263411 - Billing Clearinghouse Services

The Alabama Department of Public Health (ADPH) is seeking a supplier to provide an Electronic Submission of Medical Documentation System to access the Fiscal Intermediary Standard System (FISS) through Direct Data Entry (DDE). The system must meet all HIPAA requirements for electronic transmission of health information and ensure data security through robust encryption and access controls. The supplier must provide responsive technical support and maintain continuous system availability and performance. The scope of work includes claim submission and processing, file transfer service, Medicare analytics, Medicare direct data entry verification, claims management, remittance and reconciliation, and system integration and compatibility. Key features of the required system include: • Support for batch and real-time claim submissions • Pre-submission validation and edit checks • Detailed error reports for rejected claims • Resubmission of corrected claims • File transfer service for 837 and 835 files • Medicare analytics and tracking of claims • HIPAA-compliant connection to Medicare's DDE and FISS system • Claims management and tracking • Remittance and reconciliation support • System integration and compatibility with ADPH's existing billing systems and data formats