2423-859_Am1_Q-A.pdf

STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

PO Box 45811, Olympia WA 98504-5811

DATE: September 24, 2024

TO: RFQQ #2423-859 Bidders

FROM: Stephaine Ssaaka, Solicitation Coordinator

DSHS Central Contracts and Legal Services

SUBJECT: Amendment No. 01 –Answers to Bidders Conference Questions, Questions received to Date, and Bidder Conference Presentation.

DSHS amends the RFQQ #2423-859 to provide guidance and answers to questions received at Bidder Conference held on September 11, 2024, to questions received by the Solicitation Coordinator as of the close of business on September 18, 2024, and to provide the presentation that was given during the Bidder Conference.

Questions received at Bidder Conference

Question #1: What are the accepted clearinghouses for the bid?

A: Based on what is posted on the VA website, they accept many clearinghouses. I have been told verbally over the phone that we can use any one we want but no list was provided. They are very familiar with Optum Change Healthcare and that is the one that they work with the most.

Question #2: Could you please clarify the expectations regarding the online platform? Specifically, are you envisioning a Software-as-a-Service (SaaS) product that will facilitate the processing of claims, denials, and related tasks, thereby providing a fully digitized solution? We would like to confirm if this aligns with your expectations for the platform's functionality.

A: Yes, essentially what we are trying to accomplish is once we receive the information on the client services that we are provided for the moth we need to be able to bill the VA for those on an Online Billing Platform and the VA required that in a UBO4 Format providing the clients names, date of birth, address and then breaks it down by the date of service and the dollar amount for each of those dates. We need to put it in that format and sent it to the Veteran Administration. If it is rejected for any reason DSHS needs to be able to go back and open the submission and correct what might have been an error and resubmit.

Question #3: Is your team doing the manual work of using the software and the software would then help you to validate the claims and reprocess if needed? No manual intervention is required from the vendor?

A: Correct, we should be able to punch in information and the software should be able to validate that the important fields were filled out such as a name, DOB, address etc. My team does manually enter this information each month for each client and send it over.

Question #4: Are there any restrictions on the use of AI or cloud platforms for the Software-as-a-Service (SaaS) platform, or are these technologies allowed as part of the solution?

A: Were okay with cloud platforms, we prefer that you stay with AWS, Azure or Google. AI is still iffy; we do not have a lot of solid policies around that. I would say it is allowed with parameters.

Question #5: As we provide the proposal of the technology solution, will we have more meetings to dive deep with the team from a security perspective and compliance perspective?

A: Yes, we will.

Question #6: It seems the team needs to digitize the UBO4 form that is currently available and be able to send it out and track it. Is that a good understanding of the project scope?

A: Yes, the UB04 formatting is what we are required to utilize. Yes we would like to be able to track it as well meaning see if its been accepted, rejected, paid, denied by the VA.

Question #7: Given that we have a similar product available working with Washington HCA, would it be possible to do a demo?

A: If you are invited to an Oral Evaluation, you will have an opportunity to share your platform, until then we will only be able to evaluate your written proposal.

Question #8: If there are additional questions that come up as we prepare, how do we reach to the Solicitation Coordinator?

A: You can reach out to Stephaine Ssaaka via email at stephaine.ssaaka@dshs.wa.gov

Question #9: If we have technical questions, will they be forwarded to the rest of the team?

A: Yes, they will.

Question #10: Where is the information from the VA about Optum Change Healthcare?

A: VA: US Department of Veteran Affairs

Questions received by September 18, 2024 Deadline

Question #11: What is the average number of claims processed each month or year? This will help us understand the costs with the clearinghouses.

A: DSHS currently serves about 160 clients in this program, and it grows steadily per year. Each client needs at least 1 submission per month. There are few occasions where there will be two submissions per month for the same client.

Question #12: How many members of the team would be using the platform and what are some of their roles? Would there be super-login admin requirements?

A: There is one DSHS staff member assigned to this process however it is ideal that at least 3 staff members are trained for use as support. Each staff member needs to have their own log in information. I don’t see any reason for needing super-login admin requirements for this solution and it would be best if we didn’t.

Question #13: Does the bid value of $149,000 only cover the platform build or does it also cover the monthly fees and overage rates (if occurred)?

A: The $149,000 is intended to cover the cost of the platform weather that is cost to build or monthly fees for usage for the life of the contract. The $149,000 is also intended to include training fees associated with educating DSHS staff on how to utilize the system.

mailto:stephaine.ssaaka@dshs.wa.gov https://www.va.gov/COMMUNITYCARE/revenue-ops/Veteran-Care-Claims.asp

Question #14: Is passing the money from the VA to DSHS through the clearinghouse part of this project? Or is it handled via another system? If yes, are all payments to be made via clearinghouse, or are you considering instant payment systems like RTP and FedNow?

A: The VA reimburses DSHS via ACH payment. That process is not effected by this project. This project is more based on how we can effectively, securely and quickly bill VA for services provided.

Question #15: According to the RFP, the billing system will be handling confidential health information – does the system need to be HIPAA compliant?

A: Any provider who accepts (or brokers) payment from any health plan or other insurance company must comply with HIPAA if they conduct the adopted transactions electronically. These providers must also have written agreements in place to ensure business associates comply with HIPAA.Sep 10, 2024. Adopted Standards and Operating Rules - CMS Centers for Medicare & Medicaid Services | CMS (.gov) https://www.cms.gov › administrative-simplification › hipaa

Protected health information needs to be redacted if it is shared with entities who you do not have a HIPAA data sharing agreement (BAA) with, or if the data is being transmitted or sent over unsecured, unencrypted channels.

Question #16: Can you elaborate on what claim information and health parameters are being passed to the VA as part of the claims process?

A: Below is an example of a fake client in UB04 paper billing format. The billings contain things like client name, DOB, SSN, address, gender, unique VA authorization code, provider name & number, diagnosis code, dates of service, price per date of service etc. Attached are also written instructions on what VA requires on submissions. Note, the names in the example instructions are completely fictional- No PHI is listed here.

https://www.cms.gov/

Question #17: We are considering submitting a joint proposal. In terms of references, do you only want references for the prime bidder, or do you references for the subcontractor as well?

References for both are requested.

A: References for both are requested.

Question #18: How will the information be passed from the billing system to the VA? Is there an existing API available to use?

A: As of right now, we compile the information on their website, submit and it feed to the VA through the clearinghouse. The VA partners with Change Healthcare/Optum but we can use any clearinghouse. We do not have an API available for this purpose. We do recommend following the OWASP API Guidelines for building or acquiring APIs. https://owasp.org/www-project-api-security

Question #19: Does DSHS have a preference for the software platform on which this system will be built?

A: No preference, as long as the data stays within the U.S and the cloud provider or hosting service has a current SOC 2 Type 2 audit report, or the cloud service is FedRAMP Moderate ATO. The state Office of Cybersecurity prefers AWS or Azure if you are comfortable with those platforms.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fowasp.org%2Fwww-project-api-security&data=05%7C02%7Cstephaine.ssaaka%40dshs.wa.gov%7Cf8cb8487a2f14f23f20008dcd9b320d0%7C11d0e217264e400a8ba057dcc127d72d%7C0%7C0%7C638624610613198048%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=69xDVko5OKvnsceAYYe16nHNZUQZdTPm3xJY3SsQbvk%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fowasp.org%2Fwww-project-api-security&data=05%7C02%7Cstephaine.ssaaka%40dshs.wa.gov%7Cf8cb8487a2f14f23f20008dcd9b320d0%7C11d0e217264e400a8ba057dcc127d72d%7C0%7C0%7C638624610613198048%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=69xDVko5OKvnsceAYYe16nHNZUQZdTPm3xJY3SsQbvk%3D&reserved=0

Question #20: Does the platform need to be fully functional and ready by January 1, 2025, or is there a period for Onboarding, Customization, Testing and Training after which the product will be used?

A: We need the product fully functional by January 1, 2025.

Question #21: Does DSHS have specific preferences for how the SaaS platform should be hosted (e.g., cloud provider requirements, data residency, security compliance)?

A: No preference, as long as the data stays within the U.S and the cloud provider or hosting service has a current SOC 2 Type 2 audit report, or the cloud service is FedRAMP Moderate ATO. The state Office of Cybersecurity prefers AWS or Azure if you are comfortable with those platforms. SaaS must use encryption for data at rest, SaaS must use encryption for data in transport, single sign-on preferred or requires hardened accounts, multifactor authentication, must meet OCIO 141.10 compliance requirements, the SaaS must have WAF (Web Application Firewall).

Question #22: Is there a preferred Clearinghouse that you would like to use?

Please specify the timeline of clearinghouse integration, does it need to be ready by the contract start date or does the integration need to be in place at the time of the bid submission?

A: DSHS currently uses Optum Clearinghouse (formerly Change Healthcare). The VA also lists Optum as their familiar vendor however we are not required to stick to that clearinghouse.

Question #23: Will DSHS provide any requirement or support for API documentation for integrating with the clearinghouse and will DSHS provide an API key?

A: We do not have an API available for this purpose. We do recommend following the OWASP API Guidelines for building or acquiring APIs.

https://owasp.org/www-project-api-security

Question #24: What are the specific expectations for support over the five-year contract period (e.g., response times, SLA requirements)?

A: DSHS needs to have the ability to reach out to the vendor for assistance on issues that cannot be resolved internally. This can be a live helpdesk or assigned individual to work with DSHS directly. Preferred method is real human interaction (not some sort of auto computer helpdesk) that can provide real time feedback and support. DSHS needs responses within 1 business day to keep things moving and avoid any delay un submission.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fowasp.org%2Fwww-project-api-security&data=05%7C02%7Cstephaine.ssaaka%40dshs.wa.gov%7Cf8cb8487a2f14f23f20008dcd9b320d0%7C11d0e217264e400a8ba057dcc127d72d%7C0%7C0%7C638624610613198048%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=69xDVko5OKvnsceAYYe16nHNZUQZdTPm3xJY3SsQbvk%3D&reserved=0

Question #25: Any additional services or change requests to the product such as new features, or integrations (such as adding additional clearinghouses) will be charged separately. Are there any specific expectations the bidder needs to consider in the initial bid?

A: At this time DSHS is only looking to find a platform that allows us to bill VA for client services provided, in required UB04 format via a clearinghouse that VA accepts. As mentioned in the RFQQ it needs to be secure and retention information that can be referenced at any time. There should not be any need for additional clearinghouses.

Question #26: We are currently in the process of obtaining the Washington small business certification, or is the certification mandatory at the time of bid submission?

A: You need to self-certify at the time of bid submission. Below is some language from our RFQQ document:

Small Business – An in-state business, including a sole proprietorship, corporation, partnership, or other legal entity, that certifies under penalty of perjury that they are Washington Small Business as defined in RCW 39.26.010(22).

And from our standard Attachment D:

According to Chapter 39.26.010 RCW, to qualify as a Washington Small Business, Bidder must meet three requirements:

a. Location. Bidder’s principal office/place of business must be located in and identified as being in the State of Washington. A principal office or principal place of business is a firm’s headquarters where business decisions are made and the location for the firm’s books and records as well as the firm’s senior management personnel.

b. Size. Bidder must be owned and operated independently from all other businesses and have either: (a) fifty (50) or fewer employees; or

(b) gross revenue of less than seven million dollars ($7,000,000) annually as reported on Bidder’s federal income tax return or its return filed with the Washington State Department of Revenue over the previous three consecutive years.

c. WEBS Certification. Bidder must have certified its Washington Small Business status in Washington’s Electronic Business Solution

(WEBS).

https://gcc02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.des.wa.gov%2Fservices%2FContractingPurchasing%2FBusiness%2FPages%2FWEBSRegistration.aspx&data=05%7C02%7Cstephaine.ssaaka%40dshs.wa.gov%7C41efe623b44f4174561e08dcd7268822%7C11d0e217264e400a8ba057dcc127d72d%7C0%7C0%7C638621807707022481%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=oR5EAeIPku6R1S0c5DiMfbxrrNr44fWWsBAg3h8xQAM%3D&reserved=0

All other terms and conditions in this Solicitation remain the same.

Attendees at the September 11, 2024 Bidder Conference included the following:

1. Stephaine Ssaaka, DSHS

2. Elisa Mancuso, DSHS

3. Steve Bowker, DSHS

4. Ngan Nguyen, DSHS

5. Julia Mosier, DSHS

6. Shuchi Sud, Aiolos Labs

7. Zain Patrawala, Encore Health Solutions

Welcome to the Bidder Conference

ALTSA/MSD Request for Qualification and Quotation #2423-859

VA Online Billing Platform

September 11, 2024 2:00 to 4:00 p.m. Pacific Time via Microsoft Teams

Agenda

• Introductions and Ground Rules

• Opening Remarks

• Project Scope and RFQQ Goals

• Important Reminders & Key Dates

• Q&A

Introductions and Ground Rules

• DSHS Introductions

• Presentation, followed by Q&A

• Please hold questions until end

• Questions must be sent to the RFQQ Coordinator via Chat

• List of attendees may become a public record

• Focus on general issues related to RFQQ instructions, requirements, etc.

• Verbal responses to questions are unofficial

• Official responses to be posted as an RFQQ amendment

Procurement Goals

• Fair, open and competitive procurement process

• DSHS is a public entity and subject to state procurement rules and regulations

• This competitive solicitation is issued to assist the

ALTSA Administration, MSD Division of the Washington State Department of Social and Health Services (DSHS) in seeking qualified Contractor (s) for online claim submission, tracking, processing and record retention regarding client services provided by DSHS to be reimbursed by the Veteran Administration.

Background

• DSHS provides service to various veterans throughout WA state.

• DSHS bills the VA for reimbursement for those expenses.

• This process used to be paper format-we want to utilize a online platform.

Project Scope

• DSHS needs (but not limited to)

– Easy to use

– Provide security & confidentiality

– Provide historical record retention

– Has UB04 format capabilities

– Real time communication on submissions

– Platform that uses VA accepted clearinghouse

Based on the terms, conditions and deliverables set forth in the RFQQ and Attachment A: Sample Contract

Provide clear, concise, direct, detailed and specific responses

Ensure responses are accurate, without assumptions

Apparent Successful Bidder’s Proposal may become part of the Contract

Bidders’ Proposals

Submitting a Proposal that does not follow the RFQQ requirements will be deemed non-responsive

Submission Requirements Attachment B: Sample Submission Letter Attachment C: Certifications & Assurances Attachment D: Bidder Response Form

1. Bidder Information (Administrative Response)

2. Bidder EO 18-03 Certification

3. Bidder Certification – Washington Small Business

4. Bidder Certification – Veteran Owned Business

5. Bidder Qualifications and Experience (Management Response)

6. Bidders Solution to RFQQ (Technical Response)

7. Bidders Proposed Pricing (Cost Response)

Attachment E: Contractor Inclusion Plan

As Amendments are posted to WEBS, these should be carefully reviewed and downloaded by the Bidders

DSHS is committed to ensuring a fair and open competitive process

To ensure that all Bidders receive a fair and open opportunity, it is vital that all interested parties abide by the requirements

All questions and information regarding this RFQQ should be directed to the RFQQ Coordinator and to no one else, unless otherwise directed in writing by the RFQQ Coordinator

Important Reminders

Bidders may submit written questions or requests for change in Solicitation Requirements until 3:00 p.m. Pacific Time

September 18, 2024

DSHS intends to post responses to written questions

September 24, 2024

Bidders must submit Proposals by 3:00 p.m.

Pacific Time

September 30, 2024

Oral Evaluations October 28-November 11, 2024

Announcement of Apparent Successful Bidder on WEBS

November 8, 2024

Contract Execution/Start Date January 1, 2025

Questions must be sent to the RFQQ Coordinator directly via Chat

Verbal responses to questions are unofficial Official responses shall be posted on WEBS as an

RFQQ Amendment If there are questions that we do not get to today, please submit these via email to the RFQQ Coordinator at: stephaine.ssaaka@dshs.wa.gov

Final Questions are due via email no later than September 18, 2024, by

5:00PM PT

DSHS appreciates your time and interest in this solicitation!