Specifications include, but are not limited to: • The Contractor must provide a vendor-hosted, SaaS, system for access management, performance management, and claims management for medical billing. This system should have the ability to enter medical billing data, generate patient statements, account numbers, medical record numbers, process claims to third parties (clearinghouse), and manage the accounting cycle for medical billing/receiving. • The Contractor must comply with the rules, regulations and policies as outlined by the Centers for Medicare & Medicaid Services (CMS) Regulations & Guidance; applicable Idaho Medicaid Program Provider laws, rules and applicable administrative codes, and to ICD-10 standards. • The Contractor systems must follow procedural and technological safeguards to continuously meet confidentiality requirements in accordance with the most up to date IRS and HIPAA compliance standards. • The Contractor systems must maintain an environment current and in compliance with IRS, HIPAA and other applicable industry standards for protecting medical records and personally identifiable information on an ongoing basis. • The Contractor must adhere to Department requirements for Protections and Disclosure of Department records IDAPA 16.05.01...
