SOURCES SOUGHT
R -- Medical Claims Processing Services - Medical Claims Processing Sources Sought
- Notice Date
- 10/22/2014
- Notice Type
- Sources Sought
- NAICS
- 524291
— Claims Adjusting
- Contracting Office
- Department of Health and Human Services, Program Support Center, Division of Acquisition Management, 12501 Ardennes Avenue, Suite 400, Rockville, Maryland, 20857, United States
- ZIP Code
- 20857
- Solicitation Number
- IHS0002
- Archive Date
- 11/18/2014
- Point of Contact
- Michael Fischer, Phone: 301-443-6749
- E-Mail Address
-
michael.fischer@ihs.gov
(michael.fischer@ihs.gov)
- Small Business Set-Aside
- Total Small Business
- Description
- Sources Sought Document INTRODUCTION & PURPOSE This is a Small Business Sources Sought notice. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding: (1) the availability and capability of qualified small business sources; (2) whether they are small businesses; HUBZone small businesses; service-disabled, veteran-owned small businesses; 8(a) small businesses; veteran-owned small businesses; woman-owned small businesses; or small disadvantaged businesses; and (3) their size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition. Your responses to the information will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. An organization that is not considered a small business under the applicable NAICS code should not submit a response to this notice. BACKGROUND The Indian Health Service (IHS), an agency within the Department of Health and Human Services is responsible for providing federal health services to American Indians and Alaska Natives (AI/AN). IHS provides a comprehensive health service delivery system for approximately 1.9 million AI/AN who belong to 566 federally recognized tribes in 35 states. The IHS is divided into twelve physical areas of the United States; Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland and Tucson. Each of these areas has a unique group of Tribes that they work with on a day to day basis. The purpose of this acquisition is to obtain the services of a certified fiscal intermediary (FI) agent to provide a centralized medical and dental claims processing service, reimbursement and reporting system on behalf of the Indian Health Service (IHS) for those health care providers within the Purchased Referred Care (PRC) program. The IHS does not have the capacity to calculate the Medicare DRG reimbursement rates in accordance with the IHS payment policy. The IHS payment policy states the IHS contract with those providers who accept Medicare reimbursement rates. Paying at the Medicare rates allow the PRC program to purchase more health care for Indian patients. The use of an FI will give IHS the capability to capture and retrieve data from a centralized database. This type of capability is essential when IHS Headquarters has to respond to Congressional inquiries. The reports generated by the Contractor from the centralized database allows IHS managers at all levels to compare and make more informed decisions about the types of services for which the service is paying. The use of an FI is necessary to coordinate patient benefits and process medical and dental claims, ensure that the IHS is the payor of last resort for services provided to patients and calculate Medicare rates in accordance with Medical Like Rates (MLR) regulations and the IHS payment policy. These FI services must also be made available to tribes that contract and compact their PRC programs under the Indian Self-Determination Education and Assistance Act (P.L. 93-638). The IHS provides a comprehensive health service delivery system for AI/AN patients with the PRC Program playing an important role in the provision of care. Under the PRC program, primary and specialty health care services that are not available at IHS or tribal facilities are purchased from private health care providers. Because of PRC funding is limited by Congressional appropriations, the Program relies on strict adherence to specific guidelines to ensure the most effect use of PRC resources. The IHS has contracted for FI services since 1986 under the authority contained in the Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law 99-272, Section 17003 which "provides authority for the Secretary of the Department of Health and Human Services to contract with fiscal agents to perform claims payment, processing and audit functions with respect to services purchased on a contract basis by the Public Health Service... Fiscal Agents must either be entities which could qualify as carriers for Medicare purposes, or Indian tribes or Tribal organizations acting under the Indian Self-Determination Act contracts. While the fiscal agents need not be Medicare carriers, they must meet the same requirements as Medicare carriers regarding efficiency and effectiveness of operations, surety bonds, and financial controls." Project Requirements The contractor will be expected to understand the mission of the IHS and its health care delivery system as well as the purpose and function of the PRC Program. The contractor will process and pay medical and dental claims under its health care delivery system and interface with the Unified Financial Management System (UFMS) an Oracle based financial system for all IHS financial transactions, The UFMS interface is initiated through the IHS Resource and Patient Management System (RPMS) and Purchased Referred Care/Management Information System (PRC/MIS). The RPMS system is a decentralized integrated solution for management of both clinical and administrative information in the IHS healthcare facilities. Flexible hardware configurations, over 50 software applications, and network communication components combine to create a comprehensive clinical, financial, and administrative solution; a solution that can stand alone or function in concert with other components as needed. RPMS software applications have been, and continue to be, customized and enhanced based on input from users throughout the entire Indian Healthcare system. As the foundation of the Indian Health information technology support system, RPMS is mission critical. The RPMS system has four main components that include hardware, software, network, and database; each of these are vital to the overall success of the system. RPMS allow facilities large and small to work independently and within the larger network of the Indian Health system, and, are an integral component for providing the best and most effective healthcare to individual patients and to the community as a whole. Professionals in AI/AN, and private sector health facilities use RPMS to efficiently manage programs, maximize revenue generation, and most important, to provide high-quality care for patients. The contractor shall operate a claims payment system that meets the programmatic, financial, and statistical needs of the IHS with assurances that include but are not limited to confirmation of zero duplicate claim payments, payments within established amounts and payments within established timeframes. The technical aspects of this acquisition include the ability to operate and maintain a system capable of processing claims and payments for hundreds of providers associated with over 75 federal and tribal healthcare facilities. The system must be capable of warehousing data and producing workload, financial and statistical reports on a regular and as needed basis. The FI system will be used to collect, compile and organize workload and financial data and produce statistical and financial reports necessary for Congressional responses, budget formulation activities, Government Performance and Results Act (GPRA) tracking and reporting. The database system will also have the capability to provide IHS with necessary reports and information within a reasonable timeframe typically not to exceed two weeks. These systems must be in place and operable within three months of contract award. The contractor will also be expected to ensure their systems are ICD-10 compliant by October 1, 2015. Types of Services: Claims Processing System: Provide and operate an automated system for medical and dental claims processing, adjustments, reimbursements, payment recovery, and controls to ensure accurate and timely payments in accordance with established HHS and IHS accounting practices. Claims Payment and Recovery: Make payments for medical and dental claims in accordance with the IHS Contracts or negotiated rate agreements. Provide recovery and accounting procedures for duplicate or erroneous provider payments. The contractor will be responsible for processing, making adjustments, reimbursements, payment recovery and making payments for approximately 365,000 medical and dental claims. The Contractor shall develop and implement internal controls as part of the claims processing system Reimbursements: The Contractor shall use the reimbursement methodologies within Section 506 of the Medicare Modernization Act of 2003 as applicable. Data/Information/Reporting: The hardware, software, and communications network technologies required to manage a PRC Automated Data Processing Claims system (ADP) business application includes communications networks, equipment capacities, operational procedures, and technology capabilities. Technologies used shall carry out key activities-such as data security, preparation, storage, and retrieval-across functional, organizational, and geographic boundaries. The Contractor shall implement and provide a system, which will provide services, equipment, and material required to support current and future operations for IHS, PRC claims processing. Support Services: The Contractor shall provide and maintain a newsletter and periodic special issues that will be accessible on line. Before the newsletter is released the Contractor must receive approval from the COR. Newsletters shall address a wide range of issues aimed at informing PRC staff on systems operations, modifications, and suggestions for improved operational performance. A quarterly issue shall be considered the minimum. Management: The Contractor shall maintain the technical capacity, either by direct personnel or contracted personnel, to maintain and operate a claims processing system and implement program requirements in a timely manner. The Contractor shall ensure that the management staff are capable of effectively planning for timely implementation of routine changes in program requirements, as well as, ensuring efficient and effective daily operations. Tribal Use of Contract: Tribes operating PRC programs under the Indian Self-Determination and Education Assistance Act (ISDEAA), Public Law 93-638, as amended, may leave their shares with the IHS or take them. In the event the Tribes take their shares, they can buy back services from the Federal Government and IHS will continue to assist Tribes. Reporting: The Contractor shall provide reports on a regular basis or upon request according to the following: Payment Cycle Status Reports, Weekly, Monthly, Quarterly, Semi-Annual on Payments, and Pended Claims. Electronic Medical Records. Electronic Medical Records are prohibited unless otherwise pre-approved, in writing. All medical documents must be maintained on paper. All records must be maintained in a secure, locked filing cabinet or locked room, separate from other medical files and with access restricted to individuals with a need to know and authorized as noted above in accordance with federal medical confidentiality laws. Security Checks: All office personnel who have access to the records and administrative information pertaining to IHS employees shall be subject to a National Agency Check (NAC). The process for Security checks will be coordinated by the COR and the Security Officer assigned to the IHS Field Office upon contract award. Fingerprints for identification purposes will be required. Any contracted personnel who perform services under this agreement may be subject to a background investigation. Only persons authorized and cleared by the federal government shall perform services and have access to any medical information. The Contractor agrees to fully cooperate with the government agency to complete the security process by promptly completing necessary forms, scheduling finger printing, and providing required documentation within thirty (30) days of contract award date. SPECIAL SECURITY REQUIREMENTS: The contractor shall not photocopy, or in any way retain, any identification documents belonging to IHS personnel, including, but not limited to IHS documents, or personal driver's licenses. The contractor shall not use any Personally identifiable information such as a home address for IHS personnel. Disclaimer and Important Notes. This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization's qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in Federal Business Opportunities. However, responses to this notice will not be considered adequate responses to a solicitation. Confidentiality. No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s). Interested small business firms are highly encouraged to respond to this notice. However, firms should understand that generic capability statements are not sufficient for effective evaluation of their capacity and capability to perform the work required. Responses must directly demonstrate the company's capability, experience, and ability to marshal resources to effectively and efficiently perform the objectives described above. RESPONSE INFORMATION In order to respond to this notice, interested firms should address the depth and breadth of corporate and technical capabilities, and must be able to clearly convey its experience and/or ability to provide the services in the following areas, which are identified as core services. This is a Small Business Sources Sought notice. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding: (1) the availability and capability of qualified small business sources; (2) whether they are small businesses; HUBZone small businesses; service-disabled, veteran-owned small businesses; 8(a) small businesses; veteran-owned small businesses; woman-owned small businesses; or small disadvantaged businesses; and (3) their size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition. Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. An organization that is not considered a small business under the applicable NAICS code should not submit a response to this notice. Interested respondents shall provide a capability statement to include the following: Information regarding the difficulty and/or feasibility of the potential requirement or proposed acquisition Information regarding core competencies: (a) Staff expertise, experience, and formal and other training; (b) Current corporate capability and capacity to perform the work; (c) Prior completed projects of similar nature; (d) Corporate experience and management capability; (e) Examples of prior completed Government contracts, references, and other related information; The written response to this notice should consist of the following items: • Company Name. • Company DUNS number. • Company point of contact, mailing address, telephone and fax numbers, and website address • Name, telephone number, and e-mail address of a company point of contact who has the authority and knowledge to clarify responses with government representatives • Date submitted. • Applicable company GSA Schedule number or other available procurement vehicle. • Do you have a Government approved accounting system? If so, please identify the agency that approved the system. • Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). All respondents must register on the CCR located at http://www.ccr.gov/index.asp Responses must be submitted to the email below, no later than November 3, 2014 at 5:00PM EST. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is ten (10) pages. Capability statements should be emailed electronically to the name and email below. As previously stated, the Government will not entertain questions regarding this Market Research; however, general questions may be forwarded to the following: Michael T. Fischer Contract Specialist Department of Health and Human Services Office: (301) 443-6749 Email: Michael.Fischer@ihs.gov
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/PSC/DAM/IHS0002/listing.html)
- Place of Performance
- Address: TBD, United States
- Record
- SN03555973-W 20141024/141022234331-d64ae7f74d1b34f8bc51a5fc11aa549e (fbodaily.com)
- Source
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