Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the Agreement with Experian Health, Inc. to Provide Claims and Remittance Software
RECOMMENDATION:
title
Adopt a resolution authorizing a sixth amendment to the agreement with Experian Health, Inc. to provide claims and remittance software, extending the term through December 31, 2021 and increasing the amount by $171,480 to an amount not to exceed $1,424,329.44.
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BACKGROUND:
In October 2011, San Mateo Medical Center (SMMC) completed a Request for Proposals (RFP) for an electronic claims processing information system. Data Systems Group of California, Inc. (DSG) was chosen because of its extensive Medi-Cal and Medi-Cal Managed Care experience, as well as its ability to modify its software to efficiently process SMMC claims filed with the Health Plan of San Mateo.
The agreement has been amended several times to expand the scope of work, with an associated increase to the amount. In addition, after Experian Health Inc. (Experian) acquired DSG, SMMC executed an agreement to reassign the agreement to Experian.
Finally, in June 2017, an RFP was conducted for these services, as well as claim editing and management, and a different vendor was chosen.
DISCUSSION:
This amendment will extend the current term of the agreement with Experian to support the transition period to the new vendor. SMMC is requesting your Board authorize an extension to the term of the agreement through December 31, 2021, with an associated increase of $171,480, to an amount not to exceed $1,424,329.44.
The amendment and resolution have been reviewed and approved by County Counsel as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
The County’s Contract Compliance Committee has approved a waiver request for a nine-and-a-half-year term for this agreement.
It is anticipated that 75% of “clean” claims will be adjudicated within 14 days from billing.
PERFORMANCE MEASURE:
|
Measure |
FY 2019-20 Estimated |
FY 2020-21 Projected |
|
Percentage of “clean” claims adjudicated within 14 days from billing |
75% |
85% |
FISCAL IMPACT:
The term of the revised agreement is July 1, 2012 through December 31, 2021. The amount of the agreement is not to exceed $1,424,329.44. This amendment increases the amount by $171,480. Funds in the amount of $85,740 are included in the SMMC FY 2019-20 Adopted Budget. Funds in the amount of $85,740 will be included in the SMMC FY 2020-21 Recommended Budget.
Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care is covered by the County’s General Fund contribution to SMMC, and is within the existing annual appropriation.