Notice ID: 75H70523R00007
Description
Bemidji Area Indian Health Service provides service and support to 34 Federally-recognized Tribes and 4 Urban Indian Health programs located in Illinois, Indiana, Michigan, Minnesota and Wisconsin. Tribal Health services are provided through 11 P.L. 93-638 Title V compacts and 23 Title I contracts.
SCOPE
- Clearinghouse will provide a single, unified user experience which means user log-on to one system.
- Clearinghouse will provide real-time point-of-service eligibility data from third party insurance databases to include commercial payers, Medicare intermediaries, and state Medicaid plans. Queries will be conducted pre-encounter. This may occur in either batches the day before or in real-time.
- Clearinghouse will provide secure data transmission of all electronic claims, approximately 45,000 encounters per month for three service units. Payer enrollment and ability to transmit electronic VA claims is required.
- Clearinghouse will provide initial data checks, initial data scrubbing to ensure clean claim submission to the end-payer, and claim status inquiry and response.
- Clearinghouse will ensure HIPAA Compliant transactions and password protected access and meet IHS security requirements.
- Clearinghouse will have capabilities to drop an electronic claim to paper.
- All claims with errors will be rejected to a site within the portal where rework can occur. Portal should have simple response rejections messages and intuitive interactive decision support through use of ‘help tiles’ within the portal. Claim attachment functionality is necessary. The denial workflow allows direct resubmission.
- All inquiries and responses will provide accurate and up-to-date eligibility information available to the end user. All information will be uploaded for electronic claims transmissions in order for clean claim billing and third-party revenue activities…
