RFI 2024-07 Medi-Cal Billing and Revenue Cycle Management Ventura County Probation Agency

This is a Request for Information (RFI) to identify potential providers of Medi-Cal billing and revenue cycle management for Ventura County Probation Agency (VCPA). VCPA oversees the county’s youth correctional facility for up to 85 youth and young adults ages 12 to 25. All health-related services in the youth facility are rendered by a team of clinical and non-clinical professionals 24 hours per day, 7 days per week. In the future VCPA will be submitting Medi-Cal claims to the State of California’s Medi-Cal system (CA-MMIS) for reimbursement of pre-release services for youth in the last 90 days of incarceration. The Medi-Cal services are divided into two parts, including fee-for-service and bundled rates. Medi-Cal Fee For Service includes the following service categories:
Clinical consultations (physical, mental health, substance use). Laboratory and radiology services performed offsite. All medications, including physician-administered drugs and long-term injectables. Medication Assisted Therapy (MAT), including treatments and counseling. Reimbursements for in-reach providers working in the facility.
Medi-Cal Bundled rates include the following service categories:
Health Risk Assessment Care Coordination Care Manager Warm Handoff Development of a Reentry Care Plan Post-Transition Support
Bundled rates are equivalent to capitated rate payment methodologies, and the VCPA would be reimbursed by the State of California for completing a series of steps related to each service bundle. Frequency limitations do exist for each of the bundled services listed above. VCPA does not currently own or operate an electronic health record system, practice management system, or medical billing system. Purpose: VCPA is looking to identify existing service providers for Medi-Cal billing and revenue cycle management services to generate, submit, and manage claiming to the State of California.