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INSURANCE CLAIMS PROCESSING CLEARINGHOUSE SERVICE FOR STATE LAB OF HYGIENE
(contract last updated 02/04/2011)

SCOPE: The Wisconsin State Laboratory of Hygiene (WSLH) provides specialized clinical, toxicology, environmental, occupational and proficiency laboratory testing to academic, health-care, governmental and private-sector organizations at the local, state, national, and international levels.  By statute, the WSLH is administratively attached to the University of Wisconsin, has many academic staff appointments and serves as the state public health laboratory for the Wisconsin Departments of Health Services and Natural Resources.   The WSLH uses a single billing system for all of its laboratory areas, and currently processes all of its medical claims internally.  The WSLH is upgrading its current Epic Systems (“EPIC”) billing system from “Resolute” to “Reference Lab Billing” with a go-live date of May 2, 2011. 

As part of this billing system upgrade, WSLH has determined that use of a third party clearinghouse for managing medical claims submissions would be more cost effective than performing this service in-house.  The WSLH has submitted approximately 185,000 insurance claims over the last 30 month period.  The monthly average is 6,000 claims with as few as 3,700 claims and as many as 8,400 in a single month.  About 77% of claims were filed electronically with Wisconsin Medicaid and 1% with Medicare.  The remaining 22% are filed on paper with other private insurance companies.  The purpose of this contract bid is to establish a contract for services for electronic claim submission, claim rejection management, and explanation of benefit (EOB) management.  Set up, installation, training and maintenance should be included in this contract.  The WSLH will continue to accept payments directly from insurance companies and would not use a clearinghouse service to process those payments. 

CONTRACT # DESCRIPTION
11-5322 INSURANCE CLAIMS PROCESSING CLEARINGHOUSE SERVICE FOR STATE LAB OF HYGIENE
CONTRACT ORIGIN: ADDITIONAL INFORMATION:
UW-Madison
Purchasing Services
21 N Park St, Ste 6101
Madison, WI 53715-1218		 UW-Madison users contact:
Vint Quamme
(608) 262-1147 FAX (608) 262-4467
vquamme@bussvc.wisc.edu
  Non-UW-Madison users contact: Vendor Representative
COOPERATIVE PURCHASING: YES
CONTRACT TERM: February 1, 2011 through January 31, 2013, with automatic renewal extensions to January 31, 2016, unless amended, cancelled or rebid.
Vendor(s)
136199
Gateway EDI LLC
501 N Broadway  3rd Fl
Saint Louis  MO  63102
     
Sales Representative: PHONE # FAX #
Dot Desjardin 800-9699-3666 X1488 314-802-6822
E-mail sfoate@dunhamexpress.com
  PHONE # FAX #
Ordering/Expediting: 800-9699-3666 X1488 314-802-6822
Invoice Information: 800-9699-3666 X1217 314-802-6822
Returns: 800-9699-3666 X1488 314-802-6822
Supplier Diversity Reporting: N/A  
Website: www.gatewayedi.com/
Commodity Code 946-10
Federal Employee ID # (FEIN) 26-3923727
F.O.B. “V” F.O.B. SERVICE/MAINTENANCE
$250.00 Set-Up fee per new Client Site
Terms: N/30
Invoicing: Invoices shall reflect contract pricing.
Orders: E-mail, Fax, Mail, Phone
Pricing Information: SEE BELOW

DESCRIPTION

FLAT RATE
 PER MONTH

Insurance Claims Processing Clearinghouse Services

 

Fee includes:

  • 1-6000 electronic claims per month
  • Unlimited paper claims
  • Unlimited secondary claims
  • Unlimited Electronic Remits

$1,320.00

All inclusive fee includes:

  • 6001- or more
  • Unlimited paper claims
  • Unlimited Secondaries
  • Unlimited Electronic Remits

$.18 each claim

SPECIFICATIONS

ITEM DESCRIPTION

 

General Service Requests:  The Contractor should be able to demonstrate service experience with Epic billing systems.  Services should include:

1. ensuring that all WSLH providers that are capable of electronic claims submittal are able to do so;
2. unlimited submission of electronic claims;
3. unlimited submission of paper claims (includes printing and mailing);
4. electronic remittance advice (ERA) for all payers;
5. unlimited submission of secondary claims to secondary payers (electronic and paper);
6. ability for buyer to access and print secondary documentation for patients online;
7. standard and customizable online reports by payer, provider and office;
8. online access to claim status and management reports.

 

 

 

Specific Supplier Responsibilities:
1. Electronic claim submission

 
  • Claim submission interface between Epic Reference Lab Billing and the clearinghouse.
2. Paper claim printing, folding, stuffing, stamping and mailing

 
  • Claims are to be analyzed as they are processed to determine if they could be sent electronically.   The clearinghouse would walk WSLH through the steps to ensure they are submitted electronically in the future.
3. Electronic remittance

 
  • Clearinghouse to organize data from multiple payers in one area, in one format for electronic payment posting.

 
  • Remittance interface between the clearinghouse and Epic products.
4. Claim status messaging.
5. Interfacing payer status messages with Epic product.
6. Error and rejection management.
7. Eligibility verification:

 
  • Centralized access with standardized interface with administration by the clearinghouse.

 
  • Ability to batch eligibility inquiries.

 
  • Eligibility to be verified on a patient-by-patient basis as needed through the clearinghouse website, eliminating the need for access to each payer’s website
8. Analysis and reporting.
9. Secondary claim/EOB matching.
10. EOB management tools:

 
  • Find, analyze and print EOB information.
11. Support services and maintenance.
12. Set up, installation and training.

Revision History
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