Claims Management Services

Agency: State Government of New Hampshire
State: New Hampshire
Type of Government: State & Local
NAICS Category:
  • 541611 - Administrative Management and General Management Consulting Services
Posted Date: Nov 3, 2021
Due Date: Dec 8, 2021
Solicitation No: RFP-2022-NHH-04-CLAIM
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Description

This Request for Proposals (RFP) is published to solicit proposals for Claims Management Services that provide electronic management of New Hampshire Hospital claims, including:

  • Electronic acknowledgment of reimbursement (Explanation of Benefits);
  • Verification of benefit eligibility both online and via a batch process;
  • Ability to correct or modify claims;
  • Ability to electronically forward secondary claims; and
  • Compatibility or capability of interfacing with New Hampshire Hospital’s Electronic Health Record.
Documents RFP-2022-NHH-04-CLAIM
Release Date November 3, 2021
Closing Date/Time December 8, 2021
Program Area New Hampshire Hospital
Contact Dean B. Fancy
Telephone (603) 271-9610
E-mail Address dean.fancy@dhhs.nh.gov

Attachment Preview

State of New Hampshire
Department of Health and Human Services
REQUEST FOR PROPOSALS
RFP-2022-NHH-04-CLAIM
FOR
Claims Management Services
November 3, 2021
New Hampshire Department of Health and Human Services
Claims Management Services
TABLE OF CONTENTS
1. INTRODUCTION
4
Purpose and Overview
4
Contract Period
4
New Hampshire Department of Health and Human Services, New Hampshire Hospital
4
Background
4
3. STATEMENT OF WORK
6
Scope of Services
6
Technical Questions
7
Compliance
9
Contract Monitoring Provisions
11
4. FINANCE
12
Financial Standards
12
Technical Proposal
12
Price Proposal
12
Information Technology Requirements
12
6. PROPOSAL PROCESS
12
Contact Information Sole Point of Contact
13
Procurement Timetable
13
Letter of Intent
13
Questions and Answers
14
Exceptions
14
RFP Amendment
15
Proposal Submission
15
Non-Collusion
16
Collaborative Proposals
16
Validity of Proposals
16
Property of Department
16
Proposal Withdrawal
16
Public Disclosure
16
Non-Commitment
17
Liability
17
Request for Additional Information or Materials
18
Oral Presentations and Discussions
18
Successful Proposer Notice and Contract Negotiations
18
Scope of Award and Contract Award Notice
18
Site Visits
18
Protest of Intended Award
18
Contingency
19
Ethical Requirements
19
7. PROPOSAL OUTLINE AND REQUIREMENTS
19
Presentation and Identification
19
Outline and Detail
19
8. MANDATORY BUSINESS SPECIFICATIONS
23
Contract Terms, Conditions and Liquidated Damages, Forms
23
9. ADDITIONAL INFORMATION
24
Appendix A Form P-37 General Provisions and Standard Exhibits
24
Appendix B Contract Monitoring Provisions
24
Appendix C Reserved
24
Appendix D Price Proposal
24
RFP-2022-NHH-04-CLAIM
Page 2 of 24
New Hampshire Department of Health and Human Services
Claims Management Services
Appendix E Business and Technical Requirements
24
Appendix F Activities, Deliverables, and Milestones Schedule
24
RFP-2022-NHH-04-CLAIM
Page 3 of 24
New Hampshire Department of Health and Human Services
Claims Management Services
1. INTRODUCTION
Purpose and Overview
This Request for Proposals (RFP) is published to solicit proposals for Claims
Management Services that provide electronic management of New Hampshire
Hospital Claims, including:
Electronic acknowledgment of reimbursement (Explanation of Benefits);
Verification of benefit eligibility both online and via a batch process;
Ability to correct or modify claims;
Ability to electronically forward secondary claims; and
Compatibility or capability of interfacing with New Hampshire Hospital’s Electronic
Health Record.
The New Hampshire Department of Health and Human Services (Department)
anticipates awarding one (1) contract for the services in this RFP.
Contract Period
The Contract resulting from this RFP is anticipated to be effective February 1, 2022,
or upon Governor and Executive Council approval, whichever is later, through a period
of three (3) years.
The Department may extend contracted services for up to six (6) additional years,
contingent upon satisfactory Contractor performance, continued funding, and
Governor and Executive Council approval.
2. BACKGROUND
New Hampshire Department of Health and Human Services, New
Hampshire Hospital
The Department of Health and Human Services’ Mission is to join communities and
families in providing opportunities for citizens to achieve health and independence.
New Hampshire Hospital (NHH) is a fully accredited, state-operated, acute psychiatric
inpatient facility located in Concord, NH. The Hospital has accredited beds serving
children, adults and the elderly with severe mental illness who need active treatment
and other essential supports within a continuum of community-based care. NHH
employs a staff of approximately 600 full time and 200 part-time employees who
provide all direct care, clinical support, and administrative support services.
Specialized diagnostic and therapeutic services are provided for 2,000 patients each
year, keeping 175 beds full. Half of hospital patients are discharged within 10 days.
Background
NHH must provide services and seek reimbursement through various payers. NHH
utilizes an Electronic Health Records solution (myAvatar) that provides both clinical
RFP-2022-NHH-04-CLAIM
Page 4 of 24
New Hampshire Department of Health and Human Services
Claims Management Services
and business operations. Currently, reimbursement claims are entered manually into
five (5) different systems, depending on the type of claim.
Additionally, most secondary claims are processed manually and mailed. NHH would
like to reduce processing times for claims and the potential for manual errors that are
present in the current system. NHH is seeking a solution to enhance NHH’s ability to
meet business operations that will leverage the best available technology.
RFP-2022-NHH-04-CLAIM
Page 5 of 24

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