Description
The Navajo Nation is seeking a qualified vendor to provide comprehensive ambulance billing and coding services across Arizona, New Mexico, and Utah. The contractor must integrate with the agency’s ePCR system, submit clean claims within 72 hours, manage denials within five business days, and deliver real‑time reporting dashboards while complying with tribal, federal, and state regulations. The contract is for a three‑year term with performance‑based metrics and requires certified coding staff and multi‑state Medicaid credentials.
• Core services: ePCR integration, medical coding (ICD‑10/HCPCS), claim submission, payer management, denial handling, and patient invoicing.
• Compliance: HIPAA, OIG, FTCA, and Navajo Nation privacy/sovereignty requirements; mandatory enrollment in AZ, NM, UT Medicaid programs.
• Deliverables: Online dashboard, monthly financial reports, participation in annual audits, and adherence to 95 % clean‑claim submission within 72 hours.