To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Contract #77-317-4 with Availity, L.L.C.
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to execute on behalf of the County Contract #77-317-4 with Availity, L.L.C., a limited liability company, in an amount not to exceed $1,100,000, to provide electronic claims processing services for the Contra Costa Health Plan (CCHP) and Behavioral Health Services Divisions for the period February 29, 2024 through February 28, 2025.
FISCAL IMPACT:
Approval of this contract will result in contractual service expenditures of up to $1,100,000 over a one-year period and will be funded 100% by CCHP Enterprise Fund II revenues. (No rate increase)
BACKGROUND:
CCHP has an obligation to provide certain specialized claim processing services for its Providers under the terms of the Individual and Group Health Plan membership contracts with the County. CCHP and the Behavioral Health Division requires the most current electronic claims processing services for expedient and accurate claims processing services for reimbursement to CCHP Providers. This contractor has been providing these services and fostering a deep understanding of the CCHP organizations mission, values, and long-term objectives since March 1, 2021. This contract is entered into under and subject to the following legal authorities: California Government Code §§ 26227 and 31000; Health and Safety Code § 1451. Health Services Personnel approved this contract to ensure no conflicts with labor relations. This contractor currently cooperates with and participates in CCHP’s Quality Management Program which consists of quality improvement activities to improve the quality of care and services and member experience. Cooperation includes collection and evaluation of performance measurement data and participation in the organization’s clinical and service measure Quality Improvement Programs.
The nature of the electronic claims processing services needed is complex and requires seamless coordination, integration and collaboration with existing programs and systems. This contract renewal will maintain comprehensive area coverage for the entire CCHP membership and meet the Knox-Keene Act, time and distance mandate required by the State of California Department of Managed Health Care (DMHC) services. This contractor has been approved by the Public Works Department’s Purchasing Division on March 20, 2024.
On January 10, 2023, the Board of Supervisors approved Contract #77-317-3 with Availity, L.L.C., in an amount not to exceed $1,00,000, for the provision of electronic claims processing services for CCHP Providers for reimbursement of services rendered to CCHP members for the period March 1, 2023 through February 28, 2024.
Approval of Contract #77-317-4 will allow the contractor to continue providing electronic claims processing services through February 28, 2025. This contract was delayed due to ongoing negotiations between the division, contractor, and the Department of Health Care Services (DHCS).
CONSEQUENCE OF NEGATIVE ACTION:
If this contract is not approved, electronic claims processing services will not be provided to CCHP Providers under contract with County.