SW-121147 - USA (New Jersey) - RFI for Healthcare Data Auditing Billing and Coding Optimization Software - Deadline November 6,2026

Vendor needs to provide healthcare data auditing billing and coding optimization software.1. Enterprise platform and user experience:– An enterprise–capable solution or interoperable suite available to authorized users across geographically distributed facilities.– Role–based access, configurable menus, work queues, dashboards, alerts, and administrative controls.– A coherent user experience across coding, documentation integrity, billing, compliance, workflow, and reporting functions, while allowing modular components when beneficial.2. Coding and encounter management:– Support identification, assignment, review, coding, recoding, completion, and tracking of inpatient, outpatient, surgical, emergency, behavioral health, long–term care, and other encounters.– Support current diagnosis, inpatient procedure, professional procedure, supply, dental, and other applicable code sets, including effective–date validation and version management.– Support code lookup and integration with one or more coding reference or encoder products through documented interfaces.3. Clinical documentation integrity:– Provide independent, role–appropriate work queues for concurrent and retrospective review.– Identify potential documentation improvement opportunities using configurable criteria and transparent logic.– Capture documentation–review codes, grouping results, severity, risk, expected length of stay, quality indicators, and comparison with final coded outcomes where applicable.4. Billing, claim editing and compliance:– Provide institutional and professional claim review before and, where needed, after submission.– Apply national, local, payer, technical, coding, medical necessity, provider identifier, present–on–admission, grouping, sequencing, and Government–defined edits.– Support individual and batch claim review, transparent edit explanations, configurable messages, and authorized maintenance of custom rules.– Identify incomplete, duplicate, non–billable, held, cancelled, retrospective–insurance, and same–day related encounters and preserve supporting rationale.5. Workflow and auditability:– Enable secure communication among coding, documentation integrity, billing, clinical, utilization review, compliance, supervisory, and technical personnel.6. Reporting, analytics and data portability:– Provide configurable dashboards, recurring reports, ad hoc analysis, data mining, filtering, sorting, alerts, and exports.– Support enterprise, regional, facility, service, team, role, and user–level reporting for workload, timeliness, productivity, accuracy, quality, compliance, workflow, and revenue status.