SOURCES SOUGHT
Q--Q -- Electronic Healthcare Eligility and Benefits Inquiry Services
- Notice Date
- 2/16/2006
- Notice Type
- Sources Sought
- Contracting Office
- Attn: Department of Veterans Affairs, Acquisition Operations Service, (049A3), 810 Vermont Avenue, N.W., Washington, District Of Columbia 20420
- ZIP Code
- 20420
- Solicitation Number
- 101-10-06
- Response Due
- 2/28/2006
- Archive Date
- 3/30/2006
- Small Business Set-Aside
- N/A
- Description
- Request for Information Electronic Health Care Eligibility and Benefit Inquiry Services Introduction: Veterans Health Administration (VHA) is the United States largest healthcare provider networks, with medical centers, clinics and pharmacies throughout the country. While some of the care provided is service related, much of the care is not service related and may be reimbursable by a patient?s health insurance plan. VHA needs to have current, accurate healthcare coverage and benefits information. The purpose of this Request for Information (RFI) is to solicit information from interested parties to assist VHA in improving its healthcare insurance eligibility verification and identification processes. Disclaimers: 1. This is not a procurement document. At this time, VHA is requesting only information. This may result in one or more formal procurements. Pricing information and/or price quotes are not being requested. 2. Only written responses to this RFI will be accepted. No requests to schedule meetings with VHA resources or to present information in-person or electronically will be granted. Responders may submit materials on electronic media, including product demonstrations. We reserve the right to contact selected responders to request additional information, meetings and/or demonstrations. 3. VHA, as part of the Department of Veterans Affairs, is a Federal agency, subject to various public records rules and regulations. Responders must not submit any information that they deem confidential and/or proprietary. Background: VHA, like most healthcare providers, attempts to collect accurate health insurance information from its patients prior to the provision of service. We understand that this information is dynamic and coverage and benefits information needs to be verified by the health plan. VHA is seeking opportunities to improve this process through the use of technology and standards. VHA also needs to improve the process for identification of health insurance. Due to a number of factors, VHA may not be aware of a patient?s health insurance. The relationship between VHA and Medicare and Medicaid is unique. Because these are other federally funded healthcare programs, VHA can not be reimbursed by them. VHA currently submits ?claims? through a single Medicare Intermediary and Carrier, Trailblazer Health Enterprise, for the purposes of obtaining accurate coordination of benefits data to be submitted to payers Secondary to Medicare. VHA can not be reimbursed by Medicare HMO (Part C), Medicare Pharmacy (Part D) and Medicaid plans. Therefore, there is no requirement for coverage/benefit identification and verification with these health plans. VHA has emphasized the use of information technology to improve the efficiency and effectiveness of healthcare administrative processing. VHA has implemented the use of the HIPAA standard Health Care Eligibility Benefit Inquiry and Response (270/271) electronic transaction (see Technology Environment section for further information). VHA has also used external vendors, primarily Public Consulting Group, to identify health insurance coverage for its patients. VHA is specifically interested in solutions that will leverage its investments in the HIPAA standard transactions and data integration. Technology Environment: VHA operates a distributed ?practice management? software application ? Veterans Health Information Systems and Technology Architecture (VistA). There is currently no centralized information store of health insurance information. Within each VistA system, patient health insurance information is maintained, including data about the payer/health plan, insurance plan, coverage dates and benefits. This data is then used in the billing process to generate medical claims to the appropriate health plan. As stated earlier, VHA has implemented and is currently in production with the HIPAA Health Care Eligibility Benefit Inquiry and Response (270/271) electronic transaction. Medical Centers through the system generate eligibility inquiries. These inquiries are transferred to a central computing facility (the Financial Services Center (FSC) located with the Austin Automation Center (AAC)) from the VistA applications in a batch process daily. This data is then translated into HIPAA compliant 270 ?real-time? transactions and communicated to a single healthcare clearinghouse, Emdeon. Emdeon distributes the 270 transactions to the appropriate Information Source, which may be a health plan or an internal data store. Emdeon communicates ?real-time? 271 Response transactions back to the VA. The responses are distributed back the requesting VistA site as a batch data extract. Current Issues: Like many healthcare provider organizations, VHA does not feel that they have had adequate return on investment for the implementation of the HIPAA standard eligibility inquiry and response. The following are issues that of particular interest that VHA would like responders to address in their responses to this RFI: Limited Payer Access ? VHA, as a national healthcare provider, interacts with the majority of health plans (except those noted previously). The current implementation model provides VHA with access to only limited health plans. VHA is particularly interested in being able to conduct 270/271 processing with all Blue Cross Blue Shield plans and payers Secondary to Medicare. Limited Payer Responses ? Many payers that do provide an eligibility response provide only confirmation of coverage, which is the HIPAA minimal response. While this is useful, VHA staff has to contact the payer by phone in order to obtain more detailed benefit information. VHA is interested in solutions that improve the completeness of payer responses, including benefit information and other payment sources, such as ?carve-out? payers for dental, mental health, pharmacy, vision and other benefits. Payer Identification ? VHA recognizes that the HIPAA 270/271 transactions are intended for verification, not identification, of health insurance. VHA is interested in options that will assist in the identification of payment sources for its patient population. Unreliable Payer Responses ? VHA has experienced payer 271 responses that have been inaccurate. This has been discovered when other information sources, such as a payer Internet site or phone calls to the payer. Some of the incidences may be related to patient identification. Responding to this Request for Information: Respondents are encouraged to provide concise, targeted responses to this RFI. Ideally, respondents will provide information about payers that can be accessed, proven solutions that can improve eligibility responses accuracy and completeness and/or options for health insurance identification. Respondents are not required to address all of the issues above. VHA is open to a ?best of breed? approach to solutions. Respondents are cautioned from providing pricing and proprietary information. While marketing materials will be accepted, there is no guarantee that all information will be reviewed. No submitted materials can be returned. Questions and Inquiries: Due to the nature of this RFI, there will not be responses to any questions or inquiries. Responders are encouraged review the VA Web site (www.va.gov) for additional information.
- Place of Performance
- Address: Washington, DC
- Zip Code: 20420
- Country: United States
- Zip Code: 20420
- Record
- SN00989611-W 20060218/060216212032 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
| FSG Index | This Issue's Index | Today's FBO Daily Index Page |