Zero-Balance Audit and Payment Compliance Review Services

The University of Texas Health Science Center at San Antonio (UTHSA) is issuing Request for Proposal 745-26-P12 for Zero-Balance Audit and Payment Compliance Review Services, a professional services procurement focused exclusively on hospital billing operations. The selected vendor will perform a comprehensive audit and payer payment compliance review to identify and recover lost or underpaid revenue by validating payments received from commercial and governmental payers against their contracted terms. The vendor must utilize proprietary or licensed software to enter payer contract payment terms and model expected payments for services rendered over the preceding twelve months, with the analysis identifying discrepancies between expected and actual reimbursement to determine recoverable revenue opportunities. The audit period will begin at the project start date and extend backward twelve months to align with standard payer retrospective review limitations. Required qualifications include demonstrated experience delivering similar revenue recovery and compliance review services within the past five years, with a minimum of three customer references from comparable organizations, financial stability documentation, key personnel with relevant expertise, and a clearly defined work plan with milestones and timelines. Evaluation criteria encompass company background and qualifications, approach and methodology, financial stability, implementation capabilities, reporting features, contingency planning, and any value-added services. The deadline for submission of questions is March 3, 2026, at 3:00 PM Central Standard Time, and all proposals must be submitted through the University's online Procurement Portal (Euna) by March 18, 2026, at 3:00 PM CST. All proposals must include a completed Historically Underutilized Business (HUB) Subcontracting Plan, Addenda Checklist, Execution of Offer with certifications and representations, General Questionnaire responses, pricing and delivery schedule, and acknowledgment of terms and conditions, with failure to submit a properly completed HUB Subcontracting Plan resulting in automatic disqualification.

This procurement includes a mandatory HUB Subcontracting Plan requirement, indicating a set-aside or preference for participation by historically underutilized businesses as defined by Texas state procurement law. Vendors must execute a Business Associate Agreement compliant with the Health Insurance Portability and Accountability Act (HIPAA) and Texas Medical Records Privacy Act, with explicit prohibitions on using Protected Health Information for artificial intelligence training or deployment without prior written consent, and all PHI must be stored, transmitted, and processed exclusively within the United States. If the selected vendor provides cloud computing services, TX-RAMP Certification Level compliance is mandatory in accordance with Texas Government Code 2054.0593. Additional requirements include compliance with Texas ethics laws, conflicts of interest policies, and various state-specific certifications regarding boycotts of Israel and energy companies, non-discrimination against firearm entities, cybersecurity training certification, criminal background checks for all personnel, and debarment screening. Compensation will be structured on an hourly rate basis with rates remaining firm throughout the initial four-year contract term and any renewal periods, with all associated costs for labor, equipment, materials, fees, overhead, profit, insurance, and licenses included in stated rates, though UTHSA does not guarantee any specific amount of compensation, volume, minimum, or maximum services. The contract includes an option to renew for one additional one-year term under the same terms and conditions, with payment due within thirty days of invoice receipt and supporting documentation subject to University approval. All submitted materials become non-confidential and subject to public disclosure under the Texas Public Information Act upon contract execution, except for information protected under specific Government Code sections.