Description
The Department of Veterans Affairs is conducting market research to identify capable vendors and explore alternative solutions for revenue operations workflow, payer compliance, and technical process optimization. The goal is to determine the best approach to support the Revenue Operations team. The procurement may include the renewal of software licenses and associated technical support services. The Government is open to considering different technologies and strategies, including COTS/SaaS integrated LC/NC RO case management solutions.
Key aspects of the project include:
• Revenue operations workflow functionality and cloud computing
• Payer compliance and technical process optimization
• Scenario modeling of insurance carrier agreements
• Reports displaying agreements in various views and search capabilities
• Adjustment codes, bill type, and estimated allowance at the bill, medical center, Veterans Integrated Services Network, and CPAC level
• Monitoring of front-end process, including verification of third-party insurance and related authorization or pre-certification activities
• Third-party claim monitoring, follow-up, and account resolution processes
• Communication regarding resolution of specific encounters across all areas of the CPAC revenue cycle
• Monitoring, communication, and resolution of various first-party processes, including claims matching, bankruptcies, repayment plans, aged debt, etc.