Health Care Financing Administration 7500 Security Blvd.,Mailstop S2-01-23, Baltimore, MD 21244-1850

70 -- COMMERCIALLY AVAILABLE MEDICAL CLAIMS PROCESSING SOFTWARE POC William J. Tate, Contracting Officer,(410)786-1535 Contact Point: Georgette Vlangas, Contract Specialist, (410)786-8372. HEALTH CARE FINANCING ADMINISTRATION, 7500 SECURITY BLVD., BALTIMORE, MD 21244-1850 Request for Information: Commercially Available Medical Claims Processing Software, POC: Georgette Vlangas (410)786-8372 The Health Care Financing Administration (HCFA) is currently seeking information on commercially available software used to detect unacceptable or inappropriate coding of medical claims. HCFA is interested in companies with capabilities in the following areas: unbundling/rebundling of codes, duplicate procedures, the use of unecessary assistant surgeons, and global service period. Specific interests include but are not limited to: terms and conditions and warranty practices under which commercial sales of the software are made; terms and conditions under which modifications are made to the software to meet customer needs; terms and conditions under which software updates are made available to the customer; descriptions of all services that the software reviews and edits, e.g., physician services only, or physician and diagnostic services, or ambulatory services only, etc.; indication of whether the software matches inpatient claims to outpatient claims and is capable of determining inappropriate payment; description of the sources of savings that the customer achieves when using the software, e.,g., 40% of all savings result from rebundling, 30% from global service period violations; a description of the volume of claims that the software identifies for adjustment, e.g., 15% of all claims processed are identified for adjustment/action; and a description of the number of months and type(s) of historical claims data needed to accomplish all editing capabilities of the software. Please also include the catalog identification, total sales of the same or similar items to the public, length of time the product has been sold in the commercial market place, and other pertinent information necessary to determine that the product is a commercial or commercial-type product. All submissions shall also include the potential cost of moditying commercial software to meet the customer needs. Information received is for planning purposes and shall not be construed as an obligation on the part of the Government to acquire any of the above mentioned capabilities. However, in the event HCFA does acquire a COTS, it may be used in the Medicare Transaction System (MTS). The Government does not intend at this time to award a contract or otherwise pay for information provided. No entitlement to payment of direct costs or charges by the Government will arise as a result of submission of responses. Any procurement will be separately synopsized in the Commerce Business Daily. Responses will be accepted through April 2, 1996. Send information to the Health Care Financing Administration, ATTN: Georgette Vlangas, S2-01-23, 7500 Security Blvd., Baltimore, MD 21244-1850. (0080)

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