Medicare Claim Management, Revenue Cycle Management and Insurance Eligibility Service

The Indian Health Service is seeking a secure exchange data software solution to provide Medicare claim management, revenue cycle management, and insurance eligibility services. The agency needs to enhance and maximize third-party revenue and collection activities while maintaining an efficient, streamlined process for claims management and eligibility verification. The goal is to eliminate repetitive tasks, save time through batch imports, and improve workflow management using a customizable dashboard that prioritizes patients, payers, and daily task lists. The requested scope of work covers connectivity to the Medicare Direct Data Entry and Fiscal Intermediary Standard System, automated claims status reporting, and payment floor details. The software must process all claim types, including emergency, inpatient, outpatient, and specialty clinics, while providing both solicited and unsolicited claims status. Additionally, the system must perform batch eligibility checks, provide start and end dates of coverage, offer access to transaction history, apply rigorous custom business rules, and allow self-monitoring of usage thresholds. 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 looking for proposals to determine the budget for this project. The source document does not specify evaluation criteria or key dates for this opportunity.