Final_ 01 May 26_RFI, Revenue Cycle Modernization.docx

720-5247, RFI, Revenue Cycle Modernization

1220 Bank Street Richmond, Virginia 23218

REQUEST FOR INFORMATION (RFI) 720-5247

FOR:

Revenue Cycle Modernization

NOTE: To the extent allowed by law, this public body does not discriminate against faith-based organizations in accordance with § 2.2-4343.1 of the Code of Virginia, or against a bidder or offeror because of race, religion, color, sex, national origin, age, disability, sexual orientation, gender identity or expression, political affiliation, or status as a service disabled veteran or any other basis prohibited by state law relating to discrimination in employment.

DBHDS is committed to increasing procurement opportunities for small, women-owned, and minority-owned (“SWaM”) businesses.

TABLE OF CONTENTS

INTRODUCTION

The intent of this Request for Information (“RFI”) is solely to gather information; it is not a formal procurement. Information received may be used for informational and planning purposes. Nothing in this RFI should be construed as an intent, commitment, or promise to solicit or procure a solution. Responding to the RFI is not a pre-requisite to submit a proposal for any subsequent procurement should a formal solicitation be issued. Respondents should not provide any confidential or proprietary information. Information submitted in response to this RFI will become the property of the Commonwealth of Virginia.

DBHDS and the Commonwealth of Virginia will not pay for any information herein requested and provided by Supplier. DBHDS and the Commonwealth of Virginia will not be liable for any costs incurred by the Supplier related to this RFI. All such costs are the Supplier’s sole responsibility. DBHDS is not at this time seeking proposals and will not accept unsolicited proposals.

Following receipt and review of the RFI responses, DBHDS may contact a respondent(s) to schedule a one-on-one meeting to gain additional understanding and/or obtain further clarification of the respondent’s response to the RFI. Submitting a response to the RFI is a prerequisite for participation in the one-on-one meeting.

PURPOSE

On behalf of the Commonwealth of Virginia, the Department of Behavioral Health & Developmental Services (DBHDS) is seeking information from the marketplace to assess available options and guide decision‑making related to replacing its current Revenue Cycle Management (RCM) system with a solution capable of supporting the unique clinical, regulatory, and financial complexities of a psychiatric care environment.

A major goal of DBHDS is to provide a modern, efficient, and integrated revenue cycle environment that supports accurate billing, improves operational workflows, enhances financial transparency, and ensures compliance with federal and state requirements across all DBHDS facilities.

For the purposes of this RFI, DBHDS defines a Revenue Cycle System as a comprehensive, configurable solution that supports end‑to‑end revenue cycle processes including patient registration, eligibility verification, documentation integration, charge capture, claims management, payment posting, accounts receivable management, and reporting while fully integrating with the existing Electronic Health Record (EHR) system and accommodating the unique clinical and billing environments across DBHDS facilities.

Goals and Objectives DBHDS is interested in learning about current industry/marketplace solutions for the following goals and objectives:

· Providing tools that streamline workflows, reduce manual processes, improve data quality, and support automation of revenue cycle functions such as eligibility checks, charge capture, and claim edits.

· Implementing a Revenue Cycle System that:

· Maximizes revenue capture by ensuring all billable services are accurately coded, documented, and submitted without delay.

· Reduces claim denials by minimizing coding errors, missing authorizations, and eligibility gaps that result in payer rejections or write-offs.

· Reduces Days in Accounts Receivable (A/R) by accelerating claim follow-up and payment posting to improve cash flow.

· Automate manual processes, including eligibility verification, prior authorization tracking, and claim scrubbing to reduce administrative burden and human error.

· Standardize processes to create repeatable, auditable workflows that perform consistently across departments and service lines.

· Ensure coding accuracy by applying correct ICD-10, CPT, and HCPCS codes that fully and precisely reflect services rendered.

· Is compliant with federal and state Accessibility Standards

· Maintain regulatory compliance with CMS guidelines, HIPAA requirements, and payer-specific billing rules.

· Support audit readiness by maintaining complete, organized documentation trails for both internal reviews and external audits.

· Reduce billing disputes by getting claims right the first time, minimizing friction between patients and payers.

· Provide actionable reporting through dashboards that surface denial trends, payer performance, aging balances, and staff productivity

· Integrate with clinical systems by connecting directly to EHR data to eliminate redundant data entry and improve charge capture accuracy.

· Integration with existing agency systems

· Modern, scalable architecture for inpatient psychiatric care, long-term care (LTC), and residential care settings across the enterprise.

· Configuration-first approach to minimize customization and technical debt; system should meet needs with minimal customization and reflect vendor understanding of behavioral health

· Enterprise identity/access management integration; Active Directory/Single Sign-On (SSO).

· User Interface (UI) consistency; in-app guidance; training aids; onboarding support; multilingual and accessible UI.

· Support for backend databases or regular structured data extracts for data analysts (tabular, query formats).

ORGANIZATION OVERVIEW

DBHDS’s Mission and Vision

MISSION: Supporting individuals by promoting recovery, self-determination, and wellness in all aspects of life.

VISION: A life of possibilities for all Virginians.

DBHDS operates twelve facilities, including eight behavioral health facilities for adults, a training center, a psychiatric facility for children and adolescents, a medical center, and a center for behavioral rehabilitation.

PRESENT SITUATION

DBHDS operates eight behavioral health hospitals and one adolescent behavioral health facility. All facilities are accredited, though not all are certified for Medicare and/or Medicaid billing. DBHDS also operates one Intermediate Care Facility (ICF) for individuals with intellectual and developmental disabilities, as well as a Medical Center that includes a skilled nursing facility, a long-term care medical facility, and a rehabilitation facility for individuals requiring extended recovery services.

Each DBHDS facility provides varying levels of care. For example, one hospital delivers acute psychiatric services, nursing facility care, and a unique level of long‑term treatment for clients who are not acute and do not meet nursing‑facility eligibility criteria. This specific category of long-term care is often not covered by third‑party insurance. Billing practices across facilities also vary by provider type, such as medical, psychiatric, ancillary, and diagnostic services, which are not billed uniformly.

DBHDS is governed by Article 2, §37.2‑715 through §37.2‑721 of the Code of Virginia, which requires that payment for each client’s stay be based on the individual’s or liable party’s ability to pay. In addition, DBHDS facilities are classified as Institutions of Mental Disease (IMDs), which are subject to federal restrictions on billing Medicaid Managed Care Organizations.

To support these operational and regulatory needs, DBHDS seeks to procure a new Revenue Cycle System that fully integrates with its Electronic Health Record (EHR) system and supports all revenue cycle processes across DBHDS facilities. The current system provides registration, bed management, census tracking, claims processing, accounts receivable, and reporting. The goal of this procurement is to implement a modern solution that maintains these capabilities while improving and expanding revenue cycle functionality in alignment with DBHDS data governance and information security standards.

QUESTIONS

Overview of a Solution

1. Please identify by name and then describe the available products and service offerings for a Revenue Cycle Modernization solution.

Enter your response here, enlarging the box as needed. Reference any attachments.

Revenue Cycle System Functionality Priority 1 (Must Have)

1. Please explain how your system can accommodate the assignment of various charges to multiple units within multiple facilities. Is your system able to assign per diem charges and all-inclusive ancillary charges?

Enter your response here, enlarging the box as needed. Reference any attachments.

2. Provide a high-level description of your organization’s overall security posture, including your governance model, alignment to recognized security frameworks (e.g., NIST, ISO 27001, SOC 2), and how security responsibilities are structured across your organization. Please include any considerations specific to environments that handle PHI or integrate with clinical systems.

Enter your response here, enlarging the box as needed. Reference any attachments.

3. How does your system handle per diem billing for inpatient psychiatric stays? Describe the logic for selecting the appropriate billing methodology.

Enter your response here, enlarging the box as needed. Reference any attachments.

4. How does your platform manage pre-registration and demographic verification for both scheduled admissions and emergency/crisis walk-in patients?

Enter your response here, enlarging the box as needed. Reference any attachments.

5. Describe how your proposed system can be integrated with other EHR systems.

Enter your response here, enlarging the box as needed. Reference any attachments.

6. Does your solution integrate with state-mandated involuntary commitment tracking systems or crisis bed registries?

Enter your response here, enlarging the box as needed. Reference any attachments.

7. Can the application meet Web Content Accessibility Guidelines (WCAG) 2.0 AA standards for Information and Communication Technology?

Enter your response here, enlarging the box as needed. Reference any attachments.

Priority 2 (Required)

8. Describe real-time eligibility verification capabilities. Which clearinghouses and payers are directly connected for behavioral health benefits? What is your average eligibility verification turnaround time? Do you offer a clearinghouse that supports claims processing?

Enter your response here, enlarging the box as needed. Reference any attachments.

9. How does your platform handle patients covered under behavioral health managed care organizations (BH MCOs) that are separate from medical MCOs?

Enter your response here, enlarging the box as needed. Reference any attachments.

10. Describe your process for identifying and managing dual-eligible (Medicare/Medicaid) psychiatric patients, including coordination of benefits workflows.

Enter your response here, enlarging the box as needed. Reference any attachments.

11. Describe your workflow for psychiatric inpatient admissions. How are urgent/emergent admissions handled within the process?

Enter your response here, enlarging the box as needed. Reference any attachments.

12. Do you have capabilities for electronic prior authorization transactions or payer portal automation for behavioral health?

Enter your response here, enlarging the box as needed. Reference any attachments.

13. Describe your Clinical Documentation Integrity (CDI) capabilities specific to psychiatric diagnoses, including DSM-5 alignment, principal diagnosis sequencing, and comorbid condition capture.

Enter your response here, enlarging the box as needed. Reference any attachments.

14. Describe your ICD-10-CM coding expertise for psychiatric disorders. Do you employ AHIMA-credentialed coders (CCS, RHIA, RHIT) with dedicated behavioral health coding experience?

Enter your response here, enlarging the box as needed. Reference any attachments.

15. How do you stay current with CMS IPPS/OPPS updates, Psychiatric PPS changes, and behavioral health billing guideline revisions?

Enter your response here, enlarging the box as needed. Reference any attachments.

16. Describe your claim scrubbing process for psychiatric hospital claims. What edit libraries are used? How are behavioral health-specific claim errors addressed?

Enter your response here, enlarging the box as needed. Reference any attachments.

17. Describe your process for UB-04 claim preparation, including proper use of psychiatric-specific revenue codes.

Enter your response here, enlarging the box as needed. Reference any attachments.

Technical

1. What level of customization is required to implement the solution?

Enter your response here, enlarging the box as needed. Reference any attachments.

2. What features are available in the solution that interface or integrate (bi-directional communication) with other tools and technologies, and would this occur in real-time (or near real-time), or at specified intervals?

Enter your response here, enlarging the box as needed. Reference any attachments.

3. What technologies does the solution support for integration with third-party Enter your response here, enlarging the box as needed. Reference any attachments.

4. Would any part of the solution require the use of third-party modules or components (e.g., business intelligence software, or a dashboard/reporting engine)? If yes, please describe, and would the third-party modules or components require a separate paid License?

Enter your response here, enlarging the box as needed. Reference any attachments.

5. Please provide a general overview of the solutions’ approach to security (architecture and controls - physical, functional, data, etc.).

Enter your response here, enlarging the box as needed. Reference any attachments.

6. Describe any capabilities the solution allows for segregating sensitive data from non-sensitive data to include record level as well as field/column-level segregation record-levels.

Enter your response here, enlarging the box as needed. Reference any attachments.

7. How scalable is the solution for handling multiple customers’ business requirements and combining multiple business processes?

Enter your response here, enlarging the box as needed. Reference any attachments.

8. What skills (rudimentary and specialized, if any) are required to implement the solution?

Enter your response here, enlarging the box as needed. Reference any attachments.

9. What resource utilization is required for ongoing operations and maintenance of the solution? (e.g., Systems Engineer - 50%, Applications Manager – 100%, etc.)

Enter your response here, enlarging the box as needed. Reference any attachments.

10. Describe the type and duration of training required to implement and maintain the solution.

Enter your response here, enlarging the box as needed. Reference any attachments.

Deployment Options

1. Which deployment options are normally offered for such a solution? Please describe, including how solution upgrades are handled.

(Check all that apply, and describe)

Licensed (Hosted by/at DBHDS)

Software-as-a-Service (SaaS)

Managed Service (Describe the particular “flavor(s)” offered)

Outsourcing

Hybrid or Other (Describe)

2. What pricing models or methodologies (i.e., which pricing approaches or structures are normally offered for this type of solution (flat fees, charges per module or sub-system, per order, per transaction, per seat, etc.)?

Implementation and Support

1. How long does implementation of a basic solution generally take? How long can a solution with customization/integration take (best case to worst case)? How long does implementation of changes or enhancements generally take?

Enter your response here, enlarging the box as needed. Reference any attachments.

2. Based on your experience in responding to solicitations for this type of solution, are there areas where organizations should take special care to ensure a Request-for-Proposals (RFP) is clear, complete, or otherwise optimized to obtain the best possible proposals?

Enter your response here, enlarging the box as needed. Reference any attachments.

3. Please provide details about the Post Implementation Support Capability that you have?

Closing

1. What else should we know about your solution?

Enter your response here, enlarging the box as needed. Reference any attachments.

2. Please provide your company’s contact information.

Company Name

Company Mailing Address

Company Website Address

Name of Contact Person

Contact Person E-mail Address

Contact Person Telephone #

How many years has your organization provided RCM services specifically to freestanding psychiatric hospitals or dedicated behavioral health facilities?

Provide the total number of current clients. How many freestanding psychiatric hospitals are? How many are multi-site behavioral health systems?

List of all relevant certifications, accreditations, or industry memberships (e.g., HFMA Peer Reviewed, CAQH CORE Certified, SOC 2 Type II, HITRUST).

3. Is your company interested in being notified when a solicitation – Request for Proposal – is issued? (Reminder: Participation in the RFI process is not a requirement to submit a response to the Request for Proposal.

SUBMISSION INSTRUCTIONS

Electronic Responses Will Be Received Until Monday, June 1, 2026 at 11am, local prevailing time.

If any supplier has questions about the RFI, questions shall be emailed to Krysten Wilson at krysten.wilson@dbhds.virginia.gov. Krysten Wilson is the single point of contact for this RFI.

DBHDS will only accept responses to this RFI electronically through eVA. Responses will be received until the closing date and time specified above. It is the respondent's responsibility to ensure that responses are received timely. The eVA system allows for the secured and sealed electronic submission of responses. Respondents shall make no other distribution of the response. Responses submitted elsewhere, including to other state or federal agencies, will not be accepted. Mailed, faxed, or emailed responses will not be accepted.

Respondents’ response to this RFI must include the following:

1. The responses should:

a. Be submitted on company letterhead that includes the company mailing address and website address.

b. Include a representative’s name, address, email address, and telephone number.

c. Be signed by a company representative.

d. Be dated.

2. A detailed cost estimate.

Respondents must be registered in eVA in order to submit an electronic response. For more information on how to respond:

If a Supplier needs assistance submitting an electronic response, the Supplier must contact eVA Customer Care prior to the closing date and time. The contact information for eVA Customer Care is located at www.eva.virginia.gov under the “Get Help-Customer Care” tab.

CONFIDENTIALITY/FREEDOM OF INFORMATION/RIGHTS RESERVED

The Virginia Freedom of Information Act, § 2.2-3700, the Code of Virginia, guarantees citizens of the Commonwealth and representatives of the media access to public records held by public bodies, public officials, and public employees. All materials submitted by the respondent shall be handled in accordance with the Freedom of Information Act and any other laws and regulations applicable to the disclosure of documents submitted under this RFI. In no event shall DBHDS, the Commonwealth, or any of their agents, representatives, consultants, directors, officers, or employees be liable to a respondent for the disclosure of any materials or information submitted in response to this RFI that is not properly marked Confidential, as specified below.

DBHDS may disclose the contents of all responses to this RFI, except the parts that may be treated as exempt or excluded in accordance with the Freedom of Information Act. Each respondent, by submitting a response to this RFI, consents to such disclosure and expressly waives any right to contest such disclosure under the Freedom of Information Act.

If a respondent has special concerns about information that it desires to make available to DBHDS but which it believes constitutes a trade secret, proprietary information, or other information exempted from disclosure, such respondent shall specifically and conspicuously designate that information by placing

“CONFIDENTIAL” in the header or footer of each such page affected, and in a separate letter, explain why that material should be exempt from public disclosure. Blanket designations that do not identify the specific information shall not be acceptable and may be cause for DBHDS to treat the entire response as public information. DBHDS will not advise a submitting party as to the nature or content of documents entitled to protection from disclosure under the Freedom of Information Act or other applicable laws, as to the interpretation of such laws, or as to the definition of trade secret. The provisions of the Freedom of Information Act or other laws shall control in the event of a conflict between the procedures described above and the applicable law.

Thank you for responding to this Request for Information.

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