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Approve a 2 year contract with eSolutions, Inc. (formerly known as ClaimRemedi), for $132,000 to provide electronic claims management services for the period of July 1, 2017 through June 30, 2019; and Authorize the County Administrator to execute the contract and any subsequent amendments that remain within budgeted appropriations
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health & Social Services (H&SS) recommends that the Board approve a 2 year contract with eSolutions, Inc. (formerly known as ClaimRemedi) for $132,000 to provide electronic claims management services for the period of July 1, 2017 through June 30, 2019; and Authorize the County Administrator to execute the contract and any subsequent amendments that remain with budgeted appropriations.
SUMMARY
On June 28, 2016, the Board approved a 1 year contract with ClaimRemedi (now known as eSolutions, Inc.) for $66,000 for the period of July 1, 2016 through June 30, 2017. Services provided include critical access through a secure web-based portal of payer eligibility and benefit information of clients being served at the County clinics. This proposed 2 year contract for $132,000 for FY2017/18 through FY2018/19 maintains the continuum of services needed to support clinic operations.
FINANCIAL IMPACT
The contract costs for FY2017/18 are included in H&SS Family Health Services Division FY2017/18 Adopted Budget. The contract costs for FY2018/19 will be included in the H&SS Family Health Services Division Requested Budget. There is no additional financial impact to the County General Fund.
DISCUSSION:
Hospitals, skilled nursing facilities, physicians’ offices and health providers, such as the County Clinics, utilize automation software to assist in the medical billing and revenue cycle management process. The County Clinics provide primary care to low income, uninsured and underinsured patients and coverage is accepted through Medi-Cal and/or Medi-Care. Payments for health services are received from claims that have been rendered as a result of clinic encounters. eSolutions, Inc. provides a web-based accessible system that provides a complete claim lifecycle management service to include: electronic claims submission, claim scrubbing, on-line editing, claim history/status, response reporting, analytics package, eligibility services, and enhanced payer connectivity.
In previous years, the ClaimRemedi, Inc. contract has been renewed annually as part of the H&SS Contract Master List Board item, an item put forth before the Board towards the end of every fiscal year to approve several H&SS contracts, plus accumulative aggregate of individual client service agreements. However, since ClaimRemedi has been acquired by eSolutions Inc., the vendor stipulated new contract language along with a multiple contract term. On June 28, 2016, the Board approved a one-year contract with ClaimRemedi. The proposed 2 year contract for $132,000 is budgeted based on the yearly contract amount. However, since this contract is fee-based, invoices are dependent on the number of claims and eligibility transactions.
Services maintained through eSolutions, Inc. will help to increase payer eligibility and benefit information, claim scrubbing, report generation, and reduction of claim denials and acceleration of revenue generated.
ALTERNATIVES:
The Board could choose not to approve this contract with eSolutions, Inc. This is not recommended as it would result in the inability to complete health services payer eligibility and benefit confirmation for clients being served at the County Clinics.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved the contract for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION