Specifications include, but are not limited to: The purpose of this Request for Proposal (RFP) is to solicit offers for a Medical Claims Clearinghouse Solution for billing services to submit electronic claims and receive payments twenty four (24) hours a day, seven (7) days a week, from the Prepaid Health Plans (PHPs) for the North Carolina Department of Health and Human Services (NCDHHS) Division of Public Health’s (DPH) Childhood Lead Poisoning Prevention Program (CLPPP) and State Laboratory of Public Health (SLPH) (Division). The Solution will have a Graphical User Interface (GUI) for Direct Data Entry (DDE), which at a minimum, will be used to verify patient eligibility information, claim editing prior to submission, and claims submission. The Solution will also include support for processing American National Standard Institute (ANSI) X12 formatted files for such tasks as Health Care Eligibility Benefit Request and Response Transaction inquiry (270/271), electronic claims submission (837 professional), Electronic Remittance Advice (835), and other Centers for Medicare and Medicaid Services (CMS) claim formats, as needed.
