To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract Amendment/Extension #77-317-6 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 #77-317-6 with Availity, L.L.C., a limited liability company, in an amount not to exceed $1,500,000 to provide electronic claims processing services for Contra Costa Health Plan (CCHP) and Behavioral Health Services Division (BHSD) for the period September 1, 2025 through August 31, 2028.
FISCAL IMPACT:
Approval of this Contract will result in additional annual expenditures of up to $1,500,000 as budgeted by the department and 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 BHSD require 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 organization’s 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. The nature of the electronic claims processing services needed is complex and requires seamless coordination, integration and collaboration with existing programs and systems. This Contractor was approved by the Public Works Department’s Purchasing Division on March 20, 2024.
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 the CCHP and Behavioral Health Services Divisions to reimburse Providers for services provided to CCHP members for the period February 29, 2024 through February 28, 2025
On February 25, 2025, the Board of Supervisors approved Contract Amendment/Extension #77-317-5 with Availity, L.L.C., effective February 1, 2025, to increase the payment limit by $240,000 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 for additional of electronic claims processing services for CCHP and Behavioral Health Service Providers for reimbursement of services rendered to CCHP members.
Approval of Contract #77-317-6 will allow the Contractor to provide additional electronic claims processing services through August 31, 2028. This Contract delay was due to extended negotiations between Contractor and Division.
CONSEQUENCE OF NEGATIVE ACTION:
If this Contract 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).