OhioMHAS Utilization Review and Billing Consultant
Closed State & local contract opportunity Posted
- Solicitation number
- SRC0000029322
- State
- Ohio
- Responses due
Opportunity facts
Opportunity details come from ohiobuys.ohio.gov. Updated .
About this opportunity
The Ohio Department of Mental Health and Addiction Services (OhioMHAS) is seeking a Utilization Review and Billing Consultant for State Fiscal Year 2025, with proposals due by April 21, 2025. The procurement focuses on providing a comprehensive evaluation and consultation of utilization review and billing processes across six regional psychiatric hospitals. Key deliverables include site visits to each hospital, identifying education opportunities, providing direct education to onsite personnel, maintaining an onsite presence as needed, and producing a written report with process improvement recommendations. The contractor must possess a minimum of five years of hospital billing and utilization review experience, including one year in a psychiatric healthcare setting and experience with electronic health records (preferably Epic). Evaluation criteria will assess the contractor's qualifications, with a minimum acceptable score of 340 out of 550 possible points. The project aims to improve internal processes, enhance billing capture rates, and optimize the recently adopted Epic electronic health record system. The contract period will cover April 1, 2025 through June 30, 2025, with proposals to be submitted through the Ohio|Buys website.
There are no specific set-aside designations or restrictions for disadvantaged enterprises mentioned in the procurement documents. The contract appears to be open to qualified healthcare consulting firms with extensive experience in hospital billing and utilization review. The existing infrastructure involves a recently implemented Epic electronic health record system, which will require careful integration and support. While a specific budget range is not explicitly stated, the contract will be contingent on state and federal fund availability, with contracts exceeding $50,000 subject to approval by the State of Ohio Controlling Board. Potential vendors should note that the contractor cannot be subject to an "unresolved" finding for recovery under Section 9.24 of Ohio Revised Code. Travel costs are expected to be encompassed within the cost of deliverables, and the successful contractor will need to demonstrate expertise in healthcare administration, hospital billing, and coding through relevant certificates or education.
Opportunity text
- MISSION & GUIDING PRINCIPLES
The mission of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) is to provide statewide leadership of a high-quality mental health and addiction prevention, treatment and recovery system that is effective and valued by all Ohioans. OhioMHAS strives to be a national leader in implementing a comprehensive, accessible, and quality-focused system of addiction and mental health care and wellness for all Ohio citizens.
- PURPOSE
The Ohio Department of Mental Health and Addiction Services (OhioMHAS) is seeking proposals from qualified contractors to provide a thorough evaluation and consultation of the structure and processes surrounding utilization review and billing to provide timelier filings and error resolution to improve internal processes and capture rate of billing
- BACKGROUND
The agency has recently adopted an Epic electronic health record and from that, many processes and job roles have switched with regards to UR and billing. There have been areas of opportunity identified in the structure and delineation of duties with the new EHR which would be augmented with an external review and modernization of the UR and billing processes.
- SCOPE OF WORK AND DELIVERABLES
The awarded vendor will need to complete the following:
- Visits to each of the 6 (six) regional psychiatric hospitals (RPH) to familiarize with the processes adopted at each site and the structure and delineation of roles.
- Identification of education opportunities primarily focused on patient registration, medical coding, charging errors, claim denial corrections, other administrative processes and support with regards to UR and Billing.
- Direct education provided as identified to onsite personnel.
- Continued onsite presence as identified by need during onsite visits for education and support.
- A written report detailing the areas of opportunities and recommendations for process or organizational change as appropriate.
- MINIMUM QUALIFICATIONS OF CONTRACTOR
- Five years of experience in hospital billing and or utilization review in a healthcare setting
- One year experience in hospital billing and or utilization review in a psychiatric healthcare setting.
- One year experience in hospital billing and or utilization review in a setting utilizing an electronic health record (Epic preferred)
- Certificates or education related to healthcare administration and or hospital billing and coding preferred
Contractor shall not be subject to an "unresolved" finding for recovery under Section 9.24 of Ohio Revised Code.
Files
| File | Type | Posted |
|---|---|---|
| Utilization Review and Billing Consultant RFP.pdf |
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