To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment/Extension #77-317-5 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 Amendment/Extension #77-317-5 with Availity, L.L.C., a limited liability company, effective February 1, 2025, to amend Contract #77-317-4, to increase the payment limit by $240,000, from $1,100,000 to a new payment limit of $1,340,000, and to extend the termination date from February 28, 2025 to August 31, 2025, for additional electronic claims processing services for the Contra Costa Health Plan (CCHP) and Behavioral Health Services Divisions.
FISCAL IMPACT:
Approval of this Amendment/Extension will result in additional expenditures of up to $240,000 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. 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.
On June 25, 2024, the Board of Supervisors approved Contract #77-317-4 with Availity, L.L.C., in an amount not to exceed $1,100,000, for the provision of electronic claims processing services for CCHP and Behavioral Health Service providers for reimbursement of services rendered to CCHP members for the period February 29, 2024 through February 28, 2025.
Approval of Contract Amendment/Extension Agreement #77-317-5 will allow the Contractor to provide additional electronic claims processing services through August 31, 2025.
CONSEQUENCE OF NEGATIVE ACTION:
If this Amendment is not approved, County will not have access to Contractor’s additional electronic claims processing services or enough funds to reimburse providers per requirements from Department of Managed Healthcare (DMHC) and Department of Health Care Services. (DHCS).