Provision of Emergency Medical Patient Billing Services on an Annual Contract

September 16, 2026
REQUEST FOR PROPOSAL
RP028-26
The Gwinnett County Board of Commissioners is soliciting competitive sealed proposals from qualified
service providers for the Provision of Emergency Medical Patient Billing Services on an Annual Contract
with four (4) additional one year options to renew for the Department of Fire and Emergency Services.
Proposals must be returned in a sealed container marked on the outside with the Request for Proposal
number and Company Name. Proposals will be received until 2:50 P.M. local time on October 7, 2026 at the
Gwinnett County Financial Services - Purchasing Division - 2nd Floor, 75 Langley Drive, Lawrenceville,
Georgia 30046. Any proposal received after this date and time will not be accepted.
Proposals will be publicly opened, and only names of submitting service providers will be read at 3:00 PM.
The opening will be virtual ONLY. To access the proposal opening, click here to join, or join by dialing 1-323-
676-6170. Access Code is: 562 823 287#. A list of service providers submitting proposals will be available the
following business day on our website www.gwinnettcounty.com.
Questions regarding proposals should be directed to Diana Turner, Purchasing Associate II at
Diana.Turner@GwinnettCounty.com or by calling 770-822-8727, no later than September 24, 2026.
Proposals are legal and binding upon the service provider when submitted. One (1) unbound original, four (4)
copies, and one (1) digital copy on a flash drive should be submitted.
Successful service provider will be required to meet insurance requirements. The Insurance Company should
be authorized to do business in Georgia by the Georgia Insurance Department, and must have an A.M. Best
rating of A-10 or higher.
Gwinnett County does not discriminate on the basis of disability in the admission or access to its programs
or activities. Any requests for reasonable accommodations required by individuals to fully participate in any
open meeting, program or activity of Gwinnett County Government should be directed to the ADA Coordinator
at the Gwinnett County Justice and Administration Center, 770-822-8165.
The written proposal documents supersede any verbal or written prior communications between the parties.
Selection criteria are outlined in the request for proposal documents. Gwinnett County reserves the right to
reject any or all proposals to waive technicalities, and to make an award deemed in its best interest.
Award notification will be posted after award on the County website, www.GwinnettCounty.com and
companies submitting a proposal will be notified via email.
We look forward to your proposal and appreciate your interest in Gwinnett County.
Diana Turner
Purchasing Associate II
The following pages should be returned as part of your proposal:
Proposal Fee Schedule, Page 13 (Separate Sealed Envelope)
Service Provider Information, Page 14
References, Page 15
Code of Ethics Affidavit, Page 38
Contractor Affidavit, Page 39

RP028-26 Page 2
PURPOSE
The Gwinnett County Board of Commissioners (Gwinnett) is soliciting proposals from qualified service providers to
provide a comprehensive emergency medical billing and records management system which will integrate with ESO
Solutions field reporting system for the Gwinnett County Fire and Emergency Services (GCFES) Department. Service
providers should provide a format, time frame, fee schedule to accomplish the work, and references. Gwinnett County
reserves the right to award the contract based upon the best interest of the County. Gwinnett County assumes no
liability, financial or otherwise for the preparation, publication, or any travel related to the preparation or submission of
this Request for Proposal (RFP).
GCFES realizes that specialty companies may be able to capitalize on revenue streams and thus enhance total
revenues through expanded operations that are beyond the scope of GCFES.
GCFES does not support the use of aggressive collection practices to enhance revenues.
BACKGROUND
GCFES is located in Northeast Metro Atlanta, Georgia and has a land area of 437 square miles and a population
approaching 1,000,000 citizens.
Gwinnett employs approximately 960 firefighters, paramedics, emergency medical technicians, EMT-I and EMT-A. The
annual call volume is approximately 95,000 of which approximately 48,500 are medical transports. Requests for fire
and emergency medical services (EMS) increase at a rate of approximately 2% per year.
The department is divided into five (5) battalions consisting of 31 fire stations housing 31 engines, 12 ladders, two (2)
staffing squads, 33 Advanced Life Support (ALS) transport medic units, as well as other specialty units and support
staff.
GCFES collects medical data in the field using ESO Solutions. EMS personnel will complete the required computerized
patient care report, including billing information and submit the file, via cellular network, to an offsite location where
the server resides. The reports are reviewed by field staff, station officers, medical supervisors, and quality
improvement officers remotely at their respective stations. The reports are uploaded immediately to Georgia State
Department of Public Health - State Office of EMS.
For the year 2025, EMS generated 48,500 transports and entered 95,000 Patient Care Reports (PCR's) including no
transports. EMS typically transports patients to four (4) in-county hospitals as well as twenty-five (25) out-of-county
area hospitals.
GCFES' current payer mix is as follows:
i. Medicare 45%
ii. Private Insurance 32%
iii. Medicaid 10%
iv. Patient 9%
v. Other 4%
EMS REVENUE BACKGROUND AND INFORMATION
GCFES bills for services on all medical transports. Services delivered on scene are not charged except when ALS
services are needed to determine end of life on scene. The billing cycle begins with the generation of a trip report at
time of service and completion of the billing information. GCFES ambulance trip reports are completed utilizing ESO
Solutions electronic patient care system which transmits the patient care report electronically to the EMS billing
service.
GCFES maintains a full-time EMS billing section comprised of two (2) full-time and (2) two part-time employees. The
section is responsible for being the liaison between GCFES and the third-party EMS billing company. This section is
also responsible for processing refunds to patients or insurance companies due to over payment of a bill. GCFES
captures the pertinent medical information for all services rendered and submits this to the billing company.
The current charges that GCFES utilizes are $975.00 flat rate plus $15.00 per mile, with an average transport of 8.3
miles.

RP028-26 Page 3
SCOPE OF SERVICES
The successful service provider will be expected to provide comprehensive emergency medical services electronic
billing. The service provider will be expected to function as an independent service provider. Rates charged for all
services rendered for County transports shall be those rates adopted by the Gwinnett County Board of Commissioners
and GCFES may modify the rates at any time. All policy decisions will be made by Gwinnett and administered by the
service provider.
The successful service provider will be expected to perform all necessary services related to the development,
implementation, operation, and maintenance of a medical billing system. This includes:
i. Associated software/hardware
ii. Establishment of master files and sub files
iii. Invoice tracking system
iv. Accounts receivable (AR) by patient name/account system
v. Cash management system
vi. Related financial reports
The successful service provider, in carrying out the above, will be expected to cooperate with GCFES to determine the
training, form requirements, necessary files, and other materials and services as required for initiating and maintaining
these operations.
Accounts sent to collections must be written off the service provider's receivable balance. A monthly report detailing
the accounts removed from the Accounts Receivable (AR) balance must be provided to Gwinnett County.
The service provider will provide a monthly report for accounts to be considered for write off with:
i. Patient's name
ii. County assigned electron patient care report (ePCR)/case number
iii. Insurance type
iv. Insurance company name
v. Adjustment code/reason
vi. Date of service (DOS) amount
The report must provide a total of the write-off dollar amount.
If GCFES determines untimely filing denials are the result of the service provider's actions or lack of actions, the
service provider will be responsible for reimbursing GCFES for the lost revenue and will not be permitted to attempt to
collect from the patient.
GCFES will be provided with 24/7 access to all data transmitted to the service provider. Approved GCFES employees
shall be provided with the ability to run reports from the data utilizing approved report writing software. If full access is
not available to the master database, GCFES will require daily downloads to a database that resides at Gwinnett
County. The service provider will provide a data dictionary for the master and all associated databases.
All monthly reports are to be provided to GCFES by the 10th business day of the month.
The successful service provider will provide monthly performance reports on GCFES' ePCR data and performance to
include but are not limited to patient demographics, insurance information, patient/guarantor signatures, patient DOB,
patient address, and medical record number by Agency and by individual medic. These reports will also provide a
comparison of GCFES to other EMS Agencies of similar size throughout the United States.
ADDITIONAL INFORMATION
While each proposal will be considered objectively, the County assumes no obligation to accept or act on any
proposal.
The County assumes no liability for any costs incurred in preparing or submitting any proposals, including costs in
relation to any opportunities for interview or presentation.
The County will check all references furnished and will consider responses received in determining the award.

RP028-26 Page 4
Service providers seeking an award of a Gwinnett County contract may not initiate or continue any verbal or written
communications regarding a solicitation with any County officer, elected official, employee or other County
representative without permission of the Purchasing Associate named in the solicitation between the date of the
issuance of the solicitation and the date of the final contract award by the Board of Commissioners. Violations will be
reviewed by the Purchasing Director. If determined that such communication has compromised the competitive
process, the offer submitted by the service provider may be disqualified from consideration for award.
A person who has legal authority to contractually bind the service provider shall sign the proposal.
PROPOSAL FORMAT
This RFP is intended to be flexible in nature to allow the service provider to be creative in the approach to meeting the
RFP requirements. This should encourage the participation of qualified service providers. It is the intent of Gwinnett to
obtain the best solution for Gwinnett's needs and request all service providers to include any and all system interfaces
that currently exist.
In an effort to protect the investment Gwinnett will make in this project, this RFP seeks assurance that the service
provider:
i. Has a proven track record in the EMS billing industry
ii. Has the ability to meet the needs of Gwinnett County Fire and Emergency Services
iii. Has the ability to deliver quality product
To evaluate the proposals fairly, each service provider is required to describe how each specification or requirement of
the RFP will be satisfied. It is not sufficient to state for example: "Acknowledged", "Understood", "Will Comply", etc.
The format of the response should follow the format of the RFP and reference the item number and repeat the
requirement prior to each response.
The service provider should indicate if the specified requirement in this section can be met and indicate what section,
number and/or letter of the RFP response where an explanation is given.
The service provider should indicate if the specified requirement in this section can be met and indicate what
section, number and/or letter of the RFP response where an explanation is given.
The proposal should be presented in the following order and must include, but is not limited to, the following items.
I. QUALIFICATIONS, PERSONNEL AND COMPANY EXPERIENCE
a. Qualifications
i. Include a description of the service provider's business history.
ii. Provide a company profile detailing financial status, company locations, number of
employees, number of years of operation, and number of years the service provider has
provided EMS billing services.
iii. Provide any former name(s) of the company.
iv. Provide the service provider's legal business name and business designation, address,
telephone number, fax number, and e-mail address. If the service provider is a joint venture,
provide a list of all members.
If the service provider is a subsidiary, identify the parent company. If the service provider is a
corporation, provide the names of all officers of the Board of Directors/Trustees. If the
service provider is a partnership, provide the names of all partners.
v. Disclose any key business partners and/or contractor relationships.
vi. Ensure County Information remains within approved geographic regions and is not
transferred outside the United States without written approval. This includes data gathering,
coding, claims processing, payment posting, customer service, appeals, and claim follow-up.

RP028-26 Page 5
vii. Provide a yearly internal processes audit, upon request, at no cost to Gwinnett County.
viii. Provide a detailed listing of all data breaches including volume of patients affected and
status.
ix. Include an acknowledgement of any controversy about the company's billing practices,
and/or whether Center for Medicare & Medicaid Services (CMS) / Department of Justice
(DOJ) or any entity has ever investigated the company.
x. Provide evidence that the service provider has been engaged in the business of providing
ambulance billing services for the past five (5) years.
xi. Confirm that the service provider's primary business model is EMS billing.
xii. The County also requires the service provider to review the enclosed APPENDIX A - VENDOR
SECURITY & PRIVACY REQUIREMENTS EXHIBIT and respond to all items included by noting
the service provider acceptance to all as written or providing "redline" comments back on the
contents of that document. Exceptions to the County's standard language must be provided
with the proposal response. The ability of the County to accept those edits will be included
as part of the negotiation process, not after the contract is awarded.
b. Personnel
i. Provide a detailed description of the service provider's customer relations policy and
operations.
ii. Provide details regarding employees assigned to this project including education and
experience related to the EMS billing field. Provide background information, assignment, and
any degrees/certifications relevant to the job performed.
iii. Provide the name and title of the primary contact person and secondary contact person who
will be assigned to perform service to GCFES under this proposal and include a commitment
statement concerning the availability of the primary and secondary contact persons.
iv. Provide an organizational chart providing the organizational responsibilities of the persons
who will manage and/or be assigned to perform services under the proposal.
c. Experience
i. Include, in detail, the service provider's credentials in the field of providing emergency
medical billing services.
ii. Demonstrate a proven track record in problem diagnoses and reliable maintenance and
support.
iii. Demonstrate in-house experience managing Ambulance Supplemental Payment Program
(ASPP) services for clients. How many of the service provider's clients participate in the
ASPP? Describe how the service provider assists with the submission for the program.
iv. How many of the service provider's clients participate in the Georgia ASPP program?
v. Detail a comprehensive understanding of Medicare, Medicaid, and other insurance
companies' rules, regulations, and procedures as relating to operations in the State of
Georgia and surrounding states.
vi. Describe the methodology by which the service provider is notified of changes in legislation,
on a state and federal level, and how that information is incorporated into the system by the
required change date and how GCFES will receive notification.

RP028-26 Page 6
vii. Assist GCFES with any discussions held with medical carriers relevant to transport billing
and provide documentation and support on relevant topics whenever possible.
viii. Describe any prior improvements achieved for municipal providers in the State of Georgia.
II. Service Requirements
a. Executive Summary
i. Include a detailed description of why the service provider is qualified to offer the services
outlined herein.
b. Billing Software
i. Include a detailed description of the billing system software needed to meet the
requirements of the RFP.
ii. List any additional licenses that are necessary to fully operate all available aspects of
proposed software to include reporting software.
iii. Software proposed shall comply with the National Ambulance Code set as defined by the
Centers for Medicare and Medicaid Services.
iv. Provide regular systems maintenance updates and provide system repairs as necessary and
advise GCFES a minimum of 72 hours prior to maintenance if access to the system will be
affected.
v. It shall be the responsibility of the successful service provider to constantly update the
billing system so that it complies with the current requirements established by the medical
carriers. This shall include, but not be limited to, revising programming, updating master CPT
coding and descriptions, and updating current ICD codes.
vi. Provide a system disaster recovery plan as well as a full description of system backup and
recovery plans.
vii. Provide GCFES access to the billing agency's database via an unlimited number of users to
monitor daily activity and have 24/7 full access to the service provider's system.
1. Provide logging of all account activities by the service provider and GCFES. Access
to all transactions, notes or activities made or modified on a patient's account for all
dates of service must be available to GCFES.
viii. The successful service provider shall be a direct electronic claims processor. Electronic
Claims shall be filed for Medicaid and Medicare for Georgia and surrounding states.
ix. The service provider must transmit/receive Medicare claims via the required national
standard format, or any future standard format Medicare or Medicaid may require. The
service provider must also be currently filing electronic claims with all Commercial Insurance
Carriers that accept electronic claims.
c. ePCR Interface
GCFES will provide the ePCR in National Emergency Medical Services Information System NEMSIS
format with the associated billing information (any interface costs to be identified in the fee
schedule) to include an Adobe PDF of the actual ePCR for storage within the successful service
provider's account information. The ePCR data will be transmitted daily to the successful service
provider.
i. The successful service provider shall be responsible for all costs and/or resources required
to complete the interface with GCFES' current ePCR system (ESO Solutions).

RP028-26 Page 7
ii. Demonstrate existing interface with ESO Solutions ePCR/EHR software. Does interface
include PDF of the completed patient care report?
iii. Explain the format that the patient care report ePCR data will be uploaded into the billing
program; and what fields will be included, i.e. patient demographics, insurance, guarantor,
medical procedures performed, chief complaint, dispatched as, and found to be.
iv. The transport units will collect preliminary billing and demographic information. It is the
responsibility of the successful service provider to ensure records are complete prior to
billing. Describe how this will be accomplished.
v. GCFES shall continue to collect data on all EMS runs. Describe how the service provider will
receive this data to update the patient's record and prepare reports specified in the reporting
section.
vi. GCFES reserves the right to add fields to the EMS trip report. Confirm that the service
provider's system shall accommodate such changes at no additional cost.
vii. GCFES reserves the right to change or upgrade ePCR software. Confirm that the service
provider's system shall accommodate such changes at no additional cost.
d. Billing Process Description
i. Describe the end-to-end billing process.
ii. Describe the month end reconciliation process
iii. Describe solutions for remedying the problem of incomplete billing information.
iv. Provide the method used for coordination with hospitals in obtaining billing information.
v. The successful service provider is responsible for determining the information to be
collected and retained to meet the criteria established by Medicare, Medicaid, and private
medical carriers for billing appeals, auditing, and other functions defined by these carriers.
vi. The successful service provider is responsible for contacting patients, patients' families,
financially responsible parties, employers, or any other parties necessary to complete
documentation of GCFES transports.
vii. The successful service provider shall design all necessary internal forms. The design and
wording to be used in the forms and letters shall be mutually agreed upon by the service
provider and GCFES.
viii. Implement a billing process that utilizes subsequent notices. The language shall be mutually
agreed upon by the successful service provider and GCFES.
ix. The successful service provider will be responsible for inputting billing information,
processing, and transmitting invoices to medical insurance carriers once all necessary
information has been received from GCFES or other sources.
x. Describe the appeals/review process for denied claims. The service provider shall be
responsible for rejections and pursuing all appeals.
e. Payment and Collection Process
GCFES utilizes a lock box contract to facilitate receipt and deposit of payments on customers'
accounts. The service provider will be provided read only access to the lock box account.
i. Confirm that the service provider will pay all costs associated with the lock box account.

RP028-26 Page 8
ii. Post payments to patient accounts daily.
iii. Follow GCFES' current billing policy for EMS transports.
iv. Provide an online ability (portal access) for patients to make credit card payments
f. Reporting and Performance Monitoring
Reports must be designed to give GCFES the information needed to accurately measure
performance. This shall be approved by GCFES in a format requested.
i. Establish a comprehensive reporting system that will enable GCFES to monitor the
performance of EMS billing services.
ii. What type of information and reporting that GCFES may expect to receive from the service
provider?
iii. Describe the service provider's ability to generate and deliver all statistical raw data and
reports in Microsoft Excel format which will be utilized by GCFES' authorized personnel.
GCFES must have the ability to electronically access the service provider's billing software
24/7 to print patient account information, invoices and any other reports deemed necessary.
iv. Prepare and deliver statistical information and reports through an electronic format which
will be compatible with both the service provider and GCFES' computer systems and
software.
v. Reports will include, but not be limited to, the following:
1. Monthly detailed accounts receivable listing.
2. Monthly aged accounts receivable listing.
3. Monthly reconciliation of bank deposits with payments posted by service provider.
4. Daily report showing the service date and the date of filing claim.
5. Monthly report of the dollar amount and number of accounts not billable broken
down by service date and reason type.
6. Monthly report of the number and dollar amount of transports billed broken down by
service date, payer mix, and transport type.
7. Monthly report of the number and dollar amount of collections received by date of
service, payer mix, transport type, and type of payment.
8. Monthly report of the dollar amount and number of contractual write-offs and/or
adjustments broken down by payer mix.
9. Monthly report of the dollar amount and number of claim denials broken down by
payer mix.
10. Monthly report of the dollar amount of refunds.
11. Monthly report of the dollar amount and number of accounts to be sent to
collections, including explanation. The service provider will be required to attest, by
signature and date, that the required steps to collect for each account to be written
off have been followed.
Service providers may submit comparable report(s) for approval by GCFES.

RP028-26 Page 9
vi. Explain how downloading of records for use by GCFES will be accomplished, particularly the
billing and management reports.
vii. Describe whether the service provider performs any trend analysis and, if so, what type?
viii. The successful service provider shall be required to meet standards of performance. These
standards shall be reviewed no less than quarterly with a progress report submitted to the
GCFES. The standards will be determined during contract negotiation.
ix. Describe how the service provider may aid GCFES in establishing performance criteria and
performance levels for this project, including what items the company proposes to be rated,
the method or formula to be used to calculate performances, the levels of performance to be
achieved and in what time frame.
g. Implementation and Onboarding
i. Describe the implementation process and the transition to the proposed system such that
there is no interruption in the billing, accounting, and management information processes.
ii. Provide a policies and procedures manual for the operations to be performed under this
contract.
iii. Provide examples of significant changes proposed to other users that were implemented,
and the results of the implementation of those changes.
iv. Describe the commitment of resources and personnel for set-up and the initial phase of this
project, including the proposed project management plan.
v. GCFES has obtained provider status and numbers with Medicare, Medicaid, and many private
and commercial insurance carriers. If additional medical carriers are added in the future,
describe how the service provider will automatically secure provider status and numbers for
GCFES at no charge.
vi. Within 30 days of contract adoption by Gwinnett County Board of Commissioners, the
successful service provider shall be responsible for contacting all hospitals receiving
patients from GCFES to establish procedures necessary to complete billing and
demographic information.
vii. Provide current connections with GCFES' receiving facilities.
viii. Upon termination of the contract, define record retention policy and how records will be
shared with GCFES. Within one month of the termination/expiration of the contract, the
successful service provider will provide all electronic data in their custody in a format
determined by GCFES. The successful service provider shall be responsible for the transfer
of all electronic files, records and other material maintained and necessary for the
performance of the contract. All expenses incurred will be the responsibility of the
successful service provider.
h. Training Services
i. At the request of GCFES the successful service provider shall provide onsite training for the
billing software.
ii. The service provider may be required to provide documentation training at no cost to
Gwinnett a maximum of three (3) times per year. This training will be for any number of
employees to include all operations personnel.

RP028-26 Page 10
i. GCFES Patient Service
i. Provide operations during normal business hours from 8:00 am to 5:00 pm, EST Monday
through Friday except holidays.
ii. Provide a local or toll-free telephone number at the service provider's office that can be
contacted during normal business hours of 8:00 am to 5:00 pm, EST Monday through Friday
except holidays for the purpose of citizens asking questions about account status and
payments. The service provider shall be responsible for answering all citizens inquires
immediately.
iii. Provide interpreters for patients who require interaction in languages other than English. The
most common languages utilized by Gwinnett County residents include, but are not limited
to, Arabic, Bengali, Burmese, Cantonese, Creole, Farsi, French, Hindi, Hmong, Korean,
Mandarin, Portuguese, Russian, Somali, Spanish, Thai, Ukrainian, Urdu, and Vietnamese.
III. HIPAA and Compliance with Laws and Policies
a. The proposal shall include satisfactory assurances under the "business associate" provision of the
Health Insurance Portability and Accountability Act (HIPAA) privacy regulations that the service
provider will safeguard Gwinnett's protected health information in accordance with the standards set
forth in the privacy rule.
i. The successful service provider shall monitor any changes in Medicare/Medicaid or private
insurance laws related to the services provided by GCFES. The successful service provider
shall notify GCFES prior to the effective date of such changes and provide GCFES with any
proposed changes and the plan of action to address the changes.
ii. The successful service provider shall monitor any enforcement actions, guidance and
advisory opinions that relate to the services to be provided and report any applicable
information to GCFES.
iii. The successful service provider shall provide an independent audit of GCFES' accounts,
upon demand, no more than semi-annually, at the expense of the service provider.
b. Compliance with Laws and Policies
i. This contract is subject to, and the successful service provider shall comply with, all statutes,
ordinance, regulations and rules of the Federal Government, the State of Georgia, and
Gwinnett County.
ii. This contract is subject to and the service provider shall comply with the provisions of all
federal statues, regulations and policies governing the Medicare and Medicaid programs,
including but not limited to 42 U.S.C. 1396 et. Seq. Grants to States for Medical
Assistance Programs, the Medicaid Act: 42U.S.C.1320-7 General Provisions and Peer
Review, relating to Medicare and Medicaid, including 1320-a-7b(a), prohibiting making or
causing to be made false statement or representations, 1320-a 7(b), prohibiting illegal
remunerations, 1320c-9, prohibiting disclosure of information, Title 42, Code of Federal
Regulations, Public Health, specifically, Chapter IV, Health Care Financing Administration and
Chapter V, Office of the Inspector General, the Medicare Part B Medical Policy Manual
(Nationwide Insurance Enterprise),and the False Claims Act, 33 U.S.C. 3733(a)(1) et seq.
iii. The service provider shall ensure all collection methods comply with all applicable Federal,
State, and Local laws, with particular attention to Consumer Credit Protection Act, Federal
Fair Debt Collection Practices Act, and all other applicable laws.
iv. The transmission of protected patient health information between the service provider and
GCFES must comply with HIPAA requirements for data transmission.