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COMMERCE BUSINESS DAILY ISSUE OF MARCH 6,1998 PSA#2046Department of Veterans Affairs, Chief, A&MMS (90C), 1055 Clermont St,
Denver, CO 80220 R -- THIRD PARTY ELECTRONIC BILLING POC Raphelle J. Longrie (303)
393-4636 E-MAIL: Click here to contact the contracting officer via
e-mail, Raphelle.Longrie@med.va.gov. The Department of Veterans Affairs
(VA) Rocky Mountain Network VISN #19 has a requirement for electronic
billing of private health insurance carriers for the cost of
non-service-connected medical care provided at medical centers located
at Cheyenne WY, Denver CO, Fort Lyon CO, Fort Harrison MT, Grand
Junction CO, Miles City MT, Salt Lake City UT and Sheridan WY.
Prospective sources must be capable of providing the following: Install
and support an electronic data interchange (EDI) system capable of
accepting transferred health care claims generated on Digital Equipment
Corporation (DEC) ALPHA systems using the existing VA Veterans
Integrated Systems and Technology Architecture (VISTA) software.
Provide the necessary interface with VA computer system. Receive an
unmodified (as is) data stream electronically from the each site in a
format provided by the VA. Perform all work necessary to convert the
data into an ANSI-standard X.12 electronic claim transaction set
acceptable to a significant number of third party payors and forward
these bills electronically to the same insurance carriers. Claims
processing includes, but is not limited to, UB-82, UB-92 and HCFA 1500
claims using health care industry standard diagnostic and procedure
codes. Guarantee that only valid VA health insurance data are forwarded
electronically to the insurance carriers. Be certified to provide
electronic billing to payors authorized by the insurance commissioners
in all 50 of the United States of America. All VA electronic claims to
come shall be processed through the contractor's system and its edit
functionality, and not directly to the carrier. Turn-around time from
the VA transmission to the third party carrier's receipt shall not
exceed 24 hours. Where a VA health care receivable cannot be accepted
electronically by a payor, data shall be printed on standard,
acceptable forms and mailed to the specific payor. Provide same-day
electronic feedback to individual sites on any erroneous claims and
allow access at each remote site for correction of claims. Correct all
errors and/or omissions due to machine or contractor error. Provide
X.12 compliant Electronic Funds Transfer (EFT). Electronic remittance
advice documents shall be provided and electronically returned to
individual sites. Perform all work necessary to update the proprietary
X.12 software and to be Year 2000 compliant by December 1999. Provide
and maintain any intermediate device and associated software necessary
for electronic transfer of all data on a daily basis with 100%
accuracy. Maintain PC-based and intermediate system software updates to
coincide with any VA changes to its Integrated Billing (IB) and
Accounts Receivable (A/R) software package or DEC Alpha system
software. Provide individual sites with multiple workstations capable
of simultaneous access to the vendor's database. Provide availability
for unlimited telephone contacts and rapid telephone response to any
EDI-related during normal administrative hours. Provide access to
health insurance VA beneficiary eligibility data. Furnish electronic
eligibility verification to VA. Conduct on-site training at all sites
Software functional requirements: The software-based system must be
capable of processing, at minimum, an estimated 80,000 claims annually.
(a) Electronic Data Interchange (EDI) for transmitting and monitoring
of VA health care receivables to VA payors, using ANSI X.12 and Year
2000 standards or a proprietary equivalent. (b) Print and mail VA
receivables that cannot be transmitted electronically to certain
payors. (c) Electronic return to the VA of the Explanation of Benefits
(EOB) document. (d) Provide electronic health insurance eligibility
verification with a large, health insurance database. (e) Provide ANSI
X.12 compliant Electronic Funds Transfer (EFT) of payments to VA. To
successfully operate the vendors' EDI software, hardware requirements
will be provided, also. Please provide this information in writing by
March 25, 1998. THIS IS NOT A SOLICITATION. (0063) Loren Data Corp. http://www.ld.com (SYN# 0074 19980306\R-0020.SOL)
R - Professional, Administrative and Management Support Services Index Page
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