Comprehensive provider bill review

The State of South Carolina's State Accident Fund (SAF) is seeking a comprehensive provider bill review services contractor to process approximately 70,000 medical bills annually for 600 government agencies and local governments. The solicitation requires a vendor to provide electronic bill processing, scanning, indexing, and reviewing medical provider bills for workers' compensation claims, including hospital, ambulatory surgery center, dental, and pharmaceutical bills. Key deliverables include maintaining a nine-calendar-day maximum bill review turnaround time, providing 24-hour provider support, offering dispute resolution, managing preferred provider networks, and generating detailed monthly cost savings reports. Contractors must price services as a percentage of savings below the South Carolina Workers' Compensation Fee Schedule, with all costs generated exclusively from documented cost savings. The procurement timeline includes a proposal submission deadline of June 21, 2019 at 11:00 a.m., with award notification scheduled for August 20, 2019, and a contract effective date of August 1, 2019. The initial contract term is one year, with four additional one-year renewal options extending through July 31, 2024. Evaluation criteria will include technical proposal factors, operational capabilities, qualifications, and pricing, with the top three offerors potentially invited to provide oral presentations.

No specific set-aside designations or restrictions for disadvantaged enterprises were identified in the solicitation documents. The previous bill review vendor was CoreVel, which processed approximately 37,000 to 40,000 bills annually, with total billed charges of $46.9 million in 2018 and achieved approximately 72% total savings on billed charges. The contractor must provide their own scanning equipment, software, and maintenance, and must be prepared to integrate with existing SAF systems and comply with South Carolina's information security requirements. Insurance requirements include $1 million in general liability coverage and $5 million in cybersecurity and privacy coverage. Financial performance metrics from the previous contract suggest potential annual service fees ranging from $525,000 to $660,000, with the contractor generating revenue exclusively through documented cost savings. Offerors must be registered South Carolina vendors, provide audited financial statements, submit three professional references, and complete a Service Provider Security Assessment Questionnaire to demonstrate financial stability and technical capabilities.