MEDI-CAL BILLING SERVICES FOR SPECIAL ED

Agency:	Santa Clara County Office of Education
State:	California
Type of Government:	State & Local
NAICS Category:	541219 - Other Accounting Services
Posted Date:	Apr 17, 2024
Due Date:	May 10, 2024
Solicitation No:	RFP 04-24-25
Bid Source:	Please Login to View Page
Contact information:	Please Login to View Page
Bid Documents:	Please Login to View Page

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RFP#04-24-25 Medi-Cal Billing for Special Education Program

REQUEST FOR PROPOSAL (RFP#04-24-25)

FOR

MEDI-CAL BILLING FOR SPECIAL EDUCATION PROGRAM

NOTICE IS HEREBY GIVEN that the Santa Clara County Office of Education (SCCOE) calls for RFPs

to be received in Purchasing Services at 1290 Ridder Park Drive, San Jose, California 95131-2304 by

Friday, May 10, 2024 @ 3:00PM. There will not be a formal RFP opening for these proposals. All

proposals will be evaluated for pricing, specifications and other pertinent information. Any

nonconforming or incomplete proposals may be rejected. Vendors must comply with the instructions

contained in the proposal package. It shall be the full responsibility of all Vendors to ensure that

proposals are delivered to the above office by the time and date stated. Facsimile (FAX) copies or E-

mail of the proposal will not be accepted. SCCOE will not be responsible for late deliveries by U.S. mail

or any other means.

SCCOE reserves the right to accept or reject any and all proposals and to waive any irregularities or

informalities in any RFP or in the proposal process. No RFP, or any portion thereof, may be withdrawn

for a period of sixty (60) days after RFP opening.

Contact Information:

General Information

Jas Sohal

Manage Purchasing Services

1290 Ridder Park Drive - MC254

San Jose, CA. 95131

Ph.: 408-453-6858

jsohal@sccoe.org

Technical Questions

John Honerkamp

Manager, Special Education Program

Santa Clara County Office of Education

1290 Ridder Park Drive

San Jose, CA 95131-2304

Ph.: 408.453.4368

jhonerkamp@sccoe.org

Page 1 of 26

RFP#04-24-25 Medi-Cal Billing for Special Education Program

SECTION 1: PROJECT SUMMARY

1.1 Overview

The Medi-Cal Administrative Activities (MAA) is a Federal Program designed to reimburse school

SCCOEs, county offices of education, and other governmental agencies for certain costs occurred in the

administration of MAA funded activities. The Billing Service agency contracts with the LEA to recover

Medi-Cal dollars through training, program coordination, eligibility determination, supporting

documentation including manuals and fiscal worksheets, plan development, invoice preparation and

submission, claims submission, reporting, and audit readiness. The agency will provide the SCCOE

with an online MAA time survey system to complete the data collection process. The SCCOE MAA

participants will individually log in and input their entire week using the program requirements. After the

SCCOE completes the review of the time surveys to ensure accuracy and audit compliance, the agency

will perform a second review of the surveys. The agency also provides training materials and assists in

the required annual training of all MAA participants. The agency assist the SCCOE in completing the

invoice process; will use fiscal data provided by the SCCOE in conjunction with the time survey data to

complete the MAA invoice quarterly for Medi-Cal administrative activities reimbursement.

1.2: Scope of Service

I. Implementation:

a. Will work with Client to assess program potential, establish provider and site databases

for effective service tracking, and provide implementation training to Client program

coordinator(s). This implementation process will be designed to identify areas of

reimbursement and to facilitate an effective partnership between Client and SCCOE.

II. Training and Materials:

a. Will provide training to Client’s program coordinator(s) and healthcare providers as part of

the initial contract implementation and at least annually thereafter. Training will include

the following subject areas: DHCS audit requirements for Client’s LEA billing program; all

necessary information and procedures for submitting Client billing data and “best

practices” to implement and maintain an optimized, audit-ready program.

b. Will provide Client personnel with all necessary training materials including a proprietary

“Coordinator’s Handbook” containing a detailed review of the rules and regulations

governing the LEA billing program. At Client’s request, will also make available its

proprietary “provider forms” for use in documenting the delivery of healthcare services

(available in paper and electronic versions).

III. Claims Preparation and Submission:

a. Eligibility: Upon the commencement of LEA Billing Services under this Agreement and

quarterly thereafter during the Term of the Agreement, agency will use its proprietary

algorithms and know-how to determine Medi-Cal eligibility and identify Medi-Cal numbers

within limits imposed by the DHCS and county governments. Eligibility match information

will be retained by the agency and will be used solely to provide services hereunder

subject to all the confidentiality provisions provided in the Agreement.

b. Claim Submittal: Will make reasonable efforts to submit each Medi-Cal claim within

thirty (30) days of receipt from Client of all information necessary for processing that

claim. Will also make reasonable efforts to bill retroactive claims existing at the

commencement of this Agreement so as to minimize revenue lost due to Medi-Cal’s one

(1) year billing limit.

c. Review and Submittal: Will monitor the submittal and payment process, review denials,

suspensions, and holds, as reported by DHCS, and make reasonable efforts to resolve

any challenges Client reimbursement claim.

IV. Management of Reports and Program Analysis:

a. Will provide Client with periodic management reports using provider, procedure, and/or

site parameters. The frequency of such reports will be determined by mutual agreement,

but in any event shall occur no less frequently than quarterly.

Page 2 of 26

RFP#04-24-25 Medi-Cal Billing for Special Education Program

V. Coordination with Client:

a. Information Sharing: Will provide Client with information regarding program policy,

interpretation of policy, and regulatory updates as applicable. Quarterly “Bulletins” will be

provided to Client’s coordinator(s) to ensure timely communication about program

changes and updates to the systems and processes.

b. Support: Will provide a “Client Care Center” available for the use of Client’s program

Coordinator(s) and accessible via toll-free phone and email. A Help Desk will be

available to Client program coordinator(s) and participants utilizing web-based software,

accessible by toll-free phone during regular business hours and by email.

c. Audit and Site Visit Support: Will provide Client personnel with training on audit

requirements and program compliance. In the event of a program audit or review,

agency will assist in preparing for and responding to the audit to the extent permitted by

DHCS and or any other auditing party.

VI. Technology and Software:

a. Will make available its proprietary web-based software to assist Client in effective

management of program participation.

VII. Cost and Reimbursement Comparison Schedule (CRCS) Services:

a. Will prepare the annual CRCS Workbook in accordance with the claim guidelines

approved by DHCS, based on information supplied by Client for each fiscal year, in

accordance with the terms of the Agreement. Client will have final approval over the

CRCS Workbook submission prepared by the agency.

VIII. MAA Billing Services: All services described below will be provided in accordance with and to

the extent allowed by the California Department of Health Care Services (DHCS) Medi-Cal

Administrative Activities (MAA) Plan.

a. MAA Program Consulting Services: Will work with Client to assess program potential,

and establish an optimized claim plan, which consists of review and analysis of all

program participants and their fiscal eligibility. Ongoing consultation will be designed to

identify areas of reimbursement and to facilitate Client’s full participation in the MAA

program.

b. Training: Will provide training to Client’s program coordinator(s). Training will include

the following subject areas: DHCS audit requirements for Client’s MAA program;

information and procedures for submitting MAA fiscal information, and “best practices” to

implement and maintain an optimized, audit-ready program.

c. Information Sharing: Will provide Client with information regarding program policy,

interpretation of policy, and regulatory updates as applicable. Quarterly “Bulletins” will be

provided to Client’s coordinator(s) to ensure timely communication about program

changes and updates to systems and processes. Will provide Client personnel with

training on audit requirements and program compliance and will perform “compliance

reviews” to assist the Client in maintaining audit records. In the event of a program audit

or review, agency will assist in preparing for and responding to the audit to the extent

permitted by DHCS and/or any other auditing party.

d. Supplemental Support: Will provide a “Client Care Center” available for the use of

Client’s program coordinator(s) and accessible by toll-free phone during regular business

hours and by email. A Help Desk will be available to Client program coordinator(s) and

staff utilizing the agency’s web-based software, accessible by toll-free phone during

regular business hours and by email.

e. Technology and Software: Will make available, as applicable, its proprietary web-

based software to assist Client in effective program participation.

Page 3 of 26

RFP#04-24-25 Medi-Cal Billing for Special Education Program

SECTION 2: CONTACT AND SUBMISSION INFORMATION

2.1 Proposal Schedule:

4/17/24 & 4/24/24

5/1/24

5/10/24

5/17/24

Deadline to Submit Questions

Proposal Due

RFP Review

2.2 Additional Information

Inquiries regarding this RFP shall be in written form only. Responses to questions will be provided to all

known prospective respondents. The SCCOE reserves the right to amend the RFP. Addenda to this

RFP will be posted on the SCCOE’s website at:

http://www.sccoe.org/depts/bizserv/purchasing/Pages/RFPs-Posting-System.aspx.

It is the responsibility of prospective respondents to check the website for any possible addenda.

General Questions should be submitted to:

Jas Sohal

Manage Purchasing Services

1290 Ridder Park Drive - MC254

San Jose, CA. 95131

Ph.: 408-453-6858

jas_sohal@sccoe.org

Technical Questions

John Honerkamp

Manager, Special Education Program

Santa Clara County Office of Education

1290 Ridder Park Drive

San Jose, CA 95131-2304

Ph.: 408.453.4368

jhonerkamp@sccoe.org

2.3 Preparation and Submission of Proposal

Please submit three (3) hard copies of the proposal. Proposals shall be submitted in a sealed envelope

and labeled Medi-Cal Billing for Special Education Program – RFP#04-24-25 and addressed to:

Jas Sohal

Manage Purchasing Services

1290 Ridder Park Drive - MC254

San Jose, CA. 95131

Ph.: 408-453-6858

jas_sohal@sccoe.org

All proposals must be delivered to the above office on or before Friday, May 10, 2024 @ 3:00PM and

there will not be a formal RFP opening for these proposals.

Proposals received after the announced time and date for submittal will not be considered. However,

nothing in this RFP precludes the SCCOE from requesting additional information at any time during the

proposal evaluation period. The SCCOE is under no obligation to return proposals. All cost associated

with a proposal will be borne by each proposer. See Section 4 for proposal format.

Page 4 of 26

RFP#04-24-25 Medi-Cal Billing for Special Education Program

2.4 Time and Location of Proposer's Presentation

Upon completion of the review period, the SCCOE may invite finalists to make a presentation

demonstrating the merits of their proposal or provide references from other clients who have received

similar studies. Finalists will be notified to arrange specific times. The SCCOE will not be responsible

for any costs associated with the proposer’s presentation.

2.5 Right to Reject Proposals

The SCCOE reserves the right to reject any and all proposals or to waive any minor defects or

irregularities in any proposal or in the proposal process, or to solicit new proposals on the same project

or on a modified project, which may include portions of the original proposed project as in the best

interest of the SCCOE. Further, notwithstanding any other provisions of this RFP, the SCCOE reserves

the right to award a contract to the proposal that best meets the requirements of the RFP and not

necessarily to the lowest Vendor.

2.6 Award of Project and Approval of Agreement

The selected proposer shall be required to enter into a written contract with the SCCOE in a form

approved by legal counsel and/or Risk Management for the SCCOE. This RFP and the proposal, or any

part thereof, may be incorporated into and made a part of the final contract. The SCCOE reserves the

right to negotiate the terms and conditions of the contract with the selected proposer.

Award of a contract is subject to funding approved by the SCCOE.

2.7 Proposals are Public Records

Each Proposer is hereby notified that, upon submittal of its proposal to the SCCOE in accordance with

this RFP, the proposal becomes the property of the SCCOE and is a public record subject to disclosure

in accordance with Public Records Act, Government Code Section 6250-6270.

SECTION 3: EVALUATION AND AWARD CRITERIA

Selection of a proposal will be based on the following criteria:

Criteria

Methodology

Addresses the needs and criteria of RFP

Experience working with County and school districts,

specifically, with Medi-Cal Billing for Special Education Program

Staff qualifications and experience

Agency can work within the timeline provided in this RFP.

Cost of Proposal

Value

SECTION 4: PROPOSAL FORMAT

Proposals shall include the following:

1. Proposal Summary

Include an executive summary that discusses the highlights, key features, and distinguishing

points of the proposal. The summary should be specifically tailored to the scope of services

requested herein.

Include all of the following information:

a) A brief introduction of the Contractor and its leadership;

Page 5 of 26

Bid Identifier: RFP 04-24-25
MEDI-CAL BILLING SERVICES FOR SPECIAL ED
Additional Resources: Notice Inviting Proposals
Awarded Vendor:
Awarded Date:
Awarding Agency:
Agency Contact:	Jas Sohal
Phone (Agency):	4084536858
Piggybackable?	no
Issuance Date:	04/17/2024
Due Date/Time:	05/10/2024@3:00PM
Bid Status:	Open
Note:

MEDI-CAL BILLING SERVICES FOR SPECIAL ED

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