HHS IHS RFQ: Medical Claims Clearinghouse Service for the Wind River Service Unit (WRSU)

Solicitation Number: RFQ-10-20-026-KN

“The purpose of this acquisition is to contract a Medical Claims Clearinghouse Service for the Wind River Service Unit (WRSU), PHS Indian Health Center, Fort Washakie, Wyoming.”

“The WRSU is seeking a well-established Medical Claims Clearinghouse service provider whose proposed solution is the most advantageous in meeting the WRSU’s needs. The WRSU processes up to 18,000 claims per year, approximately 1,500 per monthly billing cycle. The medical claims clearinghouse will work directly with WRSU to securely and electronically transmit medical claims to insurance companies and to electronically verify patient eligibility.”

“The proposed solution will have the ability to be integrated into the existing health information system (RPMS) billing software and automatically in processing exported claims to third party payers; Medicare, Medicaid, Veterans Affairs, and Private Insurance electronic claims. The WRSU is also seeking a solution that is able to setup third party payer accounts with minimal transition from the existing clearinghouse. The proposed solution should be able to review and filter claims against established edits to identify any errors. As well as provide a means to correct the claim before the claim is submitted to the insurance company.”

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