Evidence-Based Clinical Support

The Phoenix Indian Medical Center (PIMC), Phoenix Service Unit (PSU), Phoenix, Arizona, is a 127-bed health care facility that operates 24 hours a day, seven days a week. This project is located on the PIMC's campus. PIMC requires the services of a contractor able to provide a Site-Hosted, evidence-based clinical criteria software and license for use in a hospital utilization review process. The software should be easy to use and allow for expedited workflow. The software should allow users to evaluate clinical criteria for the following:

1. Observation services 2. Inpatient admissions 3. Continued inpatient stays 4. Evaluation of discharge planning 5. Evaluate ambulatory surgical services for appropriateness of setting 6. Determine appropriate transition of care to rehabilitation care services, subacute services, and skilled nursing services. 7. Evaluate substance use disorders and appropriate transition of care. 8. Evaluate transition of care needs utilizing CMS Durable Medical Equipment.

9. Retrospective evaluation of risk management and quality care delivery evaluation. The purpose of the evidence-based clinical criteria is to satisfy the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoPs) for a healthcare organization to have a utilization review process in place. The PIMC Case Management staff will use this evidenced-based criteria for making utilization review decisions.

The software is integral to the performance and function of several departments within the PIMC. Case Management’s utilization review function is required by Third Party Billing to complete billing information prior to sending in the claim. Al interested parties please respond to the POC with the IEE Form filled out and your FEDRAMP line card.