Claims Coding, Billing and Collection Services

The State of West Virginia Department of Health and Human Resources, Office of Health Facilities is soliciting an Abbreviated Request for Qualifications for claims coding, billing, and collection services with proposals due October 8, 2026 at 10:30 a.m. EDT (extended via Addendum 1 from the original October 1 date). A mandatory pre-bid meeting is required for all bidding vendors.

The scope covers comprehensive claims coding, billing, and collection services for three state-owned hospital facilities: Mildred Mitchell-Bateman Hospital (110-bed psychiatric, Huntington), William R. Sharpe Jr. Hospital (200-bed psychiatric, Weston), and Welch Community Hospital (55-bed acute care, Welch). The vendor must provide remote off-site services with secure interface capability to existing Electronic Health Records (Medsphere CareVue), ADT/billing (Optimum), and clearinghouse (Availity) systems. The vendor is responsible for all staffing, facilities, equipment, cyber liability insurance, errors and omissions insurance, and operational resources, including maintaining access to Medicare intermediary systems and all payer portals. Service performance must achieve 98% coding accuracy, 94–97% clean claim rate, and 94% Service Level Agreement achievement; compensation is reduced 2% if SLA achievement falls below 94%. Vendors must demonstrate minimum five years' hospital billing experience across acute care, psychiatric, and outpatient settings; maintain certified coder credentials (AHIMA/AAPC); and begin service within thirty days of award.

The contract is open-end with a four-year initial term, priced using a formula of $2,000,000 monthly estimated recovery multiplied by the vendor's proposed percentage fee multiplied by 12 months, with vendors proposing a separate percentage for each contract year. Compensation is calculated as a percentage of collections during the previous month, excluding up-front collections and cost settlements. The vendor must submit a Disclosure of Interested Parties form (required for contracts valued at $1 million or more), execute a HIPAA Business Associate Agreement, comply with federal IT requirements including HIPAA, NIST 800-53, IRS Publication 1075, and CMS standards, and furnish performance bonds, labor/material payment bonds, and maintenance bonds each equal to 100% of the estimated annual contract value, along with Commercial General Liability ($1,000,000 per occurrence), Automobile Liability ($1,000,000 per occurrence), Professional/Malpractice/Errors and Omissions ($1,000,000 per occurrence), and Commercial Crime and Third Party Fidelity Insurance ($5,000,000 or greater), with the State as additional insured. Vendors must be registered with the West Virginia Purchasing Division and comply with state exempt purchasing affidavit requirements. The solicitation is structured to permit separate state-level and county/local procurements; if the same vendor wins both, contracts will be combined. Questions were due September 23, 2026. Roberta A. Wagner, procurement buyer, (304) 558-0437 or roberta.a.wagner@wv.gov.