Loren Data's SAM Daily™

FBO DAILY - FEDBIZOPPS ISSUE OF APRIL 21, 2017 FBO #5628
DOCUMENT

70 -- TAC-17-32040 Community Care Referrals and Authorization FBCS Enhancement-Modification - Attachment

Notice Date

4/19/2017
 

Notice Type

Attachment
 

NAICS

541519 — Other Computer Related Services
 

Contracting Office

Department of Veterans Affairs;Technology Acquisition Center;23 Christopher Way;Eatontown NJ 07724
 

ZIP Code

07724
 

Solicitation Number

VA11817C1535
 

Response Due

4/26/2017
 

Archive Date

5/3/2017
 

Point of Contact

Christopher Minetti
 

E-Mail Address

5-1120<br
 

Small Business Set-Aside

N/A
 

Description

Background Information As part of the Non VA (Medical) Care (NVC) program, the Department of Veterans Affairs (VA) manually adjudicates approximately 20 to 30 million claims per year for Purchased Care services provided by Non-VA providers in the community using the Fee Basis Claims System (FBCS). FBCS processes both Electronic Data Interchange (EDI) and paper claims that are scanned into FBCS. FBCS is based on distributed client server architecture and operates from 35 instances. The centralized architecture uses an application installed at a central location (presently at Austin Integrated Test Center), and uses web services to interact with both users and interfaces at the local VistA Databases, as well as the FBCS Central Server, Program Integrity Tool, and Health Processing Claims System Eligibility and Enrollment Component at the Financial Service Center. FBCS also integrates with numerous VA and VHA systems including, VistA and the Computerized Patient Record System (CPRS). High Level Requirements The Contractor shall enhance the FBCS software to include the following capabilities associated with referral and authorizations. The development, testing and release of these capabilities shall be in compliance with VIP and be completed within 3 month builds. The scope of each build will be approved by the COR and PM prior to build start. All capabilities must be released to production in three (3) builds (a maximum of nine (9) months from initial build start) or less. FBCS shall have the ability to ingest consults with differing consult title formats, including one consult and the current Non-VA care consult. (The One Consults will be designated as "the specialty" followed by Community Care, for example Endocrinology - Community Care) FBCS shall recognize the One Consult or other Community Care consult to aid in the auto-initiation of the referral/authorization FBCS shall allow for the creation of a referral/authorization including the required information currently supplied in all of the formats listed in a through d. CCN = Community Care Network FBCS shall allow the user to update inpatient authorization information including: diagnosis cost estimation procedures vendor inpatient dates (to include discharge date). The ability to update must be available even after the 7078 has been generated. FBCS shall allow the user to search for and update an outpatient referral/authorization FBCS m shall allow users to change the provider information on a referral/authorization FBCS shall allow for the creation of multiple referrals/authorization from one consult FBCS shall auto-populate specific fields within the referral authorization based upon information available from the consult FBCS shall allow a user to update the cost estimate when changes are made to a referral/authorization that impacts the original cost estimates FBCS shall allow the user to document administrative reviews within the referral, which are not displayed on the referral/authorization correspondence. This is an internal notes system. Workflow is also needed to go to the next step if there is clinical review FBCS shall allow the user to indicated the modality of care (i.e. CCN, Provider Agreement, Traditional Non-VA Care), so that the system can send the obligation information to the correct location (i.e. Vista, other system to be defined) FBCS shall create an authorization number which is unique for each authorization, in a centralized referral/authorization environment An ability to print the payer position fields (primary vs secondary) on authorization. An ability to manually assign and automatically assign to individuals. Consult needs a distinct clinical review status field. Need the ability to change status as well. The selections are approved and rejected. FBCS shall be centralized to allow for access to referral/authorization information through a portal or other secure network Episode of Care: FBCS shall interface with Episode of Care business rules to that this information is available on the referral/authorization (when available) for consults received from CPRS (this includes incorporation into any correspondence). FBCS shall also allow for the documentation of days approved and number of visits FBCS shall maintain information related to the Standardized Episodes of Care so that the information can be available for validations FBCS shall interface with Episode of Care business rules so that this information can be updated when an existing referral/authorization is updated FBCS shall initiate a prior authorization when services being requested are on the prior authorization list, so that completion of the referral can be expedited. FBCS shall interface with Revenue systems to expedite pre-certification activities FBCS shall allow access for all referrals/authorizations nationwide though one centralized referral/authorization system, so that appropriate staff can review and obtain status for all referrals FBCS shall provide referral/authorization documentation in a format which can be transmitted via RefDoc, the portal, or other secure messaging system, to the CCN provider FBCS shall provide referral/authorization documentation in a format which can be transmitted via Data Access Service(s) (DAS), the portal, or other secure messaging system, to the CCN contractor FBCS shall allow access to a list of Community Care Network Providers provided by the contractor, along with updates as submitted. FBCS shall initiate an unique referral record in a centralized referral/authorization system. Program Integrity Tool (PIT): Ability to Transmit Referral Information to the PIT. Ability to Transmit Authorization Information to the PIT. Capabilities and Product Overview Responses for this section should be 5 pages or less Provide a brief summary of your technical approach to meet the VA s requirements to modify FBCS, including how you will be interfacing with the proprietary software s owner DSS, Inc. Please provide an architectural overview of the modification you are proposing. Please provide a functional overview of the modification you are proposing. Provide a high level estimate of the time frame needed to implement your approach if you take exception to the three month builds listed in the draft PWS. Responses to this RFI are requested by 1:00 P.M. Eastern Time on April 26, 2017. Please send all inquiries to Christopher Minetti at Christopher.minetti@va.gov.
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/notices/645551a66ea407ba01abd3a2abf79cce)
 

Document(s)

Attachment
 

File Name: VA118-17-C-1535 P00003 VA118-17-C-1535 P00003.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3428199&FileName=VA118-17-C-1535-P00003000.docx)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3428199&FileName=VA118-17-C-1535-P00003000.docx

 

File Name: VA118-17-C-1535 P00003 VA118-17-C-1535 PWS.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3428200&FileName=VA118-17-C-1535-P00003001.docx)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3428200&FileName=VA118-17-C-1535-P00003001.docx

 

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

Record

SN04478349-W 20170421/170419235332-645551a66ea407ba01abd3a2abf79cce (fbodaily.com)
 

Source

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

---

| FSG Index  |  This Issue's Index  |  Today's FBO Daily Index Page |