Specifications include, but are not limited to: University Medical Center of Southern Nevada (UMC) is soliciting proposals from qualified vendors to provide zero balance review services. a. PROPOSER must be able to send and receive emails via Transport Layer Security (TLS) encryption to ensure strict adherence to patient privacy. b. PROPOSER will work all accounts placed with PROPOSER by UMC remotely. c. PROPOSER will identify accounts that have been denied, underpaid or over-adjusted and are due additional reimbursement, based on contracted rates. d. PROPOSER will follow protocol set forth by each payers’ contracts when pursuing additional reimbursement within the timely filing limit. e. PROPOSER’s process of working the accounts placed will include the following at minimums: i. Data analysis of zero dollar accounts to identify potential underpayments. UMC will provide PROPOSER with zero balance accounts based on agreed upon time interval. ii. Contract rate review established by managed care agreements and state fee schedules to identify potential shortages. iii. If a shortage is identified, PROPOSER will rebill claim or appeal as necessary for additional reimbursement. iv. If an account requires a correction on the claim, PROPOSER will rebill the claim as a reconsideration or appeal as required by the payer. v. If an account requires an electronic rebill, PROPOSER will submit a request to UMC to submit the rebill as required. vi. If an underpayment is due to missed charges or a coding error, the account will be referred to UMC to audit and correct. PROPOSER will rebill the corrected claim unless the corrected claim is required to be billed electronically. If the rebill is required to be submitted electronically, PROPOSER will submit the request to UMC to complete. vii. PROPOSER will follow up and notate accounts submitted for additional reimbursement consistent with UMC’s requirements. viii. A monthly report must be sent by PROPOSER identifying trends, underpaid accounts and overall recovery. The reports can be customized at no additional cost to UMC.
