To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract #27-799-16 with Health Management Systems, Inc.
?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 #27-799-16 with Health Management Systems, Inc., a corporation, in an amount not to exceed $2,000,000, to provide professional auditing services to the Contra Costa Health Plan (CCHP) claims unit for the period January 1, 2026 through December 31, 2028.
FISCAL IMPACT:
Approval of this Contract will result in contractual service expenditures of up to $2,000,000 over a three-year period and will be funded 100% by CCHP Enterprise Fund II revenues.
BACKGROUND:
CCHP is mandated by State and Federal law to have professional auditing services which includes measures that prevent, detect, and correct noncompliance, insurance billing, provider recoupment, insurance verifications and coordination of benefits with the Centers for Medicare and Medicaid Services (CMS) program requirements. This Contract is mandatory to provide the needed Managed Care Audit Services of Insurance Billing and Provider Recoupment to comply with mandated requirements of the State of California Department of Managed Health Care Services (DMHC) and Department of Health Care Service (DHCS). Contractor has been fostering a deep understanding of the CCHP organization's mission, values, and long-term objectives since May 2010.
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 cooperates and participates in the County's Quality Management Program which consists of quality improvement activities to improve the quality of care, services and me...
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