SOURCES SOUGHT
99 -- Central Billing Processing Solution
- Notice Date
- 2/26/2007
- Notice Type
- Sources Sought
- NAICS
- 519190
— All Other Information Services
- Contracting Office
- Department of Labor, Office of the Assistant Secretary for Administration and Management, Procurement Services Center, S-4306 200 Constitution Avenue, NW, Washington, DC, 20210-0001, UNITED STATES
- ZIP Code
- 00000
- Solicitation Number
- Reference-Number-DOL079RI20326
- Response Due
- 3/26/2007
- Archive Date
- 12/31/2007
- Description
- I. Introduction The Office of Workers? Compensation Programs (OWCP) under the U.S. Department of Labor (DOL) administers disability compensation programs that mitigate the impact of work-related injury for certain workers and their families, through the provision of medical treatment and other benefits. OWCP is seeking a centralized medical bill processing solution for three OWCP programs: the Division of Federal Employees? Compensation (DFEC), the Division of Coal Mine Workers? Compensation (DCMWC) and the Division of Energy Employees Occupational Illness Compensation (DEEOIC). Each OWCP program has a unique set of processing rules based on legislatively-mandated requirements, and that the CBP solution must allow for all three processes based on these unique rules. Specifically, payments are only authorized for the medical conditions accepted as being compensable by the OWCP program under which the claim is filed. The primary goals of the OWCP CBP are to: ? Ensure a smooth and timely transition from the incumbent service provider. ? Ensure efficient, accurate and timely processing of bills for compensable medical conditions. ? Ensure timely and correctly processed authorization for covered benefits. ? Assure accurate and timely responses to customer inquiries and requests. ? Incorporate state-of-the-art medical bill processes, including but not limited to, utilization reviews for medical treatments and prescriptions, and fraud and abuse protection programs. ? Establish a framework for continuous improvement. This notification is a Request for Information (RFI) from industry vendors regarding their interest, capabilities and recommendations in developing proposals for OWCP?s Central Bill Process. This RFI is intended to identify potential vendors and to solicit information useful for guidance and preparation of an RFP. II. Background OWCP seeks a contractor to perform medical bill processing operations for the three OWCP programs, to limit payment based on the medical condition being accepted as compensable by the program, to support the prior authorization of services and to respond to inquiries related to medical services from claimants and providers. CBP operations process medical bills, manage provider enrollment, support the prior authorization of services, and respond to inquiries related to medical services from claimants and providers. In contrast with typical medical bill processing operations, payments are authorized based on the medical conditions (ICD-9 codes) accepted as being compensable by the OWCP program under which the claim is filed. This is accomplished by applying OWCP?s treatment suites framework to the accepted condition. In addition to processing bills, the selected contractor shall be responsible for all inquiries regarding bills and appeals, authorization of services, suspense resolution, provider enrollment and appeals processing. As the contractor is not a fiscal agent, it will send payment files to the Treasury Department for disbursement of checks (the contractor does not disburse payment). The selected contractor shall interface with the OWCP National Office and District Offices? staff for each program in the performance of these activities. OWCP?s medical bill processing function is currently being provided as an outsourced service by an incumbent contractor. As the incumbent is providing an outsourced service, the government does not own an information system that will be transferred to a follow-on contractor. The estimated annual volumes of bills, authorizations, and inquiries, processed and the providers enrolled for each program are presented below. DFEC; DCMWC; DEEOIC; TOTAL Line items processed 10,929,598; 495,350; 300,266; 11,725,214 Call center calls processed* 917,794; 42,028; 30,057; 989,879 Authorizations processed 557,758; 958; 1,714; 560,430 Bill preparation 4,834,905; 226,119; 85,612; 5,146,636 Pages imaged 6,557,890; 622,792; 303,490; 7,484,172; New provider enrollment 7,270; 1,334; 1,042; 9,646; * Based on an average call of 4.5 minutes In 2006, there were approximately 758,291 authenticated hits against the current CBP web portal by claimants, providers and OWCP employees. Approximately 1,745 internal OWCP users, representing all 3 OWCP Programs, require read only access to the processing system. III. Scope A. Requirements The successful bill processing solution will implement the following high level requirements: General 1. Operations are to be located in either the eastern or central time zones within thirty miles of an urban center with an adequately qualified labor pool. 2. Develop a transition plan and effect a successful transition of operations from the incumbent. 3. Provide initial and ongoing training to OWCP claims examiners and to awardee?s internal operations staff to ensure correct implementation of all business rules, processes and procedures. 4. Implement well-defined and documented internal quality assurance procedures to ensure the correct and most efficient processing of bills and integrity of data. 5. Develop and manage to a performance assessment plan that includes both technical and operations performance standards and service level agreements (SLAs) acceptable to OWCP. 6. Develop and maintain all documentation as required. Document Preparation 7. Perform document preparation that encompasses all mailroom, imaging and data capture services required in preparation for bill processing to include sorting, imaging, indexing, tracking, return to provider where necessary for lack of required information, and storing. Bill Processing 8. Perform all activities required to receive and process bills for services and point-of-sale transactions of pharmacy bills, identifying the OWCP program associated with each bill. 9. Implement a solution to increase the number of bills submitted through EDI. 10. Apply edits to ensure accuracy of all bills processed, to include edits for eligibility, validity, required fields, consistency, medical appropriateness, accuracy of coding, duplicates, service limitations, unbundling, and other industry standard editing routines. 11. Apply a variety of fee schedules. 12. Process bills according to OWCP?s Treatment Suites (TS) methodology and maintain the TS database. The treatment suites are set of diagnosis-driven algorithms that determine the procedures, drugs, hospitalization, DME and all other services that are payable for the claimants? accepted condition(s). 13. Implement a suspense resolution process. Prior Authorization (PA) 14. Accept PA requests from providers in electronic (web based), telephone and hard copy formats. Electronically route PA requests to district offices as required by each program 15. Provide the ability to authorize services by one or more of the following: procedure codes, date span, provider, units etc. Appeals 16. Support the fee schedule appeals process and route all other appeals to OWCP?s district offices. Reference File Maintenance 17. Support existing multiple fee schedules and implement additional fee schedules as specified by OWCP 18. Develop and maintain the processes that support/update Treatment Suites and the coding schemes of all three OWCP programs. 19. Enroll providers and maintain a provider file to ensure payments are made to the correct providers. Reporting 20. Maintain, retain, and make available bill payment and financial history. 21. Provide timely and accurate reports including the tracking of progress against quality and productivity goals and exception reporting for both contractor and OWCP staff. 22. Provide samples and statistics for quality reviews including utilization review and fraud and abuse detection. 23. Comply with Federal requirements for financial and benefit systems and maintain documented record of compliance for use in responding to Federal audits. Comply with and report on adherence to the Improper Payment Act, Prompt Pay Act and for IT Inspector General audits. 24. Incur and report cost savings from the standardization of functions across programs and the application of state-of-the-art capabilities, including but not limited to utilization limits, fee schedules, and other industry standards. 25. Provide a data repository that will allow OWCP to develop our own ad hoc reports. Interfaces 26. Maintain electronic interfaces and data sharing arrangements (currently ~40) between the CBP and OWCP and other Federal Agency systems. Security 27. Adhere to DOL and Federal security standards as they apply for ?moderate? systems (defined by FIPS PUB 199). 28. Implement and maintain event logs as required by Federal mandates. 29. Update and maintain Federally-required documents and make them available for Federal auditors upon request. 30. Successfully pass security audits conducted by the DOL third-party contractor on the facilities, personnel, hardware and software used to process OWCP claims. Customer Interfaces 31. Provide remittance advice in various formats to providers and claimants. 32. Provide a call center with business hours that support claimants? and providers? inquiries across all continental time zones. 33. Assist providers via a Web-based interactive portal on topics such as authorization of services, and inquiry function for claimant eligibility, bill history, and remittance advices. 34. Assist providers and claimants regarding the use of all coding nomenclatures. 35. Provide assistance to district offices regarding the handling of specific cases, authorization requests, bills and appeals. 36. Perform provider outreach and training. 37. Manage and track correspondence and inquiries. B. Key Project Dates The following dates are targets and subject to change: 07/2007 RFP Posted on Fedbiz.opps.gov 08/2007 Bidders? Conference 09/2007 Proposals due to DOL Office of Procurement 01/2008 Notification of selected vendor 04/2008 Begin Transition 10/01/2009 Begin Operations IV. Information Requested DOL is requesting information from vendors regarding industry practices, vendor capabilities to provide a Central Bill Process solution, and vendors? specific experience in providing medical bill processing solutions using industry best practices. OWCP is equally interested in both sets of questions below. Responses to this RFI should consider the high level requirements from Section III to address the following: Industry: 1. Make a recommendation on OWCP purchasing a system vs. a service. 2. Make a recommendation on using customized commercial off-the-shelf (COTS)/government off-the-shelf (GOTS) products or a completely customized solution. 3. Address the length of time typically required for implementing your process/system solution for an effort of this size. 4. Recommended a costing methodology and cost structures for development/implementation and for operations. 5. Address how to ensure an adequately experienced and trained labor pool that also optimizes cost control. Include in your discussion such factors as cost of living indexes, demographics, key personnel, temporary staff, etc. 6. Provide industry standard service level agreements for bill processing, call centers, provider administration, medical authorizations, web access, imaging, technology. 7. Provide industry standard performance measurement criteria and incentives/penalties. Company-specific: 8. Provide your company?s name and address; size of company (number of personnel, finances, small or large business, 8(a), etc.); and point(s) of contact (name, phone number, address, email, etc.). 9. Identify the Federal government contracting vehicles and schedules on which the required services may be obtained. 10. Describe your company?s expertise and experience in developing and implementing large scale (provide volumes) medical bill processing solutions and in integrating these with call center operations. 11. Describe your solution?s unique abilities/characteristics that distinguish it from other service providers, including editing based on accepted condition. 12. Identify the technology platform you would utilize to implement your proposed solution. Discuss licensing, ownership of platform, technology refresh plans, etc. 13. Estimate the price for development/implementation and for operations. 14. Describe your experience implementing program management processes to support your solution that includes strategic planning, project scheduling/tracking/reporting, cost control, performance measurement and metrics, corrective action planning, quality control, system security, configuration management, risk management and responding effectively and efficiently to customer requests. 15. Discuss how your solution approaches suspending payment vs. denying payment of lines, where there are volume/cost considerations and the system cannot definitively identify the appropriate course of action. 16. Discuss how your solution would address the cost of processing errors, such as keying errors and incorrectly identifying duplicate bills. 17. Describe the impact on your solution of the probable shift from ICD-9 CM to ICD-10 CM. V. General Instructions A. How to Respond Responses to this RFI must be no more than fifteen (15) letter-sized (8.5 X 11) pages in length using one inch page margins and 12 point Times New Roman font. All responses must clearly and directly address vendor capabilities for and experience in providing medical bill processing solutions that are similar to the scope and functionality anticipated for OWCP?s Central Bill Process. Marketing brochures or corporate advertising material will not be considered an acceptable response. All responses are to be submitted electronically to the DOL contracts specialist provided below in Microsoft? Word format by 5:00 PM Eastern Standard Time (EST) on March 26, 2007 to the point of contact below. Hard copy responses will not be accepted. Name: Paula Miller-Sheelor Title: Contracts Specialist Phone: 202 693-4598 Email: sheelor.paula@dol.gov B. Disclaimers 1. Responses Responses to this RFI are not offers and cannot be accepted by DOL to form a binding contract. DOL does not intend to award a contract on the basis of this RFI or to otherwise pay for the information solicited. For the purposes of this RFI, the term ?vendor? refers to those members of the industry providing a response to this RFI. 2. Proprietary Information Respondents are not to provide any information that is considered proprietary, trade secrets, privileged, or confidential as part of the RFI responses. 3. RFI Issuance DOL will not issue paper copies of this RFI.
- Place of Performance
- Address: Washington, DC
- Zip Code: 20210
- Country: UNITED STATES
- Zip Code: 20210
- Record
- SN01238938-W 20070228/070226220403 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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