Out-of-State Medicaid and Commercial Insurance Billing Services

The County seeks a vendor to provide out-of-state Medicaid billing, commercial insurance billing, and denial follow-up services for care provided at county healthcare facilities. The selected provider will support revenue recovery through efficient claim preparation, submission, processing, monitoring, and resolution.

For out-of-state Medicaid, the vendor will prepare and submit claims to Medicaid programs in all fifty states, verify patient eligibility, assist eligible patients with enrollment when applicable, and systematically track claims through adjudication. For commercial insurance, the vendor will prepare and submit claims according to payer requirements, analyze denials to identify root causes, and correct and resubmit claims involving errors, missing information, authorization issues, coding problems, billing inaccuracies, or timely filing disputes.

The vendor must use secure, encrypted file transfer methods in compliance with HIPAA security requirements and maintain claim tracking software capable of providing real-time updates on claims, denials, appeals, and resolutions. Comprehensive monthly, quarterly, and annual reports will be required, including claim volumes, recovery rates, denial rates, appeal outcomes, accounts receivable aging, and other requested performance metrics. The contract period will be two years, and questions must be submitted by September 4, 2026.