MB-10411 - USA (California) - Out-Of-State Medicaid Billing, Commercial Insurance Billing and Denial Follow-Up Services - Deadline September 18,2026

(1) Vendor needs to provide out–of–state Medicaid billing, commercial insurance billing and denial follow–up services. – Provide maximizing revenue recovery through the efficient processing, submission, and resolution of out–of–state Medicaid claims, as well as the complete billing, submission, and follow–up process for commercial insurance claims, including the systematic resolution of denied claims.– Out–of–State Medicaid Billing Services:• Prepare, submit, and process claims to out–of–state Medicaid programs in all fifty states for services rendered at county healthcare facilities.• Verify patient eligibility for out–of–state Medicaid programs and, when applicable, assist with enrollment of eligible patients into appropriate out–of–state Medicaid programs to facilitate claim payment.• Systematically monitor, track, and follow up on all submitted claims to ensure timely adjudication.– Commercial Insurance Billing and Denial Follow–up Services:• Process, prepare, and submit commercial insurance claims in accordance with payer guidelines.• Receive, review, and analyze denied commercial insurance claims to identify root causes for denial.including eligibility issues, authorization requirements, coding errors, billing inaccuracies, and timely filing disputes.• Correct and resubmit claims that were denied due to errors, missing information, or other correctable issues.– Utilize secure, encrypted file transfer methods for all data exchanges with the County, in compliance with HIPAA security requirements.– Maintain and utilize claim tracking software capable of providing real–time status updates on all claims, denials, appeals, and resolutions.– Provide comprehensive reporting capabilities, including monthly, quarterly, and annual reports on claim volumes, recovery rates, denial rates, appeal outcomes, aging of accounts receivable, and other key performance metrics as requested by the county.(2) The contract period will be for two years. (3) All the questions must be submitted no later than September 4, 2026.