To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract Amendment #23-513-7 with OptumInsight, 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 Amendment #23-513-7 with OptumInsight, Inc., a corporation, to amend Contract #23-513-4, to increase the payment limit by $168,230, from $139,021 to a new payment limit of $307,251, and extend the termination date from January 30, 2025 to January 30, 2030, and for successive one (1) year term(s) thereafter until terminated, for additional patient billing software and support for Contra Costa Health (CCH).
FISCAL IMPACT:
Approval of this Contract Amendment will result in additional expenditures of up to $168,230 and will be funded as budgeted by the department in FYs 2025-30, 100% by Hospital Enterprise Fund I. (Rate increase)
BACKGROUND:
This Contract Amendment meets the needs of Contra Costa Health Information Systems Unit by providing software licensing and support concerning National Coverage Determination (NCD) Data, Local Coverage Determination (LCD) Data, and Optum Correct Coding Initiative Files for Physicians and Hospitals (CCI) in connection with Epic System applications. Optum provides files in a format that can easily be uploaded into the CCH Electronic Health Records system, Epic ccLink. The LCD and CCI files help CCH ensure accurate claims on initial claims submission to Medicare and Medi-Cal. While LCDs define medical necessity and coverage, CCI focuses on coding accuracy and preventing improper billing practices. LCDs and CCI do not contain Protected Health Information, but primarily consist of coding rules, coverage policies, and billing guidelines used for Medicare and Medi-Cal claims processing. This Contractor has been providing these services and fostering a deep understanding of the CCH organizat...
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