Medicare Claim Management, Revenue Cycle Management and Insurance Eligibility Service

The Indian Health Service is seeking a secure software solution to manage Medicare claims, revenue cycle operations, and insurance eligibility verification. The agency needs to maximize third-party revenue collection and streamline its healthcare business processes. The goal is to establish an efficient workflow that integrates eligibility checks with claims management while eliminating repetitive manual tasks. The requested software must connect directly to the Medicare Direct Data Entry and Fiscal Intermediary Standard System. It must enable batch eligibility checks, import eligibility data files, and maintain a complete transaction history with precise coverage start and end dates. The system must process emergency, inpatient, outpatient, and specialty clinic claims while applying rigorous custom business rules and monitoring service usage thresholds. Users require a customizable dashboard to prioritize tasks, assign patients, and manage payers in a single session. This procurement is set aside exclusively for Indian Small Business Economic Enterprises. Eligible bidders must be onshore organizations based in the United States. The agency requires the performance of all work to be conducted offsite. The agency is currently looking for proposals to determine the budget and has not disclosed a specific funding limit.