DBH - RFI for Medical Clearinghouse solution

The agency is seeking information from medical clearinghouse vendors capable of supporting a fully integrated workflow within the Epic EHR platform. Solutions should provide real-time eligibility verification, electronic claim submission, receipt and processing of payer responses (including 277/835 transactions), integration with the Medicare DDE system, and support for electronic funds transfer (EFT) enrollment and management. Clearinghouse solutions are expected to support specialized billing requirements (e.g., SUD services and state Medicaid plans), enhance viability into claims, eligibility, and reimbursement trends, and ensure compliance with HIPAA, CMS guidelines, and state mental health regulations. Vendors should offer scalable, HIPAA-compliant platforms, designed to optimize claim throughput and reduce denials specific to behavioral health and psychiatric services across a multi-hospital network.
The goals of this RFI are the following:

Understand what solutions are in the marketplace,
Understand solution coverage and ability to meet OhioDBH requirements,
Identify budgetary and cost estimates,
Understand typical project durations for implementation,
Identify suppliers with a proven track record,
Confirm supplier ability to comply with OhioDBH standard contract provisions.

The objective of this project is to explore the top vendors in this industry and to discover common features/services for vendors in today’s modern healthcare billing practices and polices

The Ohio Department of Behavioral Health (OhioDBH) has a psychiatric healthcare system that provides inpatient and outpatient behavioral health services. The agency currently uses Epic EHR and are seeking letters of interest from qualified vendors who can provide a healthcare claims clearinghouse solution that supports behavioral health operations, enhances revenue cycle performance, and ensures compliance with federal and state regulations. These services are intended to be used by the OhioDBH for its six regional psychiatric hospitals and outpatient centers to help aid in revenue cycle workflow. The intent of this RFI is not a solicitation to procure, but rather to gain familiarity with currently marketed products and services for this type of system. This RFI contains preliminary information to serve as a platform to initiate discussion with the contractor community. This information is non-binding to OhioDBH, regarding any future solicitation that may or may not be issued by this agency.