SOURCES SOUGHT
R -- EDI Technical Support
- Notice Date
- 3/30/2015
- Notice Type
- Sources Sought
- NAICS
- 541611
— Administrative Management and General Management Consulting Services
- Contracting Office
- Department of Veterans Affairs;Health Administration Center;3773 Cherry Creek Drive North, Suite 450;Denver CO 80209
- ZIP Code
- 80209
- Solicitation Number
- VA74115N0101
- Response Due
- 4/6/2015
- Archive Date
- 5/6/2015
- Point of Contact
- Richard M Stockton
- E-Mail Address
-
0-1647<br
- Small Business Set-Aside
- N/A
- Description
- REQUEST FOR INFORMATION (VHA) EDI Technical and Healthcare Revenue Cycle Processing The purpose of this Request for Information (RFI)/Sources Sought is to identify qualified small business contractors who are able to meet Veterans Health Administration (VHA) requirements and gather other readily available market information. This RFI is for information and planning purposes only. Responses to this notice are not offers and cannot be accepted by the Department of Veterans Affairs (VA) to form a binding contract. The Government is under no obligation to issue a solicitation or to award any contract on the basis of this RFI. Further, the Department of Veterans Affairs is not seeking proposals and will not accept unsolicited proposals or any cost or pricing data. Personal Services contractors are advised that the U.S. Government will not pay for any information or administrative costs incurred in response to this RFI. All costs associated with responding to this RFI will be the sole responsibility of the contractor. All submissions will be treated as business confidential materials, become Government property, and will not be returned. 1. Purpose. The Veterans Health Administration (VHA), Chief Business Office (CBO), eBusiness Solutions requires Electronic Data Interchange (EDI) health care revenue cycle processing subject matter expertise. 2. Background. The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the Department of Health and Human Services to establish national standards for electronic health care transactions and code sets, and standard identifiers for providers, health plans, and employers. It also addresses the security and privacy of patient data. The health care industry has been working towards building an infrastructure to accommodate the complex legislative mandates resulting from HIPAA. The Department of Veterans Affairs Veterans Health Administration (VHA) is a covered entity under the law. The vast diversity in the business rules and functionality inherent in each payer and provider system presents an enormous challenge to creating a functioning HIPAA-compliant health care industry. The national standards and code sets do not unify provider billing systems and payer adjudications systems nor do they address the autonomy of both provider and payer entities to establish their own respective business requirements/policies; they do however, present a standard for the electronic data exchange of healthcare information. As a result, the payer and provider community must address each other's business needs if they are to achieve both HIPAA-compliance and processing efficiency. -Performance Work Statement Governance: All work and products executed and provided to the VHA/eBusiness Solutions shall comply with applicable statutory/regulatory mandates as well as any applicable policy and/or standards guidance. Further, the Contractor shall also comply with any inadvertently omitted, applicable statutory, regulatory, policy and standards guidance and shall notify the Contracting Officers Representative (COR), immediately upon discovery of such an omission. -These Governance elements are applicable only to the work efforts and products related to the requirements of this Performance Work Statement (PWS) and do not change established federal contracting regulations or applicable laws or policies related to federal acquisitions. -VHA/eBusiness Solutions has identified the following governance elements for this Performance Work Statement: HIPAA EDI Transactions processing standards for healthcare and pharmacy claims and payments. Department of Health and Human Services (HHS) Policy and Directives VHA Policy and Directives Mandates and Regulations 3. Objectives. Veterans' Health Administration (VHA), Chief Business Office (CBO), eBusiness Solutions has invested considerable time and effort over the past several years implementing multiple electronic data interchange (EDI) initiatives and resolving the business rule conflicts between the VA and the payer community. This effort continues as Veterans Health Administration (VHA) expands its data exchange reach to include additional payers and transaction types. In addition, the HIPAA standards committees are forecasting the mandate of additional transaction sets, otherwise known as electronic data format standards. When implemented, the collective body of HIPAA transactions would give VHA a more robust business product and make VHA a more viable business partner in the e-Business community. 4. Scope. The contractor shall provide all resources necessary to accomplish the deliverables described in the performance work statement (PWS), except as may otherwise be specified. Veterans Health Administration (VHA) is modifying its VA VistA software and business processes to comply with Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Contractor shall support the Veterans Health Administration (VHA) eBusiness Solutions e-initiatives by providing technical and EDI healthcare revenue cycle processing subject matter expertise. 5. Mandatory Tasks and Deliverables. The contractor shall provide briefings, project plans, issues lists, and various reports. If for any reason any deliverable cannot be delivered on time according to the below schedule, the contractor shall provide a written explanation three days prior to the due date, to the Contracting Officer Representative (COR). This written transmittal shall include a firm commitment of when the work shall be completed. This transmittal to the COR shall cite reasons for the delay, and the impact on the overall project. The COR will review facts with the program office and issue a response in accordance with the contract terms and conditions. Unless otherwise specified, an electronic copy of the transmittal shall be placed in the designated eBusiness solutions SharePoint site or other eBusiness-designated site. Specifically, the contractor shall: Task 5.1: The contractor shall identify payers yet to comply with upcoming EDI transaction standards, using eBusiness Solutions processes, to engage the payers in compliance actions to meet compliance dates Deliverable 5.1.1: The contractor will create and maintain a log of payers, actions taken, estimated compliance dates, pending issues and resolutions. Deliverable 5.1.2: The contractor will provide input to the project manager on the progress and issues related to eBusiness project for the project manager to include in the monthly briefing. Task 5.2: The contractor shall coordinate data exchange items with external trading partners to include identifying test-ready new payers, collect transaction testing requirements, monitor test transmissions between Austin Automation Center and external trading partners. Deliverable 5.2.1: The contractor will create and maintain an issues and resolution list Deliverable 5.2.2: The contractor will provide input to the project manager on the progress and issues related to eBusiness project for the project manager to include in the monthly briefing. Task 5.3: The contractor shall identify and document impacts of HIPAA EDI transactions, including NCPDP transactions to stakeholders and end users. The catalogue of impacts shall be shared with Project Manager and Program Support, and evaluated to determine implementation actions and considerations. Action plan shall be developed to mitigate each impact. Deliverable 5.3.1: The contractor shall prepare and maintain a Stakeholder Analysis and Communications Plan that outlines impacted and influential stakeholders and document any feasible alternatives to implementing the end solution. The stakeholder Analysis and Communications plan should include implementation constraints, risks or opportunities, and recommendations for implementing the proposed design solutions, strategies to maintain compliance with existing and emerging compliance issues and opportunities to optimize project/system improvements and best practices. The communications plan at a minimum shall include key messages, message medium, timing, audience, and owner. Deliverable 5.3.2: The contractor will provide input to the project manager on the progress or issues related to eBusiness projects for the project manager to include in the monthly briefing. 6. Key Personnel. Certain skilled experience professional and/or technical personnel are essential for accomplishing the work to be performed. These individuals are defines as "Key personnel" and are those persons whose resumes were submitted and marked by the vendor as "Key Personnel". Substitutions shall only be accepted if in compliance with "Substitutions shall only be accepted if in compliance with "Substitution of Key Personnel" provision identified below. Subject Matter Experts (SME) (x2) Senior experts with enterprise-wide knowledge and experience in HIPAA and Electronic Data Interchange (EDI) revenue processes. Provides insight and advice concerning strategic direction and the applicability of best industry practices, current technology, and applicable standards. Responsible for applying advanced principles, theories, and concepts, developing solutions to complex problems. Defines key concepts for the planning, acquisition, deployment, integration, operation and/or enhancement of systems, processes, and/or organizational practices. Both SME's shall have the ability to function independently and make decisions related to the projects tasks and deliverables without requiring any additional layers of company oversight or approvals. 6.1 The Contracting Officer may notify the Contractor and request immediate removal of any personnel assigned to the task order by the Contractor that are deemed to have a conflict of interest with the government or if the performance is deemed to be unsatisfactory. The reason for removal will be documented and replacement personnel shall be identified within three business days of the notification. Employment and staffing difficulties shall not be justification for failure to meet established schedules. 6.2 Substitution of Key Personnel. All Contractor requests for approval of substitutions hereunder shall be submitted in writing to the COR and the Contracting Officer at least thirty (30) calendar days in advance of the effective date, whenever possible, and shall provide a detailed explanation of the circumstances necessitating the proposed substitution, a complete resume for the proposed substitute, and any other information requested by the Contracting Officer necessary to approve or disapprove the proposed substitution. New personnel shall not commence work until all necessary security requirements, as defined in Section J, have been fulfilled and resumes provided and accepted. The COR and the Contracting Officer will evaluate such requests and promptly notify the Contractor of approval or disapproval in writing. 6.3 The Contractor shall be responsible for managing and overseeing the activities of all Contractor personnel, as well as subcontractor efforts used in performance of this effort. The Contractor's management responsibilities shall include all activities necessary to ensure the Accomplishment of timely and effective support, performed in accordance with the Requirements contained in the performance work statement. 6.4 Domain Knowledge. Serves as e-business implementation experts. Contractors will be expected to present domain knowledge of health care revenue cycle experience. Domain knowledge criteria are specified below: 6.5 Contractor Personnel Requirements. Personnel proposed shall have an in depth knowledge of health care revenue cycle processes in addition to the following: - Expert knowledge of health care revenue cycle - EDI Transactions processing standards for healthcare and pharmacy claims and payments. - Knowledge of health care information technology laws, e.g. HIPAA Title II Electronic - Transactions and Code Sets Final Rules - Specific knowledge of VA environment, such as revenue operations 6.6 Staff Qualifications. 6.6.1 Subject Matter Expert II Minimum Education Level: Bachelors degree in related field or equivalent Minimum Experience: 8 years of experience. Education Substitution: Each year of relevant work experience may be substituted for one year of education, and vice versa. Certifications, professional licenses, and specific technical training may also be substituted for equivalent experience or education. Level of Effort: Certain skilled experience professional and/or technical personnel are essential for accomplishing the work to be performed. The government estimates that the minimum level of effort (LOE) that is required to complete all of the mandatory tasks and deliverables outlined in the PWS should be accomplished by x2 SME's as indicated above under section "Key Personnel". However, the vendor can propose any LOE or quantity of personnel over the basic SME requirement that is needed to accomplish the tasks and deliverables outlined in the PWS. Personnel proposed (key personnel) shall also meet the minimum education and experience levels listed in the PWS. Submittal Information Please responded to this RFI/Sources Sought if your company can perform this requirement in accordance with FAR Part 52.219-14 Limitations on Subcontracting (Nov 2011) Limitations on Subcontracting (Nov 2011) (a) This clause does not apply to the unrestricted portion of a partial set-aside. (b) Applicability. This clause applies only to- (1) Contracts that have been set aside or reserved for small business concerns or 8(a) concerns; (2) Part or parts of a multiple-award contract that have been set aside for small business concerns or 8(a) concerns; and (3) Orders set aside for small business or 8(a) concerns under multiple-award contracts as described in 8.405-5 and 16.505(b)(2)(i)(F). (c) By submission of an offer and execution of a contract, the Offeror/Contractor agrees that in performance of the contract in the case of a contract for- (1) Services (except construction). At least 50 percent of the cost of contract performance incurred for personnel shall be expended for employees of the concern. (2) Supplies (other than procurement from a nonmanufacturer of such supplies). The concern shall perform work for at least 50 percent of the cost of manufacturing the supplies, not including the cost of materials. (3) General construction. The concern will perform at least 15 percent of the cost of the contract, not including the cost of materials, with its own employees. (4) Construction by special trade contractors. The concern will perform at least 25 percent of the cost of the contract, not including the cost of materials, with its own employees. (End of clause) It is requested that interested contractors submit a response (electronic submission) of no more than 5 pages in length, single spaced, 12 point font minimum that addresses the above information. The Government will not review any other data, attachments that are in excess of the 5 pages. In response to the RFI/Sources Sought, interested contractors shall submit the following information no later than 04/06/2015 to richard.stockton2@va.gov. Mark your response as "Proprietary Information" if the information is considered business sensitive. NO MARKETING MATERIALS ARE ALLOWED AS PART OF THIS RFI. The government will not review any other information or attachments included, that are in excess of the 5 page limit. 1.Past Experience - Provide the following information on a maximum of three similar projects 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. 2.Capabilities/Qualifications - Description of the capabilities/qualifications/skills your company possesses to perform the work as well as your company's ability to comply with HIPPA, section 508, and VA security requirements. 3.In-house capability - Data used for this project is highly sensitive and contains individual records. Therefore, it is highly desirable that the work performed on this project is not performed through a sub-contractor. 4.Company Information /Socio-Economic Status - Provide your company size and Socio-Economic status. Provide your current Contract number under the Classification Code. 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? 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 5 page limitation. 7.Provide your response to FAR Part 52.219-14 Limitations on Subcontracting (C) (1) as called out under Submittal Information. Contractor will submit a response to each of the above seven (7) items. If non-applicable to your company's submittal, so state in your response.
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