Revenue Cycle Solution

Santa Clara Valley Healthcare (SCVH), a county-operated health system, is seeking information from qualified vendors that can provide innovative, scalable, and efficient technological solutions to support critical operational functions within our Revenue Cycle. Due to increasing service demands, SCVH is exploring advanced AI-driven and systematic tools that can streamline workflows, reduce manual effort, and improve overall performance across key financial and administrative processes. Through this Request for Information (RFI), SCVH aims to identify vendors offering proven capabilities in the following areas: systematic medical coding support, automated prior-authorization solutions, and comprehensive billing denial management. The purpose of this request is to understand the landscape of available technologies, evaluate potential alignment with SCVH's operational needs, and determine which solutions may warrant further review in a formal procurement process. SCVH seeks products that will provide: Systematic Coding Support Autonomous or rules‑driven solutions that enhance the accuracy, efficiency, and throughput of medical coding for both professional and facility services. The ideal solution should assist with charge capture, coding validation, coding quality reviews, and reduction of manual workflows, while supporting compliance with regulatory and payer guidelines. Prior‑Authorization Automation Technology capable of automatically initiating, submitting, and tracking prior‑authorization requests across major payers. Solutions should reduce manual staff workload, improve turnaround times, and ensure authorizations are obtained or flagged prior to scheduling or service delivery. Billing Denial Management (including Coding Denials) AI‑enabled or systematic tools that can identify potential claim denials including coding‑related denials before and/or after claim submission, assist in automated or semi‑automated appeal generation, analyze denial and underpayment trends, detect underpayments, and produce actionable reporting. Solutions should support improved collections, reduced rework, strengthened coding accuracy, and enhanced overall revenue integrity.