Critical Access Hospital Claims Denial Dashboard Design and Impl

Hawaii Medicare Rural Hospital Flexibility Program

Critical Access Hospital Claims Denial Dashboard Design and Implementation

I. Introduction

Overview and Purpose

The Hawaii State Department of Health (DOH), Family Health Services Division (FHSD), Office of Primary Care and Rural Health (OPCRH), is seeking to procure services to design and implement a claims denials dashboard for a critical access hospital (CAH), and to provide training on the dashboard to key CAH staff.

II. Scope of Services

A. Specifications and Requirements

The Bidder shall describe in detail how, from June 1, 2026, or upon DOH FHSD approval, through August 31, 2026, it will provide the following:

Design and implement a claims denial dashboard tailored to a CAH's environment, including the following activities and capabilities:

Data Integration

Combine electronic medical record (EMR) data and payer remittance (835 or equivalent) files to create a unified denial dataset.

Establish data mapping and validation processes necessary to support ongoing refreshes of denial data.

Denial Analytics & Visualization

Develop aggregate views of denials by, at a minimum:

Payer

Service line

Denial code/reason

Enable drill-down capabilities from aggregate views to patient-encounter level details to support operational review and follow-up.

Incorporate standard filtering and segmentation (e.g., date range, location, service type) to allow users to explore denial trends over time.

Workflow Attribution (High-Level)

Within the dashboard, provide high-level attribution of denied claims back to major components of the revenue cycle workflow (e.g., registration, coding, billing, follow-up) to support operational awareness and prioritization.

Present these attributions in a manner that is understandable to CAH leadership and staff, recognizing varying levels of data and analytics experience.

The vendor will also provide focused training to ensure that the CAH's staff understands how to us the dashboard in their day-to-day work. Activities will include:

Facilitate training sessions with key staff to walk through the dashboard, including how to navigate views, apply filters, and review denial details.

Confirm that designated users understand how to interpret the core denial metrics and visuals presented in the dashboard so they can use the tool to support denial management and revenue integrity activities.

By the completion of the project, there will be delivered a functional claims denial dashboard that the CAH can use to monitor denial trends, communicate denial performance, and support internal decision-making related to revenue integrity.

B. Period of Performance

The period of performance is from June 1, 2026 to August 31, 2026.

III. Experience of Capability

The awarded vendor:

1. Must demonstrate a thorough understanding of the purpose and scope of this service, as well as demonstrate necessary knowledge, skills, abilities, experience relating to the delivery of the proposed services. The applicant shall have verifiable relevant experience for the last seven (7) years in providing service activities.

2. Shall provide expertise through regularly scheduled discussions with the OPCRH, which may occur face-to-face, by phone, or by electronic means of communication.

3. Shall demonstrate necessary skills, abilities relating to the delivery of the proposed services by providing a description of projects and/or contracts pertinent to the proposed services.

4. Must demonstrate the necessary requirements to contract with the DOH and have knowledge and familiarity working within the context of DOH policies, rules, and regulations related to procurement processes.

IV. Compensation and Payment

A. Submitting a Proposal

1. Submit a proposal for following the requirements of the scope of work to provide the requested services for the period of June 1, 2026 to August 31, 2026;

2. A lump sum budget is not to exceed $18,000 for the entire project. The lump sum bid is negotiable and is dependent on the needs of the OPCRH. To estimate costs for the lump sum bid, please review Section II. Specification and Requirements, items 1-10;

3. The attached Cost and Timeline Proposal must be completed and submitted as a part of the bidder's response to this solicitation.

4. For technical assistance with HIePRO, please call the Hawaii Information Consortium at 808-695-4620 or send email to hiepro@hawaii.gov.

B. Procedure for Invoicing

The Awardee shall submit invoices based upon the completion of deliverables as specified in the Cost and Timeline Proposal [see last page].

C. Form of Payment

The Awardee shall be equipped to accept State purchase orders as a form of payment.

D. Fee to Hawaii Information Consortium (HIC)

Please be advised that the Awarded Vendor will be responsible to pay HIC a fee of 0.75% of the award. HIC will bill you directly via e-mail and you can make payment by sending a check via regular mail.

E. Hawaii Compliance Express (HCE)

State agencies can award amounts of $2,500.00 or greater only to those companies that are registered with HCE. The HCE is an electronic system that allows companies doing business with state or county agencies to quickly and easily obtain proof that they are compliant with applicable laws. The HCE certificate, "Certificate of Vendor Compliance," is submitted in place of a tax clearance, labor certificate, and a Certificate of Good Standing required in Hawaii Revised Statutes (HRS) 103D-310(c) and Hawaii Administrative Rules (HAR) 3-122- 112. To get started, a Taxpayer Identification Number (FEIN or SSN), Hawaii Tax ID#, Unemployment Insurance Identification number (UI ID#), if applicable, and a valid credit card for the $12 annual registration fee will be needed apply for the HCE service. Companies can register at

and click on the Frequently Asked Questions link for further details. For assistance with questions on HCE registration, please call the Hawaii Information Consortium at 808-695-4620 or email .

Cost and Timeline Proposal