Loren Data Corp.

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COMMERCE BUSINESS DAILY ISSUE OF MARCH 6,1998 PSA#2046

Department 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)

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