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FBO DAILY ISSUE OF FEBRUARY 26, 2011 FBO #3381
DOCUMENT

70 -- Non-VA Care Claims Processing - Attachment

Notice Date

2/24/2011
 

Notice Type

Attachment
 

NAICS

541519 — Other Computer Related Services
 

Contracting Office

Department of Veterans Affairs;Center for Acquisition Innovation-Austin;1701 Directors Blvd;Suite 600;Austin TX 78744
 

ZIP Code

78744
 

Solicitation Number

VA798A11RI0086
 

Response Due

3/3/2011
 

Archive Date

3/10/2011
 

Point of Contact

Lateefah S Parker
 

E-Mail Address

ct
 

Small Business Set-Aside

N/A
 

Description

Introduction: THIS IS NOT A SOLICITATION. In accordance with FAR Part 10, Market Research, and as part of VA's market research process, this is a request for information (RFI) to assist us in developing an acquisition strategy for HCP claims processing system. This RFI is for information and planning purposes only and shall not be construed as a solicitation or as an obligation on the part of the VA. The purpose of this RFI is to identify qualified sources able to meet VA requirements, to assist in planning possible future technical requirements, determine the appropriate acquisition strategy, and understand commercial pricing practices and other market information readily available. Telephone inquiries and responses will not be accepted at this time since there is no further information available. This announcement is based upon the best information available and is subject to future modification. VA will not be responsible for any costs incurred by responding to this RFI. Overview: A VA facility unable to meet the patient care requirements of a Veteran may authorize Fee Basis services (non-VA Care) for inpatient care, outpatient care, dental care, pharmaceutical care, or home health care from non-VA health care facilities. Invoices for these services are then submitted to the authorizing VA facility, which processes the invoice for payment utilizing multiple Fee Software application. The Fee Basis packages provides for more efficient and accurate operation of the fee for service program with reduction of paperwork, savings in staff hours, minimization of errors, and by allowing medical facilities to have greater control over disbursement of fee medical, pharmacy, and travel monies. The Veterans Health Administration (VHA) Chief Business Office (CBO) requests enhancements to VistA and current Commercial of the Shelf (COTs) products currently in use to improve business processes that support the entire Non-VA Care Program. These business processes include entering patient authorizations and vendor information, processing claims for approval/denial and transmitting completed batch data for processing at the VA's payment center in Austin, Texas. Background: VHA is comprised of 21 Veterans Integrated Service Networks (VISN) that are each responsible for managing health care activities within their geographic area that can include six to ten medical facilities and a number of supporting outpatient facilities. Details can be found at http://www.va.gov/directory/guide/division_flsh.asp?dnum=1. VA medical centers within a VISN work together to provide efficient, accessible health care to Veterans in their areas. With 163 VAMCs nationwide, VHA manages one of the largest health care systems in the United States. At times, Department of Veterans Affairs (VA) facilities cannot provide all of the necessary outpatient, inpatient, dental, and pharmaceutical care and services required by its patients. Additionally, the Veteran may not be able to access VA health care facilities based on geographic constraints or due to medical emergencies; or it could be economically advantageous for the VA to provide treatment to Veterans within the community they reside. In these cases, the VA may authorize and pay for medical care to private sector providers for those Veterans who meet the eligibility requirements. This concept is referred to as Fee Basis (or non-VA purchased) care. With the exception of some medical emergencies, outpatient Fee care must be authorized before Veterans receive services from non-VA facilities/providers. The current Referral and Authorization process for the Fee Program is not integrated with the Computerized Patient Record System (CPRS), resulting in weaknesses in the internal controls needed to ensure that fee care is properly justified and authorized. CBO has identified the business need to create an integrated end to end future state claims processing system to include the standardization and automation of the Referral and Authorization application for all of Purchased Care. Future state processes to automate justification, authorization, coordination and documentation of fee care rely on integration with CPRS and VistA Imaging. This request seeks to expand data capture efforts during authorization entry for inpatient and outpatient non-VA services in the Fee Basis software package via an interface from Fee Basis two-way data sharing with CPRS. Mechanisms to ensure the proper steps are followed and documented in the approval process are also requested. Key data elements to be added for any Fee service include data associated with requirements for ordering services and those associated with an industry standard health care claim such as the names of the referring VA clinician and the approving clinical review designee, cost analysis fee use justification (when necessary), type of medical care to be rendered, and auto-generated authorization funds estimate. Additionally, Fee Basis authorization reports will need to be created/updated to include the new data elements and all data should be sent to Central Fee. In addition the current functionality of the Fee Basis software package does not allow the user the ability to complete all required actions needed during the Fee care authorization process to include the addition of foreign addresses for Veterans receiving Fee care at the Manila, Philippines and San Juan, Puerto Rico facilities, and Veterans who receive care in Canada. The foreign addresses data elements will be incorporated in any Fee Basis software components. VHA seeks an integrated solution with the multiple claims processing systems. The purpose is to improve the efficiency of certain business processes in its hospitals and clinics. The goals are to help: "Allow for a comprehensive clinical record of patient treatments and services provided under the authority of the VHA Purchased Care program. "Improve the accessibility of Purchased Care information in CPRS to assist clinicians complying with clinical practice guidelines and legislative mandates. "Provide relevant information to VA providers at the point of care for improving care for veterans. "Promote VA Provider satisfaction through the use of a Picture Archiving and Communication System (PACS) which interfaces with VistA Imaging and incorporates standardized requirements for document submission. "Promote veteran satisfaction by facilitating an efficient Purchased Care referral process via an external system which leads to decreased waiting time. "Provide a source of information for a patient cost based benefit activity when patient requires treatment outside of their local VA medical facility. "Provide service level information to VA stakeholders for data-driven decision making, thus improving client satisfaction. "Generate the Authorization Letter/required forms to include approved clinical services and limitations. "Streamline and enhance VA Form 1358 Miscellaneous obligations for Purchased Care. "Establish an obligation to the VA Form 1358 at time of authorization based on applicable CPT code estimated cost. "Create alerts for VA Form 1358 balances for Purchased Care. "Manage the application of cost estimation to VA Form 1358 Obligations. "Automate the decrease/increase of the cost estimation to VA Form 1358 Obligations as the invoice is processed for payment. "Generate enhanced reports from Purchased Care obligation estimates. "Ability to complete all required actions needed during the Fee care authorization process to include the addition of foreign addresses for Veterans receiving Fee care at the Manila, Philippines, Canada, and San Juan, Puerto Rico facilities. For the purpose of this RFI, "enterprise" is defined as deployment across all VISNs. Solutions to be considered shall include: application software and all necessary hardware (servers). Requirements: 1.Assessment of capabilities to perform requirements noted in the RFI 2.Assessment of the types of changes required to accomplish the goals 3.Approach to be utilized to develop necessary changes to the systems to meet the organizational goals 4.Draft schedule to complete necessary changes Following is an overview of systems requirements: "Ability to interface the CPRS module with other VistA applications and COTS products. "Ability to manage two-way communication between Fee software and CPRS packages, to receive/send specific data elements from the applicable CPRS consult/note to any Fee software packages menu options "Ability to route clinical claim documentation to a work queue for review and processing (without impact on claim adjudication status) "Ability to interface with IFCAP to transmit disbursement detail to automatically post payments to the 1358, and make adjustments to the initial estimated obligation based on paid amounts. "VistA application enhancements for the Fee Basis and IFCAP modules. Example of these enhancements would include the ability to: "Store additional data elements "Enter additional data elements "Auto-populate cost estimates "Enter a cost analysis Fee use justification if necessary "Transmit to the Central Fee database "Process cost estimates for pre-authorizations "Generate correspondence for Veteran/vendor education "Create additional cost estimate postings on claims "Automatically adjust obligation service balances based on paid amounts "Apply multiple claims payments "Limit remarks when printing "Ability to create all required interfaces (from end-to-end) in accordance with industry standards to communicate with VA information (legacy) systems: Examples of the type of interface issues to be considered: "Programming M code (i.e. MUMPS-Massachusetts General Hospital Unitlity Multi-Programming System), to add/modify within the VistA application. "Use of a government provided VistA test environment "Ability to capture interface details through the creation of a formal Interface Control Document (ICD). "Ability to process incoming foreign address transmissions with the new address data elements. "Display the new foreign address data elements for identified packages. "Print the new foreign address format for all printed correspondence generated via Fee packages. "Transmit new foreign address to other VistA modules and external systems. Information Requested from Industry: In response to the RFI, interested contractors shall submit the following information: 1.Company Information/Socio-Economic Status - a.Provide the company size, the CAGE code, and the POC information (name, email address, telephone, and fax numbers). Identify the NAICS (North American Industry Classification System) code your company believes best represents the predominate work to accomplish the requirements. b.Indicate whether your company, subcontractors, teaming partners, joint ventures have a Federal Socio-Economic status, e.g., Small Business, Service-Disabled Veteran Owned Small Business, Veteran Owned Small Business, Woman-Owned Small Business, Disadvantaged Small Business, and Hub Zone. If Service-Disabled or Veteran Owned Small Business, is your company and or partners registered in VA's VetBiz repository? 2.Background/Past Experience - Provide the following information on a maximum of three similar projects in a healthcare environment completed within the last three years for which the responder was a prime or subcontractor. a.The name, address, and value of each project b.The Prime Contract Type, Firm Fixed-Price, Cost Reimbursement or Time and Material c.The name, telephone and address of the owner of each project d.A description of each project, including difficulties and successes e.Your company's role and services provided for each project. 3.Capabilities/Qualifications - Overview of proposed solution(s). a.Include a description of the capabilities/qualifications/skills your company possesses to perform the work as described in the identified requirements. 4.Teaming Arrangements - Description of Teaming Partners, Joint Ventures that your company would consider to perform the work. 5.Price information - Provide your commercial price history and rough order of magnitude for the same or similar products/solutions. 6.Other Market Information - Provide any other relative information, however this information must be included within the 15 page limitation. 7.Other Federal Experience - Identify the federal contract vehicles to which you are party. SPECIFIC RESPONSE INSTRUCTIONS: Please submit your response to this RFI in accordance with the following: 1) No more than 15 pages (excluding transmittal page). Include the name, email address and phone number of the appropriate representative of your company; 2) Address each of the 7 sections described above; 3) Submit your response via email to Lateefah.parker@va.gov; 4) Submit your response by 2:00 P.M. Central Time on March 3, 2011; 5) Mark your response as "Proprietary Information" if the information is considered business sensitive. 6) NO MARKETING MATERIALS ARE ALLOWED AS A PART OF THIS RFI. The Government will not review any other data, attachments that are in excess to the 15 pages.
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/notices/d91ad7287f2d866520001235214a0e93)
 

Document(s)

Attachment
 

File Name: VA798A-11-RI-0086 VA798A-11-RI-0086.doc (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=178346&FileName=VA798A-11-RI-0086-000.doc)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=178346&FileName=VA798A-11-RI-0086-000.doc

 

Note: If links are broken, refer to Point of Contact above or contact the FBO Help Desk at 877-472-3779.
 

Record

SN02387219-W 20110226/110224234744-d91ad7287f2d866520001235214a0e93 (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
(may not be valid after Archive Date)

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