The State of Texas is seeking a vendor to provide a coding audit software solution designed to improve medical billing compliance and accuracy. The primary objective is to enhance internal coding standards, ensure adherence to payer requirements, and reduce the risk of fraud, waste, and abuse in medical billing processes across the agency.

The software must support both facility and professional claims by enabling thorough review and auditing of medical coding and documentation. Key requirements include a comprehensive, user-friendly dashboard that provides real-time visibility into auditing activities and results, as well as robust data analytics, reporting, and auditing capabilities. Ongoing consulting and training services are expected, covering both continuous education for new staff and support during system upgrades or feature enhancements.

Integration with the agency’s existing Epic electronic medical record (EMR) system is essential. The solution must securely import relevant clinical and coding data—including patient charts, encounter details, and documentation—from Epic, while maintaining full compliance with all applicable data privacy and HIPAA regulations. The contract term for this engagement will be three years.