Zero-Balance Audit and Payment Compliance Review Services

Project Description: The University of Texas Health Science Center at San Antonio (UTHSA) seeks to engage a qualified third-party vendor or consultant to perform a comprehensive zero-balance audit and payer payment compliance review. The objective of this engagement is to identify and recover lost or underpaid revenue by validating payments received from commercial and governmental payers against contracted terms.
UTHSA desires the selected vendor to enter payer contract payment terms into their proprietary or licensed software to model expected payments for services rendered over the preceding twelve (12) months. The analysis should identify discrepancies between expected and actual reimbursement to determine recoverable revenue opportunities.
Because most payers limit retrospective review periods to within twelve (12) months of the final payment or denial, the audit period will begin at the project start date and extend backward twelve (12) months.
No Guarantee of Volume. UTHSA does not solicit or guarantee any specific amount of compensation, volume, minimum, or maximum amount of Services under this RFP or any contract or agreement resulting from this RFP.