SPECIAL NOTICE
R -- RFI for Health Plan Support Services
- Notice Date
- 2/23/2015
- Notice Type
- Special Notice
- NAICS
- 524292
— Third Party Administration of Insurance and Pension Funds
- Contracting Office
- Department of Health and Human Services, Centers for Disease Control and Prevention, Acquisition and Assistance Field Branch (Pittsburgh), Post Office Box 18070, Cochrans Mill Road, Pittsburgh, Pennsylvania, 15236-0070
- ZIP Code
- 15236-0070
- Solicitation Number
- 20150223WTCHP
- Archive Date
- 4/4/2015
- Point of Contact
- Abbie Jemmott,
- E-Mail Address
-
AJemmott@cdc.gov
(AJemmott@cdc.gov)
- Small Business Set-Aside
- N/A
- Description
- Request for Information for Health Plan Support Services This announcement constitutes a Request for Information (RFI) as defined in Federal Acquisition Regulation (FAR) 15.201(e), Exchanges with Industry before receipt of proposals. The Government is soliciting Requests for Information only. The purpose of this RFI is to gain knowledge of qualified sources and their respective size classification. Small businesses are encouraged to respond. Respondents should note that no funding has been reserved for this announcement. This announcement is not a request for proposals; therefore, responses to the RFI are not considered offers and cannot be accepted by the Government to form a binding contract. NO CLASSIFIED INFORMATION SHOULD BE INCLUDED IN THE RFI RESPONSE. Submission of a response is voluntary. Respondents are advised that the Government is under no obligation to provide feedback with respect to any information submitted under this RFI. The Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), World Trade Center (WTC) Health Program, is seeking responses from organizations with experience providing the services listed below related to a health plan to meet the needs of the members under the provisions of the James Zadroga 9/11 Health and Compensation Act of 2010 (http://www.gpo.gov/fdsys/pkg/PLAW-111publ347/pdf/PLAW-111publ347.pdf). Thus, it is important that Respondents have familiarity with this legislation and the WTC Health Program (http://www.cdc.gov/wtc/index.html). Responses should include what experience the respondent has in providing some or all of these services either alone, or in partnership with other entities, or through subcontracts with other entities. The Government is seeking the most cost effective approach to meet this potential requirement. Respondents should address their ability to provide these services for health care delivered in the New York City metropolitan area and/or nationwide for a diverse population (ethnicity, language, occupation, and complexity of health conditions). 1. Provide a site for secure submission of applications for enrollment of members, requests for certification of health conditions, appeals of decisions by the WTC Health Program, and other communications from members and providers. Responses should include a description of how such information would be securely transmitted to the WTC Health Program. 2. Assist with reviewing enrollment applications and following up with applicants to obtain any needed information. 3. Maintain a call center to receive and respond to inquiries from potential enrollees, members, and providers. Provide escalation as needed for properly responding to inquiries. 4. Enroll credentialed providers at the request of Clinical Centers of Excellence (CCE) and possibly the Nationwide Provider Network (NPN) to render clinical care or specialty consultation as authorized for a specified set of physical and mental health conditions. Providers include cancer care systems, a broad range of medical and surgical specialists, ancillary support services, CMS-approved organ transplantation, emergency care, same-day surgery, and inpatient facilities. 5. Receive electronic data interchange (EDI) claims from CCEs and the NPN, as well as either EDI or paper claims from the network of providers that are external to the CCEs. Create EDI claims from paper claims as needed. 6. Provide a secure web portal to allow the CCEs to approve all claims for medical services rendered outside of their organizations as medically necessary for their patients' care. All submitted EDI claims for internal CCE services and NPN services are considered approved. The portal should also give providers access to the status of their claims. 7. Adjudicate medical claims using a system that meets the needs of the WTC Health Program: • Professional and Institutional • Limited set of health conditions that are certified (approved) by the Federal government for each patient • Limited durable medical equipment • Plan service limits and pre-authorizations for certain procedures • Pricing at a maximum of Federal Employees Compensation Act (FECA) rates and some pricing at Medicare rates, including Diagnosis Related Group (DRG) pricing • National Correct Coding Initiative (NCCI) edits • National Comprehensive Cancer Network (NCCN) guidelines • Claims involving coordination of benefits with insurers that pay before the WTC Health Program 8. Review billing practices pre and/or post payment for possible Fraud, Waste, and Abuse (FWA). Responses should include a description of other FWA activities that are relevant to health plans. 9. Provide pharmacy services for filling prescriptions at local pharmacies or through mail order, with controls on formularies, members, and prescribers. Responses should include a description of access to retail and mail order pharmacy networks, electronic claims adjudication system, electronic tools for benefit manipulation and reporting, discount/rebate negotiation and specialty pharmacy services for complex cases like cancer patients, and pharmacy audit capability. The response should include authorization interfaces for prescribers and QA controls to prevent unauthorized prescriptions from being written when a limited set of health conditions are covered by specific pharmacy benefit plans (limited formularies). 10. Submit medical and pharmacy claim files to a contractor of the Centers for Medicare & Medicaid Services for payments to providers. 11. Support the CCEs, their external providers, and the NPN on processed claims to facilitate reconciliation with submitted claims, corrective actions on denied claims, and dispute resolutions. 12. Provide case management for particular members as requested by CCEs or the NPN. Responses should demonstrate experience providing case management services to assist with cancer care navigation, after hours nurse advice line to support members with complex health conditions, and technical support to providers regarding service authorization limitations. 13. Create and maintain a data warehouse of all member information, including certified health conditions, and claims for medical and pharmacy benefits provided. Responses should demonstrate experience with Federal security and Health Insurance Portability and Accountability Act (HIPAA) requirements. 14. Prepare standard and ad hoc reports to track claims, review paid and denied claims, show trends for numbers and costs of services by parameters that give insights to health care delivery, and detect areas of concern. CONTENT: RFI responses shall include the company name; company address; and the name, title, phone number, and email address of the point of contact having the authority and knowledge to discuss the RFI submission. Qualified respondents shall provide a comprehensive capability statement, supporting their experience to provide the services described above, to include any relevant past performance. All responses to this RFI shall be submitted via email only to the Contracting Officer, Abbie Jemmott at AJemmott@cdc.gov no later than 4PM EST, Friday, 20 Mar 15.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/CDCP/CMBP/20150223WTCHP/listing.html)
- Place of Performance
- Address: New York City metropolitan area and/or nationwide, United States
- Record
- SN03648972-W 20150225/150223235011-2d802ef245746413ee3c65dbc6cea431 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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