ARFQ-0512-OHF2700000001-1 | Claims Coding, Billing and Collection Services

The State of West Virginia, through the Department of Health Facilities, is seeking an open-end Agency Master Agreement for comprehensive inpatient and outpatient claims coding, billing, and collection services. This contract supports three state-owned facilities: Mildred Mitchell-Bateman Hospital, William R. Sharpe, Jr. Hospital, and Welch Community Hospital. The scope of work includes the identification and coding of diagnoses and procedures, electronic submission of claims to Medicare, Medicaid, and private carriers, and the management of patient invoicing. The contract is structured over a four-year period, with vendors required to quote a percentage fee for recovery based on a monthly estimate of 2,000,000.00 dollars. Qualified vendors must possess at least five years of experience in hospital billing for acute care, psychiatric, and outpatient clinics, and must provide proof of coder credentials from AHIMA or AAPC. Strict performance benchmarks are mandated, including a 98 percent accuracy level for coding and billing, a clean claim rate of 94 to 97 percent, and a first-pass resolution rate target of 92 to 95 percent. Security requirements are rigorous, requiring SOC 2 Type II or HITRUST accreditation, network encryption, and full compliance with HIPAA and the HITECH Act. Additionally, the successful vendor must provide a performance bond equal to 100 percent of the contract value and maintain cyber liability and errors and omissions insurance. Bids are due by October 1, 2026, via the wvOASIS portal or physical delivery to Charleston, West Virginia.