Claims Coding, Billing and Collection Services

The West Virginia Department of Health and Human Resources, Office of Health Facilities is requesting quotes for claims coding, billing, and collection services under ARFQ OHF27-01, with quotes due October 1, 2026 at 10:30 a.m. EDT and questions due by September 23, 2026.

The scope encompasses comprehensive claims coding, billing, and collection services including medical claims processing, coding verification per ICD-10/CPT/HCPCS standards, billing operations, and collection activities. Vendors must demonstrate healthcare claims-processing experience, proficiency with billing software systems, quality assurance procedures, and capability for 24/7 customer support. HIPAA compliance is mandatory, including execution of a Business Associate Agreement establishing administrative, physical, and technical security measures and breach notification requirements. The vendor must ensure subcontractors meet equivalent HIPAA obligations and maintain audit controls and access logs.

The contract spans four years with each year as a separate line item. Compensation is structured as a percentage-of-recovery model applied against a monthly claims estimate of $2 million. Vendors must submit proposed percentage recovery rates for each contract year; annual fees are calculated as: Monthly Estimate ($2,000,000) × Vendor Percentage × 12 months.

West Virginia Code 5-22-1(i) eligibility requirements apply: vendors and related parties must certify they do not owe aggregate debts exceeding one thousand dollars and are not in employer default under workers' compensation law. For contracts valued at $1 million or more, a Disclosure of Interested Parties form executed under oath is required before work begins.

Solicitation documents incorporate federal compliance standards under 2 C.F.R. 200.317–200.327. A separate evaluation track may apply to federal-funded portions without state preferences; if different bidders win state and federal evaluations, multiple contracts may be awarded. Additional federal requirements include Davis-Bacon wage rates for construction exceeding $2,000, Contract Work Hours and Safety Standards Act compliance for awards exceeding $100,000, and debarment verification through SAM.

Vendor must provide liability insurance, bonding, disaster recovery capabilities, and detailed cost proposals addressing system integration with existing state operations. Submission location is Kanawha Valley Building, Health and Human Resources Department, 300 Capitol Street, 7th Floor, Charleston, West Virginia 25301. Contact: Roberta A. Wagner, (304) 558-0437 or roberta.a.wagner@wv.gov.