SOLICITATION NOTICE
D -- VHA Purchased Care Claims ProcessingThe purpose of this notice is to post an RFI(Request for Information).
- Notice Date
- 10/20/2008
- Notice Type
- Synopsis
- NAICS
- 541519
— Other Computer Related Services
- Contracting Office
- Department of Veterans Affairs;Acquisition Management Section/00D;1615 Woodward Street;Austin TX 78772
- ZIP Code
- 78772
- Solicitation Number
- VA-200-09-RP-0017
- Archive Date
- 8/11/2009
- Point of Contact
- Wayne Miller512-326-6646
- Small Business Set-Aside
- N/A
- Description
- Request for Information for Software and System support to VHA Purchased Care Claims ProcessingSTATEMENT OF NEEDThe Department of Veterans Affairs (VA), Veteran's Health Administration (VHA) is one of the world's largest health care delivery organizations. As part of an integrated strategy to provide veterans with timely access to quality health care services, VA healthcare facilities are authorized to pay for health care services acquired from non-VA health care providers. These services may be provided to eligible veterans from non-VA health care providers when VA determines medically necessary services are not available from VA on a timely basis, in an emergency or when VA or other Federal facilities are not feasibly available. VA manages the authorization, claims processing and reimbursement for services acquired from non-VA health care providers through the Purchased Care Program. The basic provisions of and authority for the Purchased Care Program are provided through public laws passed by Congress. These laws have been codified into the United States Code and further clarified in the Code of Federal Regulations. Various VA policies and directives have been written to provide additional interpretation.VA seeks an interim system to improve Purchased Care claims management. Due to the length of time needed to deploy long-term business process and technology changes, an interim technology system is needed to support and improve current operations. The product will support the following objective:Deliver an interim enterprise-wide system to support Purchased Care claims management through automation that produces standardization across facilities by providing: a. Simplified management and tracking of Purchased Care (Fee Basis) claims processing activitiesb. Reduced manual data entry and improved accuracyc. Use of Electronic Data Interchange (EDI) for claims processing d. Integration with VistA clinical and financial system of systemsA software solution is needed to improve Purchased Care claims management and adjudication. The system must provide efficiencies for the processing of claims as well as provide reporting capabilities needed to strategically guide the decisions made about Purchased (Non-VA) care at the facility/VISN and enterprise levels. The software must provide the following salient characteristics:Handling and Processing of Claims:Scanning" The software will support the imaging and digital storage of any color paper claims through the use of Optical Character Recognition (OCR)." Extract claim data using OCR from claim forms and automatically feed data into the adjudication engine to eliminate manual data entry" Support the entry and use of business rules to ensure OCR scanned data is accurate and complete" Provide the ability to print scanned claimsProcessing and Tracking" Index and track claims received for processing" Provide integrated claims scrubbing functionality" Provide electronic management of workload assignments and claim processing workflow" Provide electronic storage and retrieval of claims." Automate and improve claims adjudication data provided to non-VA Providers" Automatically generate Veteran and Provider letters when claim is processed." Identify duplicate claims." Provide the ability for users to sort their assigned work queues." Provide the ability to re-route claims to distribute workload." Allow management to track staff workload and productivity." Accept EDI ClaimsAuthorization" Provide real time match of authorization to claim through Veterans Integrated Systems and Technology Architecture (VistA) integration." Display the Consult from VistA/Computerized Patient Record System (CPRS) for efficient Authorization entry." Provide Clinical Tracking functionality to allow Utilization Review staff to track and document authorization activities" Provide the ability to add, edit and "early stage" delete notifications through Windows GUI interface." Provide the ability to add, edit, complete and delete authorizations through Windows GUI interface." Apply VistA business rules to validate patient, status, eligibility upon Authorization creation." Prevent users from creating duplicate authorizations for care (VA form: VAF 10-7078)." Track and manage authorization (or Referral) number throughout the system." Provide functionality to replace the Report of Contact process and serve as the entry point for the authorization (VAF10-7078) creation process.Payment" Allow Centers for Medicare and Medicaid Services (CMS) Office of Inspector General (OIG) excluded providers to be identified and excluded during claim processing" Define claim payment rules to promote consistency in claims pricing and processing" Automate delivery to/from electronic re-pricer agent (EDI)" Display a user's active batches listed by Integrated Funds Distrubtionm Control Point Activity, Accounting and Procurement (IFCAP) Fund Control Point (FCP) or obligation number" Provide exception-based payment processing by routing claims with edits to work lists for user follow-up" Automate the population of all relevant claim data in the payment module" Track available funds for each FCP and obligation number" Validation edits identify missing or invalid data prior to submission to Austin Information Technology Center (AITC) (vendor, authorization #, Social Security Number)" Store payment history tables" Sort, group, and filter claims when preparing batches for payment" Adhere to all VistA Fee business rules " Provide ability to open, close, re-open, edit and delete batches." Provide ability to sort, group, filter and pay facility and associated ancillary claims" Simplify the Supervisor Pricer Batch Release process through reduction to a one-click process within the inpatient payment module that transmits to AITC. " Post obligations to the miscellaneous obligation (1358) upon creation of the authorization (VAF 10-7078)." Manage pricer transmissions to and from AITC" Integrate the per diem calculation to support inpatient claims processingVistA Integration" Display VistA data (i.e. Service Connected/Non Service Connected, insurance, pre-authorization) in all workflows." Allow staff ability to retrieve claim status/history by veteran or vendor." Provide integration with VistA Fee to support the obligation of FCP" Manage records that meet the VA requirement for Cost Recovery" Automatically open a VistaA Patient Treatment File (PTF) record upon creation of the authorization (VAF 10-7078)." Pull FCP from the Authorization module" Fully functional VistA interface to accomplish above actionsGeneral" Provide a Windows based GUI user interface" Provide the ability to manage system files (i.e. vendor file, etc)" Provide ad-hoc reporting capabilities" Provide user role based security capabilities that can be mapped to a specific job functionPricing Information:VA requests information about how you license/price your product - e.g., by user, by site. Please provide commercial price list and product literature. Demonstrated Past experience The offeror is encouraged to discuss specific past experience with VistA and with deployment of similar health care applications.ADDITIONAL INFORMATIONResponses should include the (1) business name and address; (2) name of company representative, phone number, and their business title; (3) DUNS information and socio-economic status; (4) contract vehicles available that would be available to the Government for the procurement of the product and service, to include General Service Administration (GSA) Federal Supply Schedules (FSS), or any other Government Agency contract vehicle.The anticipated North American Industry Classification System Code (NAICS) for this requirement is 541519 (Other Computer Related Services). The size standard is $25M."Small businesses are strongly encouraged to provide responses to this RFI, in order to assist the VA in determining the potential levels of interest, competition and technical capability to provide the required products and services within the Small Business community. In addition, this information will also be used to assist the VA in establishing a basis for developing any subsequent potential subcontract plan and/or small business goal percentages." NOTE: THIS NOTICE MAY HAVE POSTED ON FEDBIZOPPS ON THE DATE INDICATED IN THE NOTICE ITSELF (20-OCT-2008). IT ACTUALLY APPEARED OR REAPPEARED ON THE FEDBIZOPPS SYSTEM ON 13-MAY-2009, BUT REAPPEARED IN THE FTP FEED FOR THIS POSTING DATE. PLEASE CONTACT 877-472-3779 or fbo.support@gsa.gov REGARDING THIS ISSUE.
- Web Link
-
Link To Document
(https://www.fbo.gov/spg/VA/VAAAC/VAAAC/VA-200-09-RP-0017/listing.html)
- Record
- SN01815700-F 20090515/090513233026 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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