Medical Claims Transmission and Remittance Service
Overview
Fit Score
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SUMMARY
DESCRIPTION
A government agency in South Dakota is seeking a vendor to provide a secure software solution for medical claims transmission and remittance services. The selected contractor will deliver a platform enabling secure data exchange and connectivity with Medicare systems and various clearinghouse services.
Key requirements include the ability to submit electronic claims and conduct real-time claim status inquiries with Medicare, as well as provide eligibility verification for Medicare, Medicaid, and other third-party payers. The solution should facilitate validation, approval, and processing of medical claims—including inpatient, outpatient, and specialty clinic claims—to be transmitted to Medicare, Medicaid, VA, and commercial payers.
The system must also offer secure internet-based connectivity to all current Medicare Administrative Contractors (MACs), support automated batch file transfers (837/835), and provide automated claims status inquiry and response functionality through batch processing of 276/277 files. This service is intended to support comprehensive claims management for the agency's service units.
Source attribution
This Settle analysis is based on the issuing organization’s public RFP listing.