RFP S-44300-00010245 RFP Laboratory and Collection Services- Agency Formal.docx

State of Oregon

Cover Page Oregon Health Authority Is issuing this Request For Proposals (RFP) under OregonBuys Bid Number S-44300-00010245 for Laboratory and Collection Services Date of Issue: October 17, 2025 Closing Date and Time: November 14, 2025 at 3pm (Pacific Time)

The State of Oregon promotes equal opportunity for all individuals without regard to age, color, disability, marital status, national origin, race, religion or creed, sex or gender, sexual orientation, or veteran status.

Table of Contents

GENERAL INFORMATION

INTRODUCTION

The State of Oregon, acting by and through the Oregon Health Authority, (“Agency” or “OHA”), is issuing this Request for Proposal (“RFP”) for proposals from qualified Proposers to provide laboratory billing and collection services as listed in the Scope of Services. Services will include laboratory billing to Medicaid, Medicare, Oregon Coordinated Care Organizations (CCOs), third party Payers, and Submitters. Submitters may include medical clinics, hospitals, local public health authorities, and others who send specimens to OSPHL for testing. All persons or firms submitting Proposals are referred to as Proposers in this RFP; after execution of the Contract, the awarded Proposer will be designated as Contractor. The scope of the Contractor services and deliverables for the Contract are described in the Scope of Services. The Agency and awarded Proposer will negotiate the final Statement of Work to be included in the Contract.

Additional details on the Scope of the services are included in the Scope of Services section.

Agency anticipates the award of one (1) Contract from this RFP. Attachment A provides a sample contract that Proposers may review, with negotiable items identified below in Section 5.4.1. The initial term of the Contract is anticipated to be 5 years with an option to renew at Agency’s discretion.

SCHEDULE

The table below represents a tentative schedule of events. All times are listed in Pacific Time. All dates listed are subject to change. Changes to dates will be modified by Amendment to the RFP.

RFP Protest Period Ends

7 calendar days prior to RFP Closing

SINGLE POINT OF CONTACT (SPC)

The SPC for this RFP is identified on the Cover Page, along with the SPC’s contact information. Proposer shall direct all communications related to any provision of the RFP only to the SPC, whether about the technical requirements of the RFP, contractual requirements, the RFP process, or any other provision.

AUTHORITY, OVERVIEW, AND SCOPE

AUTHORITY AND METHOD

Agency is issuing this RFP pursuant to its authority under Amendment 1, dated September 30, 2022, to Delegation Request No. REQ-10000-00020921 (the “Delegation of Authority”), DAS PS delegated to OHA authority to enter into contracts for information technology services for OHA-specific projects.

Agency is using the Competitive Sealed Proposals method, pursuant to ORS 279B.060 and OAR 125-247-0260. Agency may use a combination of the methods for Competitive Sealed Proposals, including optional procedures: a) Competitive Range; b) Discussions and Revised Proposals; c) Revised Rounds of Negotiations; d) Negotiations; e) Best and Final Offers; and f) Multistep Sealed Proposals.

DEFINITION OF TERMS

For the purposes of this RFP, capitalized words will refer to the following definitions.

General Definitions.

Capitalized terms not specifically defined in this document are defined in OAR 125-246-0110.

Project Specific Definitions.

Clean Claim Rate means the percentage of medical billing claims that process without rejection or error by the Payer and does not require manual processing for resolution.

Contract means the Contract awarded as a result of this RFP.

Contractor means the Proposer selected through this RFP to enter into a Contract with OHA to perform the Work.

CPT (Current Procedural Terminology) means terminology used for billing medical procedures including laboratory services.

Key Personnel or Key Persons means the person or persons on Proposer’s staff to be assigned to perform the Work under the Contract.

Office of Contracts and Procurement (OC&P) means the entity that is responsible for the procurement process for OHA.

OSPHL means Oregon State Public Health Laboratory.

Payer means a private or public medical insurance plan. Examples include but are not limited to Medicaid, Medicare, and private insurance plans.

Proposal means a written response submitted to OC&P in response to this RFP.

Proposer means the person or entity that submits a Proposal.

Submitter means a laboratory, local public health authority, or other facility that submits specimens to the OSPHL for testing services.

Work means the required activities, tasks, deliverables, reporting, and invoicing requirements, as described in Scope of Services of this RFP.

OVERVIEW AND PURPOSE

Agency Overview The Oregon Health Authority is at the forefront of lowering and containing costs, improving quality and increasing access to health care in order to improve the lifelong health of Oregonians. OHA is overseen by the nine-member citizen Oregon Health Policy Board working towards comprehensive health reform in our state.

The Oregon State Public Health Laboratory (OSPHL) has been actively protecting the public's health since 1903 by supporting state and local infectious disease control efforts, identify infants affected by specific medical conditions at birth in time to prevent impairment, and assuring the quality of testing in clinical and environmental laboratories.

The Communicable Disease testing program provides essential screening, diagnostic, and reference testing in general microbiology and virology/immunology. OSPHL supports testing and detection of over 50 types and subtypes of bacterial pathogens and over 40 types and subtypes of viral pathogens – a service that impacts patient treatment directly but also contributes to state and national surveillance of communicable diseases.

The Newborn Bloodspot Screening program at OSPHL performs screening tests for over 40 medical conditions and disorders for babies born in Oregon and New Mexico, as well as several Tribal nations and military bases. Through newborn bloodspot screening, potentially severe disorders can be caught early and treated, preventing developmental impairment or, in some cases, death.

OSPHL also includes the Oregon Laboratory Compliance section and the Oregon Environmental Laboratory Accreditation Program (ORELAP). These programs oversee laboratories (both clinical and environmental) to ensure that they are in compliance with federal and state regulations.

Project Overview and Background The OSPHL does not have the professional expertise to manage claims billing and collection in-house and therefore seeks a Contractor to perform the work. The OSPHL has submitted approximately 105,000 claim records to the current contractor providing these services for processing within the past year. The monthly average is 8,630 claim records, with as few as 7,500 claim records and as many as 9,600 claim records in a single month. Approximately 45% of claims were deemed not billable to Payers or Submitters based on the OSPHL billing rules and reports of these records provided to the OSPHL. Approximately 16% of records were billed to public and private Payers (Medicaid, Medicare, Oregon CCOs, and private insurance plans), and approximately 39% of records invoiced to facilities submitting specimens to the OSPHL. The percentage of claims to public and private Payers is expected to increase during the contract period.

Purpose The OSPHL seeks to contract for billing and claims management services. The Contractor will apply OSPHL billing rules to claim records and for electronic claim submission, claim rejection management, explanation of benefit (EOB) management, and related services as described in this RFP. Set up, installation, training, and maintenance services are anticipated to be included in this contract. All payments from billing and claiming activities must be accepted into an account held by the State of Oregon. The Contractor will be provided access to the associated bank lock box image files to view payments received and associated back-up documentation provided for payment posting. The Contractor will also be provided access to additional Payer databases as needed for necessary claims management activities. The Contractor must provide reports to the OSPHL as described in the Scope of Services.

SCOPE OF SERVICES

Objective: The objective is to procure billing and collection services that meet the specific requirements and fulfills the business needs of the Agency, including but not limited to the following activities.

Implementation, Planning, and Testing: The contract resulting from this RFP is anticipated to cover the implementation of the billing and collection services. Contractor shall configure and test its solution to ensure it performs to meet the business needs identified below. Additionally, successful Proposer’s Services must be fully available for use by agency no later than May 29, 2026. Examples of implementation activities will include the following but may not be all inclusive.

a. Provide OSPHL with a proposed project implementation plan, including specific activities to be completed and proposed timelines. Collaborate with OSPHL to modify as needed.

b. Define methods to log and track errors and defects identified during implementation and testing and to verify that they are corrected.

i. Defect levels will be agreed upon by Agency and Contractor.

ii. Defects are to be categorized Levels 1 through 4 in accordance with the Sample Contract in Attachment A.

c. Work with the State of Oregon to establish and test a secure file transfer protocol (sFTP).

i. Testing will be defined by the State of Oregon and will include but may not be limited to the transfer of non-patient data.

d. Build OSPHL Submitters, Payers, pricing lists and other data into Contractor data systems (Attachments I; Attachment J; Attachment K).

e. Build or code OSPHL billing rules (Attachment L) into Contractor data systems; test functionality of billing rules to ensure accurate billing and claims management.

i. Using non-patient data files, ensure the file parses correctly through the billing rules build to be filed as non-billable, billed to specific Payers, or billed to Submitters.

ii. Using non-patient data files, ensure that claims denied or with requested adjustments are re-billed correctly to Payers, submitters, and/or placed on OSPHL reports.

f. Establish electronic connections to third party Payers for electronic transmission of claims and remittance data.

i. Test functionality of bi-directional file transmission with Payers.

g. Obtain access to Payer portals and OSPHL bank account lock box.

h. Negotiate and determine the format of OSPHL Submitter invoice cover sheet and charges detail in alignment with the requirements in this Scope of Services.

i. Finalize format of reports to be delivered monthly to OSPHL as defined in this Scope of Services.

j. Establish phone, email and fax at Contractor offices to support customer service functions.

k. Establish standards for medical billing or public records requests with OSPHL staff.

i. Establish a communication mechanism for requests.

ii. Provide a primary and back-up point of contact for requests.

iii. Establish a standard record set to be provided to OSPHL for requests.

l. Meet with OSPHL committee or designee at least weekly to review progress toward implementation.

m. Collaborate with OSPHL and the current vendor to define a plan for data migration or cut-over if needed.

n. Document processes in standard operating procedures; share processes and procedures with OSPHL.

Stabilization Period: During this period, all Billing and Collection Services will be in place. The Contractor and Agency will actively monitor the implementation activities to ensure success and correct any challenges identified.

a. Meet with OSPHL committee or designee at least every other week to review Billing and Collection Services, review results, and develop solutions to any problems encountered.

b. Implement change management practices for problem resolution, including but not limited to:

i. Proactive communication with OSPHL regarding problems and status toward resolution.

ii. Reports to describe the scope of problems (e.g., number of Submitters, Payers, or claims affected; amount of revenue impacted).

iii. Active progress toward resolution of the problems.

iv. Collaboration with OSPHL to develop messages to Submitters to describe the challenges and progress toward resolution, if applicable.

v. Testing and implementation of solutions.

Ongoing Services - Billing and Collection Services:

a. Perform the following Billing tasks:

ii. Receive billing files from OSPHL in CSV format via secure File Transfer Protocol (sFTP) hosted by the State of Oregon. See Attachment I for example billing file header list.

iii. Perform screening for Medicaid or Coordinated Care Organization (CCO) enrollment with Oregon Medicaid when no coverage is provided to OSPHL. This currently involves sending a 270 file to Medicaid and receiving a 271 response file for eligibility.

iv. Coordinate and manage all claims submissions to Payers, payment posting, accounts receivables, and claims follow-up for both electronic and paper-based claims.

v. Establish and maintain necessary electronic connections with Payers to ensure appropriate claims submission and payment to OSPHL.

vi. Bill Payers, Submitters, and Patients using adjustments to the OSPHL usual and customary rate (UCR) based on OSPHL’s policy and billing rules.

A. Each Submitter is assigned a billing category, B through D, to determine the fees assessed for each test. See an example of this table in Attachment J.

B. OSPHL provides the billing vendor with a list of CPT codes and charges by billing category. A limited set of CPT codes with category charges is provided as an example in Attachment K.

C. OSPHL provides the billing vendor with a set of billing rules to apply to the billing file for appropriate billing. An example is provided in Attachment L.

b. Consolidate charges into an invoice summarizing charges for Submitters with outstanding balances.

I. Contractor shall provide Submitters with the option to receive invoices via US mail or secure email.

II. Invoices must include at least the following elements.

A. A cover sheet listing:

1) The total new and outstanding charges (separated and in total),

2) Contractor contact information (phone, email, fax),

3) Date of invoice,

4) Submitter location,

5) Invoice number.

B. A detail of charges applied to the invoice, both new and outstanding charges, separated as such. The invoice detail must provide the following elements.

1) Submitter information:

(i) Facility name,

(ii) OSPHL location number, address, phone number, and contract number with OSPHL (if applicable).

i. Note: Contract number can change over time.

2) Claim data:

(i) OSPHL specimen number,

(ii) Date of specimen collection

(iii) Patient name

(iv) Date of birth

(v) Medical record number (if supported by Proposer systems and provided by the Submitter)

(vi) CPT code or test name

(vii) Charge amount

(viii) Status code describing the reason the charge is on the invoice, if applicable. See Attachment L for more details about status codes.

c. Maintain the following billing and claim filing practices:

I. Bill and submit all charges within 5 business days of receipt of OSPHL billing files or Medicaid eligibility 271 files referenced in 2.4.1.3.a.iii above.

II. 95% Clean Claim Rate III. Follow Payers’ claim submission requirements.

IV. Process and submit claims according to Payer-specific timely filing, resubmission, and appeal deadlines.

d. Monitor claim submission timelines and notify OSPHL of noncompliance with claim submission or invoicing timelines.

e. Follow up on claim submission or invoicing as directed by OSPHL.

f. Maintain claims tracking records for six (6) full years plus the current year.

g. Bill all Payers for OSPHL, including but not limited to Oregon’s Coordinated Care Organizations (CCOs) and associated Payers or sub-plans.

h. Change billing rules as needed based on programmatic needs, including testing and stabilization of the changes.

i. Comply with applicable federal regulations, which may change from time to time, including, but not limited to: HIPAA, ICD-10, and HITECH Act. Ongoing compliance updates may be needed as laws change.

Collections

a. Post all payments within 5 business days of receipt.

b. Re-categorize claims appropriately after receiving payment/remit from the primary Payer and handle all secondary and tertiary billing.

c. Process and categorize denials and adjustments and rebill as appropriate, in accordance with OSPHL’s policies and billing rules. Rebilling may include adding adjusted claims to OSPHL’s monthly reports rather than billing to a payer. Examples are provided in Attachment L.

d. Maintain access to accounts held by OHA to retrieve payment and remittance files for payment and denial posting. Examples include but are not limited to: bank account lockbox, Payer portals.

e. Receive payments by credit card, entering payment information into a payment portal hosted by the Oregon Office of Financial Services on behalf of OSPHL.

f. Notify OSPHL of necessary refunds and overpayments within 5 business days of identifying the need for refund.

g. Reconcile posted payments monthly by the 3rd business day of the following month.

h. Notify OSPHL of problems resulting in claim denial trends within 7 calendar days of discovery; partner with OSPHL to find solutions. This includes monitoring for Submitter non-payment.

i. Upon notification from OSPHL, immediately suspend any invoicing or collection efforts on an account.

j. Monitor unpaid debts and/or claims and provide OSPHL with monthly reports showing outstanding debts 60 days from the date of claim. OSPHL will determine the appropriate follow-up needed.

k. Follow OSPHL’s instructions regarding whether a debt should be sent to collections agencies.

Customer Service Standards

a. Provide customer service by email and toll-free phone line, from 8:00am-5:00pm Monday-Friday Pacific Time, except State of Oregon holidays and business closure days (e.g., New Year's Day, Martin Luther King Day, Presidents Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veterans Day, Thanksgiving Day, the day after Thanksgiving, and Christmas Day).

b. Provide a HIPAA-secure fax line for transmission of documentation.

c. Provide a central email address with an option for secure email to be used for replies to Submitter questions or inquiries.

d. Multiple Contractor staff members must be able to access the central email address, phone, and fax records to provide for redundancy.

e. Reply to Submitter inquiries with initial acknowledgement within 24 working hours of the inquiry. Resolution will be provided within 72 working hours of the inquiry.

I. If the inquiry identifies a larger scale problem with the project, timelines will defer to the appropriate area of the Scope of Services or Contract. Status will be provided to the Submitter by Contractor or Agency.

f. Provide a mechanism for complaint management process and procedures, including reporting of complaints to OSPHL.

g. Provide bilingual staff or translation services, or have these services available upon request. (English/Spanish minimum required; Availability of Vietnamese, Chinese, Russian, and Korean preferred; additional language access welcome)

h. Record all Customer Service calls and make these records available to OSPHL for review upon request.

i. Retain recordings of customer service calls for 1 full year plus the current year.

j. Coordinate with OSPHL staff, Payers, and/or patients to reconcile billing discrepancies.

Reporting: Provide detailed reports to monitor billing and collection progress. All reports shall include definitions and the dates on which the reports are being pulled (e.g., date of service, date of payment posting). Date on which reports can be pulled shall be negotiated with Agency and Proposer.

Reports must include, but are not limited to:

a. Monthly reports including:

i. Summary of claims billed including charges, adjustments, and payments.

ii. Summary of total charges, refunds, adjustments, and payments by month.

iii. CPT code units charged, paid, and adjusted by month, and totaled for the Fiscal Year.

iv. Payer analysis, showing charges, payments, adjustments, remaining balance, and payment percentage for the Fiscal Year by Payer.

v. Medicaid and Coordinated Care Organizations aging report, showing current claims, and outstanding claims based on billed date at key timing intervals.

vi. Commercial Payer aging report, showing current claims, and outstanding claims based on billed date at key timing intervals.

vii. Submitter analysis, showing charges, payments, adjustments, remaining balance, and payment percentage for the Fiscal Year by Submitter.

viii. Submitter aging report, showing current claims, and outstanding claims based on billed date at key timing intervals.

ix. Summary aging report showing Submitter, Medicaid, and Commercial Payer total current claims, and outstanding claims at key timing intervals.

x. Categorization of claim denial reasons by month.

xi. Status codes report showing claims not billed to Payers or Submitters and therefore instead charged to public health grants.

xii. Clean Claim Rate report by Payer by month.

xiii. Other reports as needed or requested.

b. Other reports as needed or requested.

Other Related Services:

c. Communicate with OSPHL about and release records to OSPHL for billing records requests or public record requests:

i. Acknowledge requests for such records from OSPHL within 48 business hours of request.

ii. Release patient billing records to OSPHL for medical billing or public records requests within 5 business days of request.

iii. Refer Submitters, Payers, or patients requesting such records to OSPHL for complete recordkeeping of the request.

iv. The procedures for requesting and releasing records will be established during implementation.

d. Establish and maintain necessary electronic interfaces to complete the functions described in this scope of services. Electronic transmission of claims, remittance, and claims tracking data with Payers is preferred.

e. During the contract period, Agency anticipates changing Laboratory Information Management Systems, which may change the format of the file exported to the Proposer. Agency will make its best reasonable attempts to minimize impacts to the project. Proposer will be expected to ensure implementation, planning, testing, and stabilization are completed successfully with the Agency.

Ongoing Support: The anticipated contract will also encompass ongoing support for the Billing and Collection Services detailed above. This includes maintenance, updates, troubleshooting, and any necessary enhancements or modifications to ensure the service operates smoothly.

a. Provide proactive analysis and communication related to all billing and collections issues.

b. Meet with OSPHL committee or designee at least monthly after implementation thereafter to review results and develop solutions to any problems encountered.

c. Establish and maintain key performance measures for claims submissions, posting, accounts receivables, Net Collection Percentage, bad debt rates.

d. Ensure compliance with all applicable laws and standards, including any necessary billing changes.

e. Provide adequate staffing to ensure the services are performed as defined.

f. Modify billing rules and associated logic or other processes as public health grants or operational needs change.

Laboratory Medical Billing Consultation (Optional)

1. If Contractor elects, Contractor shall provide staff trained to consult on medical coding and billing.

g. During Implementation Phase, Agency will provide testing methods used to the person(s) in the consultant role(s). Consultant will help Agency assign the most current and appropriate CPT coding for review and acceptance for use in the billing process.

h. Contractor will conduct an annual coding update review against PHL methods, billing procedures, and guidelines.

i. Contractor will be available as needed to answer questions for Agency staff regarding testing method changes and related CPT coding guidance.

j. Contractor will help support any needed communications or messages to Agency Submitters regarding medical coding and billing practices as they relate to OSPHL services.

PROCUREMENT REQUIREMENTS AND EVALUATION

MINIMUM SUBMISSION REQUIREMENTS

Round 1 Proposal Submissions To be considered for evaluation, Proposal must contain each of the following elements (further detailed in Proposal Requirements section below):

1. Proposer Information and Certification Sheet (Attachment C)

2. Executive Summary

3. Proposer’s Organization Profile

4. Experience and Capabilities

5. Key Persons, Organizational Chart, Subcontractors

6. Scope of Services Approach

7. Project Samples

8. Security Statement

9. Value Added Services

10. Price Proposal (Attachment E)

11. Underlying Agreements

12. Affidavit of Exemption from Disclosure (Attachment B) – submit 1 copy only

13. Certified Disadvantaged Business Outreach Plan (Attachment F) – If applicable, submit 1 copy only

14. Responsibility Inquiry (Attachment G) - submit 1 copy only Proposal Page Limits Proposal is not limited by the number of pages.

Proposal Format and Quantity

1. Proposal should follow the format and reference the sections listed in the Proposal Requirements section. Responses to each section and subsection should be labeled to indicate the item being addressed.

2. OregonBuys Electronic Response. Proposer must submit its Proposal electronically through OregonBuys. Proposer should follow the procedures outlined in Section 4.6 for electronic submission.

3. Proposer shall submit one copy of its Proposal and all other submittal requirements, with Attachment C Proposer Information and Certification Sheet bearing the Proposer’s authorized representative’s Signature, in one of the following formats: Adobe Acrobat (pdf), Microsoft Word (docx), or Microsoft Excel (xlsx). If Proposer believes any of its Proposal is exempt from disclosure under Oregon Public Records Law (ORS 192.311 through 192.478), Proposer shall complete and submit the Disclosure Exemption Affidavit (Attachment B). Proposer shall also mark as “Confidential” in OregonBuys all attachments to its Proposal that Proposer believes are exempt from disclosure.

Authorized Representative Failure of the authorized representative to sign the Proposal may subject the Proposal to rejection by Agency.

ROUND 1 PROPOSAL REQUIREMENTS

Proposal must address each of the items listed in this section and all other requirements set forth in this RFP. Proposer shall describe the Services to be performed. A Proposal that merely offers to provide the services as stated in this RFP may be considered non-Responsive to this RFP and will not be considered further.

Proposal should not include extensive artwork, unusual printing or other materials not essential to the utility and clarity of the Proposal. Do not include marketing or advertising material in the Proposal. Proposal should be straightforward and address the requests of the RFP. Proposal containing excess marketing or advertising material may receive a lower evaluation score if specific information is difficult to locate.

ADMINISTRATIVE PROPOSAL

Proposer Information and Certification Sheet (Required, Not Scored) Proposer shall complete and submit the Attachment C (Proposer Information and Certification Sheet).

Failure to demonstrate compliance with Oregon Tax Laws and sign the Proposer Information and Certification Sheet (Attachment C) may result in a finding of non-Responsibility.

Executive Summary (Required, Scored) Proposer shall submit a comprehensive, succinct Executive Summary that summarizes the proposed required services. The summary must not exceed three pages. Proposers are to summarize:

k. Distinctive features of the services, and how the services will fulfill the State’s requirements.

l. Any pertinent or unique features of their organization, project management approach, or approach to the services.

m. Details of any subcontracting relationships and the value of each subcontract to the services.

n. Potential single points of failure in the proposed services.

Proposer’s Organization Profile (Required, Scored) Proposer must provide a profile of its organization. This is Proposer’s opportunity to give an overview of its organization, describe the structure of its business, and discuss how the organization can effectively deliver the Services described in this RFP. The Profile must include at a minimum:

o. Ownership. If incorporated, the state in which the organization is incorporated and the date of the incorporation;

p. Location of the organization’s offices (headquarters and branches);

q. Number of employees located in the United States and internationally;

r. Location of the office from which employees will be assigned to work on the project for the Agency;

s. Established business relationships with proposed subcontractors (e.g., data conversion contractor, clearinghouse(s)); and

t. Organization’s customer base.

OPERATIONAL PROPOSAL

Experience and Capabilities (Required, Scored) Proposer must demonstrate Contractor has a minimum of five (5) years of experience providing medical billing services. Contractor must have at least one (1) set of services successfully implemented in the past three (3) years of similar scope and size. Experience with successfully billing each of the specified Payer sources listed in the Project Overview and Background is required.

The Proposer will provide their Business Continuity Management & Disaster Recovery plans as part of their proposal, detailing how services are restored and delivered in the event of service disruption.

Key Persons, Organizational Chart and Subcontractors (Required, Scored)

1. Key Persons. Specify key persons to be assigned to the Services and include a current resume (not to exceed two (2) pages each) for each individual that demonstrates qualifications and experience for the Services proposed.

Due to the nature of services, Key Person(s) may need to be available to work on-site as agreed upon between all parties. Work site is designated as Agency’s headquarters office in Hillsboro, Oregon.

Prosper may suggest a single person may fill more than one key person role. OHA does not require that a full FTE be assigned to each role; however, it is expected that the key persons have sufficient FTE allocated in their workdays to focus on the OHA project.

Proposer may also suggest an alternate allocation or assignment of key persons and their duties based on their experience with similar projects. Reasonable adjustments may be made to provide adequate staffing for the tasks outlined in this RFP.

Adequate staffing to provide the services outlined is required regardless of the staffing structure utilized.

Key Person(s) Requirements and Preferences for the project include the roles detailed below. Roles marked with an asterisk (*) are anticipated to continue through the Ongoing Services phase.

At a minimum, all Key Persons are expected to be familiar with Agency’s business operations and objectives. All Key Persons are expected to participate in meetings between the Agency and Proposer at the frequency of meetings for each phase specified in the Scope of Services.

a. Key Persons’ duties may include but not be limited to the following tasks:

i. Project Manager A. Develops and provides to key persons and Agency a project plan for the implementation and stabilization of the services.

B. Tracks the status of each item and the progress toward goals using detailed progress reports.

C. Keeps the project on the agreed upon timelines and modifies timelines as agreed upon by all parties.

ii. Account Manager * A. Provides oversight to the operational components of the project plan, including implementation of the project, troubleshooting, solutions building, and implementation of effective process and solutions.

B. Serves as a back-up to the Business Analyst during the Implementation and Stabilization Periods.

C. Collaborates with Agency and key persons to ensure the services provided align with the project deliverables and expectations.

D. Provide measurement and monitoring reports to verify compliance with;

E. Review the Services performance and discuss possible improvements;

F. Discuss Upgrades and Enhancements to the Services or any new technologies that may be available for Agency;

G. Provide at Agency’s request such other reports as Agency may request.

iii. Business Analyst A. Understands the entirety of the project needs, assigns key persons to complete tasks, ensures the product is completed successfully.

B. Collaborates closely with the Project Manager to ensure the services delivered aligns with the project timelines.

iv. Technical Scripting* A. Accepts Agency billing rules and applies them to the billing files to ensure appropriate billing and re-billing of each claim.

B. Collaborates with Agency and other key persons to apply and modify application of the billing rules to set up services and when operational needs change or problems are identified.

v. Technical Testing* A. Reviews claims data during the testing process and production to ensure appropriate billing and re-billing of each claim.

B. Notifies Agency and other key persons of problems identified in a timely manner.

C. Provides recommendations for resolution of problems identified.

vi. Reporting* A. Responsible for ensuring understanding of the project scope, communicating project details and reporting needs to the report developer.

B. Runs requested reports and provides them to Agency on required timelines.

C. Receives report details from other key persons Agency; uses the details to write the code necessary to generate requested reports for Agency.

D. Engages in collaboration with key persons and Agency to ensure clarity of the request prior to and during report development.

E. Accept defect reports from the Technical Testing and Technical Scripting staff and validation activities and modify reporting methods to ensure report accuracy.

vii. Compliance Officer (privacy and security) * A. Shall be familiar with Agency’s privacy and security requirements. Provides expertise to the Project to ensure implementation aligns with privacy and security requirements.

B. Shall be familiar with applicable laws and regulations associated with the project. Provides expertise to the Project to ensure implementation aligns with applicable laws and regulations.

C. Participates in meetings with Agency as required or requested.

viii. Medical Billing Specialist (optional)* A. Complete a review of Agency’s testing methodologies and CPT codes. Provide recommendations for modification to improve reimbursement rates.

B. When testing methods change, provide support for CPT coding of the method.

C. Review reasons for claim denial and provide recommendations for improved reimbursements.

b. Among the key persons for the duration of the project, the following qualifications, regardless of the distribution of duties among team members must be demonstrated:

i. Project Management Institute’s Project Management Professional (“PMP”) Certification is preferred for project management.

ii. Strong project management, business analysis, budgeting, and financial analysis experience and knowledge are required.

iii. Recent experience, in last three (3) years, and knowledge serving as key advisor and partner with business and IT executives in project management strategy and approaches with multi-million-dollar projects is required including experience in the following:

iv. Reviewing, making recommendations, and drafting procedures to implement best practices, mature project management practices, and meet requirements.

v. Demonstrate Contractor has internal quality control practices for its Key Person(s) to use when reviewing, editing, and providing feedback on projects and project artifacts is required.

vi. Recent experience, in last three (3) years, developing, performing, and facilitating system testing activities is required.

vii. Strong quality control experience and knowledge required.

viii. Demonstrated experience, within the last three (3) years, in business analysis for complex billing and collection services is required.

ix. Demonstrated experience, in the last three (3) years, in data conversion/migration, and system integration is required.

x. Experience in Business Analysis Body of Knowledge, version 3 (“BABOK”) guidelines is preferred.

xi. Bachelor’s degree or higher in computer science, public administration, business management or another relevant field is preferred.

xii. Strong understanding of public sector environment is greatly preferred.

2. Organizational Chart. Provide an organizational chart identifying the staffing that will provide the Services required by this RFP, illustrating the lines of authority as appropriate.

3. Subcontractors. If Proposer intends to work with subcontractor(s), Proposer shall include a statement detailing any subcontracting firms or individual subcontractors that may be engaged as part of the Proposal to this RFP, with those entities and the Services they will provide clearly identified.

Scope of Services Approach (Required, Scored) Provide a description of the proposed approach for providing the Scope of Services described in RFP Section 2.4. The proposed approach must be separated into three required sections, plus a fourth (optional). For each section the Proposer shall provide a comprehensive description of the proposed approaches or methodologies to be implemented or used. The description should include how the Proposer has developed these methodologies to incorporate lessons learned from experiences with other customers, as well as to meet the needs described in the RFP.

Required Sections:

1. Implementation, Planning, and Testing

a. Within this section, the Proposer will also provide a deliverables-based breakdown of the work to be completed, including an anticipated schedule or timeline of the work.

b. The Proposer will describe methods used to build, test, and identify defects in the billing logic for the system.

c. The Proposer will outline their best practice methods for logging, tracking, and verifying errors/defects during implementation are identified and corrected and in alignment with this RFP.

d. The proposal shall outline how OSPHL’s complex billing rules will be incorporated into the project implementation.

e. The Proposer will describe the file formats accepted and process to build the system to be implemented, including for pricing, Submitter details, billing rules, and other information detailed in this RFP.

f. The Proposer will describe how standard operating procedures developed during implementation will be recorded and delivered to OHA.

g. Provide a draft Submitter invoice to include the elements outlined in this RFP.

h. Provide examples of billing reports to be provided to OHA outlined in this RFP.

i. Describe how requests for medical billing or public records are handled for other Submitters.

j. Describe proposed plan for data migration or cut-over from the current vendor, if needed.

2. Stabilization Period The proposer shall describe the following:

a. Project management approaches to monitor project implantation to monitor successes and identify problems needing resolution.

b. Change management best practices to manage identified problems during project implementation. Practices should include all elements included in the Scope of Services and any additional practices considered pertinent by the Proposer.

3. Ongoing Services and Support – Billing and Collection Services The proposer shall describe their approach to the services described in the Scope of Services, Ongoing Services-Billing and Collection Services and Ongoing Support. Each area of the Scope of Services shall be addressed and in the order listed in the RFP for easy reference by the scoring committee.

In addition to referencing Proposer’s approach to each area described, the Proposer shall provide OHA with a quarterly schedule for each key milestone within the project. Examples may include but not be limited to: receipt of billing files from OHA, screening for Medicaid or CCO enrollment, claim submission to public and private Payers, invoicing to Submitters, monthly reporting to OHA, billing for re-categorized claims, and adding re-categorized claims to monthly reports.

4. Answer the following questions:

a. Based on information provided in this RFP and experience in working with other States, what is the Proposer’s perspective on the most significant risks to the billing and collection services, and how does the Proposer plan to mitigate these risks?

b. Are there any times when the Proposer’s Project Team must be on-site at Agency during implementation? Are there any times when the Proposer’s Project Team would choose to be on-site at Agency during implementation? Would staff be on-site for full or partial weeks? Describe how the Proposer arrived at these on-site recommendations and why those recommendations will provide an environment for project success.

c. Please include Proposer’s plan for working remotely with the Agency Project Team. What has Proposer done to ensure successful delivery of services when working remotely with its customers?

Describe any additional assumptions made in the Proposal not already identified in detail. These should include any assumptions related to the current Agency technical environment, staffing, project management approach, and Agency resources available during Implementation, Planning, and Testing; Stabilization Period; and Ongoing Support phases.

5. Medical Billing and Coding Consultation (optional) The Proposer shall describe in detail the applicable consultation services available. The response shall detail the previous expertise and the availability of the consultancy available for each phase of the project. A description of previous experience with entities similar to OSPHL is required.

Project Samples (Required, Scored) In the proposal response, Proposer shall submit a minimum of 2 similar projects within the last 5 years that are similar to the scope of this RFP.

a. One project sample should show a project’s implementation phase; one project should show a project in the phase of delivery of ongoing services.

b. All private health information (PHI) shall be redacted from the sample submissions.

Proposers should consider including the following elements in their project samples. Additional elements may be included at the Proposer’s discretion.

a. Executive summary specifying the nature of the project; type of customer; successes, challenges, and solutions; claim volumes (number of transactions); and length of the relationship

b. Description of the implementation, including the duration of implementation process, whether the project was a new set-up or a transition from another vendor

c. Payer lists or types of Payers

d. Subcontractors used, with a notation of whether the same or different will be used for the OHA project

e. Key persons and account management structure, and whether those will be the same or different for the OHA project

f. Example invoices for ACH or check payment from Submitters

g. Sample custom fiscal reports Price Proposal (Required, Not scored) Proposer shall complete and submit the Price Proposal (Attachment E).

The Price Proposal must be submitted with the Round 1 Submittals but will not be scored in Round 1. The Price Proposal will be scored during a future round.

Security Statement (Required, Not Scored) Proposer must provide a narrative statement that attests to whether the Proposer currently meets or can, in the future, meet the following protections:

a. Proposer understands and has the capability of handling and protecting Agency Data that has been classified as Level 3 Information under the State of Oregon’s Information Asset Classification policy, available online at https://www.oregon.gov/das/Policies/107-004-050.pdf.

b. Proposer and its employees, contractors, and agents shall comply with all applicable state and federal laws and regulations, and State of Oregon policies governing Agency Data and its use and disclosure, including as those laws, regulations, and policies may be updated from time to time, including:

c. Oregon’s Statewide Information Security Standards, found online at: https://www.oregon.gov/eis/cyber-security-services/Pages/guidance-for-state-agencies.aspx including security controls that meet or exceed “Moderate” security controls in the National Institute of Standards and Technology (NIST) Special Publication (SP) 800-53.

d. Oregon’s Statewide Information Security Plan, found online at: https://www.oregon.gov/eis/cyber-security-services/Pages/guidance-for-state-agencies.aspx.

e. Statewide Cloud Computing policy: http://www.oregon.gov/das/policies/107-004-150.pdf.

f. Oregon’s Statewide Information Technology Policies: www.oregon.gov/das/Pages/policies.aspx#IT.

g. Privileged Access Monitoring and Reporting viewable at:

https://www.oregon.gov/das/Policies/107-004-140.pdf.

h. Attachment H, Statewide Information and Cyber Security Standards, is provided to Proposers as a reference for what minimum security requirements will be. Proposers are not required to complete the Attachment H spreadsheet in Round 1.

Value Added Services (Optional, Not scored) If Proposer is proposing any value-added services, Proposer shall include a statement describing these services. Proposer may submit services including but not limited to solution engineering, configuration, training, customer services, reporting, status dashboards, and maintenance/support, the corresponding prices and subcontractors and/or resellers available to provide said services.

ADDITIONAL PROPOSAL COMPONENTS

Underlying Agreements (Not Scored) Proposer will submit any additional documents required for this project (e.g., End User License Agreement (EULA), Maintenance Agreement, etc.)

Disclosure Exemption Affidavit (Pass/Fail) Proposer shall complete and submit the Disclosure Exemption Certification (Attachment B) as part of the Proposal. SUBMISSION IS REQUIRED EVEN IF PROPOSER IS NOT IDENTIFYING CONFIDENTIAL OR PROPRIETARY INFORMATION AND DATA FOR NONDISCLOSURE. If Proposer is identifying items for nondisclosure, Proposer must identify the item or portion of the Proposal that is exempt from disclosure and the basis for the exemption. Proposer must provide an appropriately redacted single hard copy and single electronic copy of the complete, original Proposal submission (see section 3.1.2).

Certified Disadvantaged Business Outreach Plan (Pass/Fail) Proposer shall complete and submit Certified Disadvantaged Business Outreach Plan (Attachment F).

SOLICITATION PROCESS

PUBLIC NOTICE

The RFP, including all Amendment(s) and attachments, is published in OregonBuys at https://oregonbuys.gov/. RFP documents will not be mailed to prospective Proposers.

Modifications, if any, to this RFP will be made by written Amendment(s) published in OregonBuys. Prospective Proposer is solely responsible for checking OregonBuys to determine whether or not any Amendment(s) have been issued. Amendment(s) are incorporated into the RFP by this reference.

OREGONBUYS

All…