Network Acquisition Program, 130 West Kingsbridge Road, MS 10N3ACQ, Bronx, NY 10468-9938

Q -- MCCF INSURANCE IDENTIFICATION & VERIFICATION SOL RFP10N3-208-00 DUE 082900 POC Oscar Diaz Jr., Contract Specialist 718-741-4320, Fax 718-741-4585 Medical Care Cost Fund The Department of Veterans Affairs VISN 3, (Network of VA hospitals located in NY and NJ) wants to negotiate a contract as follow: Intention of Contract: To perform services which will identify insurance information necessary to increase Medical Care Cost Recovery Collections for facilities within VISN 3. Objective of this contact: To obtain a highly skilled, confidential and eager contractor willing to accurately performs the tasks of A. Identification and B. verification health insurance. A. Insurance Identification: (Identification of insurance policies, which are currently active or were and can still be billed within the Filing time required. Generally, most carriers allow submission of claims within the calendar year. The following information will be required from the vendor to assure that a valid/active insurance policy has been provided: 1. Policy holder (Policy holder may be Patient or Spouse) 2. Valid VA patient 3. Policy # 4. Group # (if applicable) 5. Type of policy (Major Medical, Outpatient, Inpatient, Mental Health, and Dental. Policies should not include Indemnity Policies which are not for medical treatment but provide income protection for the patient) 6. Patient's employer and/or spouse employer The contractor will provide a listing (report) of their findings, which should include the above listed information as requested under Insurance Identification. The following Insurance information should not be included or considered identification of a valid insurance policy. 1. "No Medicare Part A or B. (VA is currently prohibited by law from billing Medicare) 2. "No Medicaid information (VA does not receive Medicaid) 3. "No Medicare replacement" (HIP, US Healthcare) This refers to those policies which provide Medicare coverage only to their subscribers) 4. No Indemnity Policies (This refers to plans designed to protect against loss of income from a disability /or major illness) . Access to information/ date base: VA will provide the contractor with computer disk or/and Internet E-mail that will contain a file(s) (report) in MS Excel; version comparable to both, VA and contractor. The VA will provide a listing based on the following database criteria. The patient currently has "Unknown", 'No Insurance" and/or "No employment" information in the VA database. The listing will include Patient, Name, SS#, DOB B. Verification (This includes process which includes contacting the insurance carrier to validate the covered services and conditions under which the insurance carrier may be billed. This information would include(but is not limited to the following: Annual Benefits/Deductibles, Group Name, Group #, Mailing address, telephone #, subscriber ID, effective date, expiration/termination date, type of policy, policy holder, deductibles; services covered, filing time frames and pre-admission requirements (including contact information and telephone). 1. Verify the filing date 2. Type of plan 3. Type of coverage Insurance cover A. Deductibles ( Amount of Deductible, Life-Time Max, etc) B. Covered Services: Inpatient, Outpatient, Major Medical, Dental, Mental Health, etc This may include identification of separate carriers for Outpatient and Mental health. Preventive Health, Lab services, etc) C. What type of plan (Major Medical, Carve-out, Supplemental,/Medigap, Inpatient only, Outpatient only) This procurement is for small and large business as well. Potential offerors may obtain a copy of the solicitation documents (Name of the company, Tele. and fax #, mailing address and attn. To & E-mail) by sending a written request by mail to the address shown above or by fax to (718) 741-4585, Documents will be available on August 29, 2000. All responsible offerors are invited to submit an offer, which shall be considered by the agency. Posted 07/28/00 (W-SN479942). (0210)

Loren Data Corp. http://www.ld.com (SYN# 0047 20000801\Q-0002.SOL)

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