: ______________________ Telephone Number: ________________________ Fax Number: ______________________________ Email Address: ____________________________

Page | 19Revised 08.26.2026

File details come from the government source that posted it. Updated .