Claims Coding, Billing and Collection Services

The West Virginia Office of Shared Administration, on behalf of the Department of Health Facilities, is issuing an open‑end Request for Quotation to establish a statewide contract for comprehensive inpatient and outpatient claims coding, billing, and collection services for three state‑owned hospitals. The vendor must operate remotely, integrate securely with the facilities’ electronic health record (Medsphere CareVue) and billing (Optimum) systems, and manage the full revenue‑cycle process—including coding (ICD‑10‑CM/PCS, CPT, HCPCS), claim submission via Availity, denial management, patient statements, and collections. Mandatory qualifications include at least five years of hospital billing experience, certified coders (AHIMA/AAPC), HIPAA‑compliant security (SOC 2 Type II, HITRUST), and the ability to commence work within 30 days of award. Performance metrics require a 92‑95 % first‑pass claim resolution rate, ≥ 94 % clean‑claim rate, and monthly reporting of staffing, financials, and denial analytics. The contract is open‑ended with monthly or annual fee structures based on a percentage of the estimated $2 million monthly collections. • Remote, off‑site service delivery for three WV state hospitals (psychiatric and acute care). • Full revenue‑cycle management: coding, claim submission, denial handling, patient billing, and collections. • Required integrations: Medsphere CareVue EHR, Optimum RCM, Availity clearinghouse (HL7/E‑DI). • Minimum vendor qualifications: 5 + years hospital billing experience, certified coders, SOC 2/HITRUST security, staffing continuity plan. • Performance standards: 92‑95 % first‑pass resolution, ≥ 94 % clean claims, 98 % coding accuracy, monthly reporting deadlines. • Fee based on a percentage of $2 M monthly collections; contract begins within 30 days of award and continues as an open‑end agreement.