SW-28962 - USA (Texas) - Integrated Software Solution - Deadline November 18,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: SW-28962

Government authority located in Texas; USA based organization looking for expert vendor for integrated software solution.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide integrated software solution to produce diagnosis related and other groupings based on inpatient and outpatient claims and encounter data to produce information, adjusted for risk, for use in healthcare claims adjudication, analytics, and quality measurement and to support HHSC and DSHS led healthcare quality and value-based improvement and incentive initiatives.
1. Produce the Centers for Medicare and Medicaid Services (CMS) Medicare Severity - Diagnosis Related Groupers codes (MS-DRGs) for inpatient services -- based on healthcare claims and encounters for inpatient hospital services that categorize patients with health conditions that are identified by diagnosis codes.
2. Produce the All Patient Refined Diagnosis Related Grouper codes (APR-DRGs) based on healthcare claims and encounters for inpatient services with additional diagnostic categories (compared to MS-DRGs), particularly for new born, pediatric and maternity patients, as well as more granular information on severity of illness and risk of mortality.
3. Produce the CMS Ambulatory Payment Classification (APC) for outpatient services -- based on healthcare claims and encounters for outpatient hospital services that categorize patients with health conditions identified by diagnosis codes.
4. Produce Enhanced Ambulatory Patient Grouper codes (EAPGs) for outpatient services that group substantially all medical outpatient services, including services provided in nonhospital settings.
5. The software should have the capability to receive and output data in a variety of formats and to interface with a variety of host systems, including to support the adjudication of hospital claims in real time.
6. The capabilities described above should be provided as integrated software, such that core functions, like the production of reports on potentially preventable events, can be performed without additional application development.
7. The integrated software should be provided with options to run in a variety of operating environments, including the Microsoft Windows environment and as a JAVA-based, platform-independent solution.
(2) All question must be submitted no later than November 8, 2019.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Monday, 18 November, 2019

Question Answer Deadline : Friday, 8 November, 2019

Category : Software, System and Application, Medical Billing and Coding

Country : USA

State : Texas

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