SOURCES SOUGHT
D -- Payment Integrity Validation and Oversight Tool (PIVOT) (VA-26-00015670) RFI 3
- Notice Date
- 1/14/2026 11:53:50 AM
- Notice Type
- Sources Sought
- NAICS
- 541519
— Other Computer Related Services
- Contracting Office
- TECHNOLOGY ACQUISITION CENTER NJ (36C10B) EATONTOWN NJ 07724 USA
- ZIP Code
- 07724
- Solicitation Number
- 36C10B26Q0121
- Archive Date
- 03/15/2026
- Point of Contact
- Kimberly Geran, Contract Specialist, Phone: 732-795-1062
- E-Mail Address
-
Kimberly.Geran@va.gov
(Kimberly.Geran@va.gov)
- Awardee
- null
- Description
- Request for Information Payment Integrity Validation and Oversight Tool (PIVOT) TAC RFI Number: 36C10B26Q0121 Please Note: All major revisions in the associated PWS 3.0 are indicated in Red Font Introduction This RFI is for planning and market research purposes only and shall not be considered an Invitation for Bid, Request for Task Execution Plan, Request for Quotation or a Request for Proposal. Additionally, there is no obligation on the part of the Government to acquire any products or services described in this RFI. Your response to this RFI will be treated only as information for the Government to consider. You will not be entitled to payment for direct or indirect costs that you incur in responding to this RFI. This request does not constitute a solicitation for proposals or the authority to enter into negotiations to award a contract. No funds have been authorized, appropriated or received for this effort. Interested parties are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. The Government does not intend to pay for the information submitted in response to this RFI. The North American Industry Classification System (NAICS) for this requirement is DA10. Be advised that set-aside decisions may be made based on the information provided in response to this RFI. Responses should be as complete and informative as possible. 2. Background The Department of Veterans Affairs (VA), Office of Information & Technology (OIT), within the Veterans Health Administration (VHA), Office of Integrated Veteran Care (IVC), provides high-quality, effective, and efficient Information Technology (IT) services. These services are crucial for those responsible for delivering care to Veterans at the point of care and throughout all stages of the Veterans health care journey, ensuring care is effective, timely and compassionate.� VA depends on Information Management/Information Technology (IM/IT) systems to meet its mission goals. VA s Office of Integrated Veteran Care (IVC) requires a Payment Integrity Validation and Oversight Tool (PIVOT) to proactively detect and prevent improper VA Community Care healthcare claims payments. Improper payments may result from inaccurate coding, billing, unauthorized services, or non-compliance with VA or CMS reimbursement policies, including fraud, waste, and abuse (FWA). Currently, VA relies on manual, retrospective processes that delay detection and recoupment efforts. PIVOT will modernize payment integrity capabilities through advanced analytics, automation, and integration with VA systems. The solution will enable systematic analysis of claims data, early detection of improper payments, and support cost containment strategies. 3. Problem Statement: VA is seeking a SaaS based solution capable of supporting a minimum of 100 concurrent users that integrates with existing VA systems, ingests a wide variety of claims and healthcare data, and leverages advanced analytics and artificial intelligence/machine learning to identify improper payments, including fraud, waste, and abuse (FWA). The solution needs to support secure, scalable, and elastic deployment models, and integrate with VA s identity and access management infrastructure, including Personal Identity Verification (PIV) authentication and role-based access controls, be accessible via VA-approved remote access methods (e.g., Azure Virtual Desktop, Citrix Access Gateway), and support high availability, disaster recovery, and secure multi-tenancy. VA would like potential vendors to provide a demonstration of their solution to be assessed for best value, technical effectiveness, implementation requirements, and potential scalability. VA will not be providing a dataset for solutions to be assessed against, and requests a live demonstration facilitated through Microsoft Teams with a description of the solution s technical functionality not to exceed two (2) pages. VA expects the demonstration to provide a clear, practical illustration of how the vendor s proposed solution meets technical and functional requirements outlined in the Performance Work Statement (PWS). Vendors should focus on showcasing core capabilities such as data ingestion and normalization, rules engine functionality, pattern recognition and anomaly detection, real-time analytics, workload modules, and user interface features. The demonstration should highlight the solutions effectiveness, scalability, security, and integration capabilities, as well as any unique features that enhance healthcare payment integrity and oversight. While VA will not provide a dataset, vendors are encouraged to use representative data to illustrate system performance and outputs. The goal is to allow VA to assess technical effectiveness, ease of implementation, and alignment with VA s mission objectives. Technical Requirements The technical requirements outlined in this document are not comprehensive of the Performance Work Statement (PWS). Consult and review the PWS in its entirety to ensure full understanding of the scope, requirements, and obligations. Summarization: Data Ingest & Management: Process 837P, 837I, 837D, NCPDP claims and remittance advice (835), aggregate and normalize data, maintain audit trails, and support real-time processing. Rules Engine: Execute VA and CMS compliance rules at scale, support configuration in sandbox, testing, pre-production, and production environments; rules library, version control, rollback, and audit logging. Pattern Recognition Engine: Detect anomalies and suspicious billing behaviors using AI/ML, provide risk and confidence scoring and explainable AI outputs, enable continuous improvement through feedback loops, and AI-Recommended Rules. Workload Module: Centralized interface for VA staff to review flagged claims, validate rule outcomes, manage approvals, and disposition cases with audit logging and performance tracking. Dashboards & Reporting: Real-time dashboards, customizable reports, and export capabilities. Security & Compliance: FedRAMP High baseline, HIPAA, FISMA compliance, role-based access control, and audit logging. Virtual Technical Demonstration (VTD) The VTDs will be conducted via Microsoft Teams. All vendors participating in the demonstration will receive detailed VTD information regarding their scheduled demonstration date and time. Demonstrations should be no longer than 90 minutes. Requests to reschedule will be approved at the discretion of the Contracting Officer (CO).The objective of the VTD is to demonstrate the vendor ability to deliver the PIVOT solution as described in the Performance Work Statement (PWS). Additionally, VA seeks to assess the potential vendor s solution for best value, technical effectiveness, implementation requirements, and scalability potential. Vendors will need to create and provide their own scenarios demonstrating their solutions. During the VTD, vendors will showcase their solutions through a PowerPoint presentation and include a live demonstration facilitated through Microsoft Teams. VA requests a description of the solution s technical functionality not to exceed two (2) pages. Please note that VA will not be providing a dataset for solutions to be assessed against. Vendors may include up to ten (10) participants for the VTD. Participants may include prime members and teaming partners (subcontractors) expected to contribute actively to the demonstration. The team participating in the VTD should represent the personnel proposed to work on the solution. The prime contractor must be represented among the VTD participants. Only members of the virtual team can perform activities during the demonstration. Communication with individuals outside of the virtual team during the VTD is not permitted. VA will be present for the entire VTD. A list of VTD participants must be included with the RFI response submission and emailed to the Contracting Officer. The vendor must provide all resources and equipment required for the VTD, including internet access, software, and any necessary supplies. Vendors shall ensure their equipment and internet bundles are sufficient to support an uninterrupted virtual demonstration session. Vendors do not need to use the entire allotted time, but may not exceed it. Corrections or revisions to the PowerPoint presentations after submission are not allowed. Portions of the PowerPoint presentation not demonstrated within the allotted time will not be reviewed. VA reserves the right to hold a Government-only caucus and to ask questions during the demonstration. Vendors must answer questions on the spot without a separate period to caucus. These questions aim to clarify the Government s understanding of the demonstration and do not constitute formal discussions or exchanges. Vendors will not have the opportunity to revise their submissions or demonstrations post-questions, regardless of whether VA conducts exchanges with Vendors. VA personnel will not provide feedback during the VTD. All costs associated with the VTD shall be borne by the vendor and will not be reimbursed by the Government. Demonstration Content Requirements Vendors shall structure their demonstrations to showcase how their solution meets VA s core functional requirements. To meet VA s technical expectations, vendors should structure their demonstrations around the following components: Data Integration and Normalization: Vendors should demonstrate how their solution ingests and integrates multiple data sources, including historical and new claims in formats such as 837P, 837I, and 837D, as well as pharmacy transactions and reference datasets. The demonstration should show how the system normalizes this data into a unified schema, ensuring consistency and traceability across all elements. Vendors should highlight how claim-to-payment and claim-to-authorization relationships are maintained and how metadata such as source, timestamps, and transformation logic is captured to support auditability. User Interface and Usability Features: The demonstration should showcase the system s user interface and overall usability, emphasizing intuitive navigation that does not require coding knowledge. Vendors should illustrate dynamic search and filtering capabilities, drill-down functionality from dashboards to claim-level details, and hyperlinked navigation that allows seamless movement between related data views. The interface should comply with Section 508 accessibility standards and demonstrate responsiveness and ease of use for both novice and advanced users. Rules Engine: Vendors should demonstrate the Rules Engine s ability to execute VA-approved rules at both the claim and line-item level. The demo should show how rules can be configured without custom coding, and how version control and rollback capabilities are implemented. Vendors should highlight transparency features such as displaying rule logic, pricing formulas, and calculation steps within the Rules Library, ensuring that all compliance logic is fully auditable. The demonstration should also briefly illustrate how rules progress through multiple environments such as development, test, pre-production, and production to ensure proper governance and VA approval before activation. The demo should also include a sample set of the vendor s mature comprehensive library of healthcare payer compliance rules, payment policies, pricing logic, reimbursement calculations, and associated business logic reflecting industry-standard operations. Pattern Recognition and Anomaly Detection: The demonstration should illustrate how the Pattern Recognition Engine detects anomalies, trends, and suspicious billing behaviors such as upcoding, unbundling, Sudden shifts in billing behavior, and modifier misuse. Vendors should explain how risk and confidence scores are generated and presented to users, and how the system provides explainable AI outputs to support decision-making. Additionally, vendors should show how flagged anomalies are routed to analyst queues and how Human-in-the-Loop feedback is captured to improve model accuracy over time. Real-time Analytical Capabilities: Vendors should exhibit how the solution performs near real-time rule execution during claim ingestion, as well as retrospective analysis of historical claims. The demonstration should show how flagged claims are prioritized based on configurable risk thresholds and how the system supports proactive identification of improper payments. This portion should make clear that the system can handle both real-time and retrospective workflows effectively. Reporting and Dashboard Functionalities: The demonstration should present the solutions reporting tools. Vendors should show dashboard customization options, and how ad hoc reporting can be performed without contractor intervention. The ability to export reports in standard formats such as CSV, Excel, and PDF should also be demonstrated. The demonstration should include tools for performing ROI analysis, demonstrating the financial impact and benefits of the PIVOT, including cost savings, recovered payments, and efficiency gains. System Performance: Vendors should validate that their solution can handle high throughput while maintaining audit trails and data integrity. The demonstration should include evidence of uptime monitoring, alerting mechanisms, and performance dashboards that track system health and responsiveness. Role-based Access Controls: Vendors should demonstrate how the system enforces role-based access controls, including user provisioning, role assignment, and audit logging for access changes. The demo should confirm compliance with VA Identity and Access Management standards, including PIV authentication, and show how the system adheres to the principle of least privilege. By effectively demonstrating these components, vendors will highlight their capability to fulfill VA s requirements and deliver a comprehensive, reliable, and efficient PIVOT solution. Submittal Information: All responsible sources may submit a response in accordance with the information below. There is a page limitation for the technical functionality description designed for this RFI of 2 pages. There is no slide limitation for the PowerPoint deck. The Government will not review any other information or attachments included, that are in excess of the 2 page limit. NO MARKETING MATERIALS ARE ALLOWED AS PART OF THIS RFI. Generic capability statements will not be accepted or reviewed. Your response must address capabilities specific to the services required in the attached PWS and must include the following, limited to 2 pages (not including the technical functionality description, also limited to 2 pages): Interested Vendors shall at a minimum, provide the following information in the initial paragraph of the submission: Name of Company Address Point of Contact Phone Number Fax Number Email address Company Business Size and Status For VOSB and SDVOSBs, proof of verification in VIP. NAICS code(s) Socioeconomic data Data Universal Numbering System (DUNS) Number Existing Contractual Vehicles (GWAC, FSS, or MAC) Indicate your size status under NAICS (code TBD). Identify existing contract vehicles (GSA, T4NG, NASA SEWP V, etc.) in which you are a contract holder that can be utilized to procure these services. Indicate whether your company intends to participate in the VA PIVOT solution demonstration. If your company intends to participate in the VA PIVOT solution demonstration, provide the list of participants (up to 10). Provide a separate Rough Order of Magnitude (ROM) cost estimate for the SaaS product in accordance with PWS. Has the draft PWS provided sufficient detail to describe the technical/functional requirements that encompass the software development and production operations support services to be performed under this effort. ______ YES _______ NO (if No, answer the next question) If NO , please provide your technical comments/recommendations on elements of the draft PWS that may contribute to a more accurate proposal submission and efficient, cost effective effort. Vendor intent to participate in the solution demos should be submitted by January 23, 2026 at 12 PM to allow time for scheduling coordination. The 2-page technical documents and PowerPoint presentations should be submitted no later than February 6, 2026 at 12 PM. All questions should be submitted no later than January 16 at 12 PM. Responses and questions are to be sent via email to Felica Griffin at Felica.Griffin@va.gov. Please include ""36C10B26Q0121"" in the subject line of your response. Mark your response as ""Proprietary Information"" if the information is considered business sensitive. The email file size shall not exceed 5 MB.
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- SN07687462-F 20260116/260114230034 (samdaily.us)
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