Medi Cal Billing Services for CalAim

The County of Kings is seeking a vendor to provide Medi-Cal billing services for the California Advancing and Innovating Medi-Cal (CalAIM) initiative. The vendor will be responsible for preparing, submitting, and tracking Medi-Cal claims for eligible services, as well as providing administrative assistance for medical, mental health, and supportive health services. The contract is expected to be for a term of three years, with the option to renew for up to two one-year terms. The services will be provided to the Kings County Jail and Kings County Juvenile Hall. Some key responsibilities of the vendor include: • Preparing, submitting, and tracking Medi-Cal claims for eligible services • Generating and forwarding requests for payment for health care services that qualify for reimbursement under CalAIM • Verifying that all submissions are complete, correct, and filed within required deadlines • Tracking the progress of submitted requests and taking necessary actions to secure timely payment • Addressing any rejected or incomplete submissions by providing additional documentation and resubmitting as required • Comparing payments received against submitted requests to maintain precise financial records • Delivering full administrative assistance for medical, mental health, and supportive health services eligible for CalAIM reimbursement • Providing guidance and instruction to County personnel regarding claims procedures and system operations • Optimizing operational workflows to enhance efficiency and minimize administrative workload for County staff • Complying with all relevant federal and state legal requirements and professional standards to protect the privacy and integrity of patient data • Continuously evaluating and enhancing information security measures to reduce risks and ensure ongoing alignment with regulatory obligations • Creating and putting into operation specialized billing and administrative strategies designed to meet the distinct operational requirements and objectives of the County's detention facilities • Collaborating with County leadership to identify facility-specific needs and modify services as necessary to improve efficiency and achieve desired results