MODIFICATION
D -- VHA Purchased Care Claims Processing Purpose of this noticeis to extend the FBO archive date.
- Notice Date
- 5/13/2009
- Notice Type
- Modification
- NAICS
- 541519
— Other Computer Related Services
- Contracting Office
- Department of Veterans Affairs;Acquisition ManagementSection/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 VHAPurchased 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 accessto quality health care services, VA healthcare facilities are authorizedto pay for health care services acquired from non-VA health careproviders. These services may be provided to eligible veterans fromnon-VA health care providers when VA determines medically necessaryservices are not available from VA on a timely basis, in an emergency orwhen VA or other Federal facilities are not feasibly available. VA manages the authorization, claims processing and reimbursement forservices acquired from non-VA health care providers through thePurchased Care Program. The basic provisions of and authority for thePurchased Care Program are provided through public laws passed byCongress. These laws have been codified into the United States Code andfurther clarified in the Code of Federal Regulations. Various VApolicies and directives have been written to provide additionalinterpretation. VA seeks an interim system to improve Purchased Care claims management.Due to the length of time needed to deploy long-term business processand technology changes, an interim technology system is needed tosupport and improve current operations. The product will support thefollowing objective: Deliver an interim enterprise-wide system to support Purchased Careclaims management through automation that produces standardizationacross 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 systems A software solution is needed to improve Purchased Care claimsmanagement and adjudication. The system must provide efficiencies forthe processing of claims as well as provide reporting capabilitiesneeded to strategically guide the decisions made about Purchased(Non-VA) care at the facility/VISN and enterprise levels. The softwaremust provide the following salient characteristics:Handling and Processing of Claims:Scanning" The software will support the imaging and digital storage of anycolor paper claims through the use of Optical Character Recognition(OCR)." Extract claim data using OCR from claim forms and automaticallyfeed data into the adjudication engine to eliminate manual data entry" Support the entry and use of business rules to ensure OCRscanned data is accurate and complete" Provide the ability to print scanned claims Processing and Tracking" Index and track claims received for processing" Provide integrated claims scrubbing functionality" Provide electronic management of workload assignments and claimprocessing workflow" Provide electronic storage and retrieval of claims." Automate and improve claims adjudication data provided to non-VAProviders" Automatically generate Veteran and Provider letters when claimis processed." Identify duplicate claims." Provide the ability for users to sort their assigned workqueues." Provide the ability to re-route claims to distribute workload." Allow management to track staff workload and productivity." Accept EDI Claims Authorization" Provide real time match of authorization to claim throughVeterans Integrated Systems and Technology Architecture (VistA)integration." Display the Consult from VistA/Computerized Patient RecordSystem (CPRS) for efficient Authorization entry." Provide Clinical Tracking functionality to allow UtilizationReview staff to track and document authorization activities" Provide the ability to add, edit and "early stage" deletenotifications through Windows GUI interface." Provide the ability to add, edit, complete and deleteauthorizations 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 throughoutthe system." Provide functionality to replace the Report of Contact processand serve as the entry point for the authorization (VAF10-7078) creationprocess.Payment" Allow Centers for Medicare and Medicaid Services (CMS) Office ofInspector General (OIG) excluded providers to be identified and excludedduring claim processing" Define claim payment rules to promote consistency in claimspricing and processing" Automate delivery to/from electronic re-pricer agent (EDI)" Display a user's active batches listed by Integrated FundsDistrubtionm Control Point Activity, Accounting and Procurement (IFCAP)Fund Control Point (FCP) or obligation number" Provide exception-based payment processing by routing claimswith edits to work lists for user follow-up" Automate the population of all relevant claim data in thepayment module" Track available funds for each FCP and obligation number" Validation edits identify missing or invalid data prior tosubmission to Austin Information Technology Center (AITC) (vendor,authorization #, Social Security Number)" Store payment history tables" Sort, group, and filter claims when preparing batches forpayment" Adhere to all VistA Fee business rules " Provide ability to open, close, re-open, edit and deletebatches." Provide ability to sort, group, filter and pay facility andassociated ancillary claims" Simplify the Supervisor Pricer Batch Release process throughreduction to a one-click process within the inpatient payment modulethat transmits to AITC. " Post obligations to the miscellaneous obligation (1358) uponcreation of the authorization (VAF 10-7078)." Manage pricer transmissions to and from AITC" Integrate the per diem calculation to support inpatient claimsprocessing VistA Integration" Display VistA data (i.e. Service Connected/Non ServiceConnected, insurance, pre-authorization) in all workflows." Allow staff ability to retrieve claim status/history by veteranor vendor." Provide integration with VistA Fee to support the obligation ofFCP" Manage records that meet the VA requirement for Cost Recovery" Automatically open a VistaA Patient Treatment File (PTF) recordupon creation of the authorization (VAF 10-7078)." Pull FCP from the Authorization module" Fully functional VistA interface to accomplish above actions General" 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 mappedto a specific job function Pricing Information:VA requests information about how you license/price your product - e.g.,by user, by site. Please provide commercial price list and productliterature. Demonstrated Past experience The offeror is encouraged to discuss specific past experience with VistAand with deployment of similar health care applications. ADDITIONAL INFORMATIONResponses should include the (1) business name and address; (2) name ofcompany representative, phone number, and their business title; (3) DUNSinformation and socio-economic status; (4) contract vehicles availablethat would be available to the Government for the procurement of theproduct and service, to include General Service Administration (GSA)Federal Supply Schedules (FSS), or any other Government Agency contractvehicle.The anticipated North American Industry Classification System Code(NAICS) for this requirement is 541519 (Other Computer RelatedServices). The size standard is $25M."Small businesses are strongly encouraged to provide responses to thisRFI, in order to assist the VA in determining the potential levels ofinterest, competition and technical capability to provide the requiredproducts and services within the Small Business community. In addition,this information will also be used to assist the VA in establishing abasis for developing any subsequent potential subcontract plan and/orsmall business goal percentages." NOTE: THIS NOTICE WAS NOT POSTED TO FEDBIZOPPS ON THE DATE INDICATED IN THE NOTICE ITSELF (13-MAY-2009); HOWEVER, IT DID APPEAR IN THE FEDBIZOPPS FTP FEED ON THIS 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
- SN01816217-F 20090515/090513233050 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
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