SOLICITATION NOTICE
R -- Federal Employees Health Benefits Medical Review Services
- Notice Date
- 7/20/2017
- Notice Type
- Presolicitation
- NAICS
- 524298
— All Other Insurance Related Activities
- Contracting Office
- Office of Personnel Management, Office of Procurement Operations, Contracting, 1900 E Street, N.W., Room 1342, Washington, District of Columbia, 20415-7710, United States
- ZIP Code
- 20415-7710
- Solicitation Number
- OPM3517R0002
- Point of Contact
- Cheryl D Allen, Phone: 202.606.2054
- E-Mail Address
-
Cheryl.Allen@opm.gov
(Cheryl.Allen@opm.gov)
- Small Business Set-Aside
- N/A
- Description
- The Office of Personnel Management's (OPM) Federal Employees Insurance Operations (FEIO) group administers the Federal Employees Health Benefits (FEHB) Program for Federal employees, retirees, temporary wildland firefighters and fire protection personnel, employees of Federally recognized Indian tribes, tribal organizations, and urban Indian organizations (tribal employer), and their eligible family members. FEIO is responsible for resolving disputed health insurance claims between members and their health insurance carrier. Two types of health insurance plans participate in the FEHB Program, Fee-for-Service (FFS) plans and Health Maintenance Organizations (HMO). FEIO is comprised of three Health Insurance Groups. Health Insurance 1 administers the Blue Cross and Blue Shield Service Benefit contract; Health Insurance 2 administers the remaining FFS plan contracts and experience-rated HMO plan contracts; and Health Insurance 3 administers the community-rated HMO plan contracts. Each health plan under the FEHB Program contracts with OPM to provide certain health benefits to all members enrolled in its participating plan. Under the terms of the contract, members are entitled to pursue claims disputes by following a formal dispute resolution process described in the plan's brochure. After giving the plan the opportunity to reconsider its decision, members may request OPM to review the plan's denial of benefits or benefit limitation. OPM is responsible for making the final determination on disputes between the health benefit carrier and insured member per Title 5 U.S.C. Chapter 89, 5 CFR Part 890. In some cases, because of the complexity of the medical issue/condition involved, it is necessary to obtain an external medical review advisory opinion from a medical consultant before OPM makes a final decision on the claim. Health Insurance 1 is responsible for monitoring the medical review services contract. Nurse consultants determine the medical specialty category and the appropriate medical specialist. The contractor is required to provide an expert opinion by medical specialists appropriate to the particular disputed claim under review. We will procure the proposed acquisition using total small business set-aside competition procedures in accordance with FAR Part 12 in conjunction with FAR Part 15. All responsible small businesses may submit a proposal, which we will consider. The proposed contract will be indefinite -delivery/indefinite quantity and include fixed prices for each contract line item number. The performance period for the proposed contract is expected to be five years: a one-year base period and four one-year options. OPM intends to issue a request for proposals (RFP) on or about August 11, 2017. The RFP and all documents relating to this requirement will only be available on the Federal Business Opportunities (FBO) website at https://www.fbo.gov. Interested parties are responsible for monitoring the FBO website for release of the RFP and all other documents relating to this requirement. We encourage interested parties to register on the FBO website for e-mail notification of all actions relating to the RFP and for the interested vendors list. After we release the RFP, we will give interested parties the opportunity to ask questions. We will include all questions and answers in an amendment to the RFP and post the amendment on the FBO web site. Proposals will be due on or about September 11, 2017. We anticipate awarding the proposed contract by December 29, 2017. The current contractor for Federal Employees Health Benefits Services is Independent Medical Expert Consulting Services, Inc. (IMEDECS).
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/OPM/OCAS/CD/OPM3517R0002/listing.html)
- Record
- SN04587338-W 20170722/170720234318-50364b3954d9a36cf24ef92c3a39d9f4 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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