Questions and Answers.xlsx
XLSX spreadsheet 19 KB Posted
- Solicitation number
- 24322625Q0020HI
- Issued by
-
Office of Personnel Management
About this file
This Questions and Answers document provides critical details for the Federal and Postal Employee Health Benefit Independent Medical Review solicitation (24322625Q0020HI) issued by the Office of Personnel Management (OPM). The IDIQ contract will require medical review services for disputed health insurance claims, with contractors providing specialized medical specialists across disciplines like psychiatry, hematology/oncology, physical medicine, and reproductive endocrinology. Key requirements include submitting five medical review writing samples, using Times New Roman 11-point font, adhering to a 60-page technical proposal limit, and possessing URAC IRO Accreditation. The contract will run from 9/30/2025 to 9/29/2026, with a base year and four potential option years, and the incumbent vendor is J29, Inc.
Contractors must provide their own medical review processing technology and will use OPM's FDC centralized platform for case management. Medical review timelines are strict - 7 days for standard reviews and 3 days for expedited cases. Reviewers will be required to provide typewritten analysis of medical claims, citing references, and must meet specific licensure requirements. The solicitation uses NAICS code 541611 for Administrative Management and General Management Consulting Services, and while no guaranteed minimum quantity is specified, OPM will monitor contractor performance through a Performance Requirements Summary with defined deliverables, performance standards, and potential incentives or price reductions based on performance.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_24322625Q0020_Amd_0002.pdf | ||
| Solicitation Amendment - Instructions to Offerors.pdf | ||
| Sol_24322625Q0020_Amd_0001.pdf | ||
| QASP.pdf | ||
| FPR Pricing Spreadsheet - Final.xlsx | XLSX spreadsheet | |
| IRO Specialty List.xlsx | XLSX spreadsheet | |
| 24322625Q0020.pdf | ||
| Medical_Review_Format.pdf | ||
| Performance Work Statement.pdf | ||
| OPM_ExpertBio_Attachment.pdf | ||
| 2025 FEHB PSHB Plans.xlsx | XLSX spreadsheet |
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Text version
Sheet1
| Question | Page | RFP Section | Response |
| Is there a specific response format that OPM would like contractors to utilize when putting together a response? (i.e. a Technical Volume) | Offerors must prepare a technical proposal and a price proposal in separate volumes. We request you do not provide brochures and other material used for marketing purposes. We will not consider such material in evaluating responses to this RFP. | ||
| Are there any page limitations? | Some sections of the offeror’s technical proposal count toward a 60-page limit. We will delete and will not evaluate the pages that exceed this 60-page limit. There is no page limit for the offeror’s price proposal. | ||
| Are there text-specific format requirements to be considered? (Font type, size, margin size). | Times New Roman 11 point font, or larger, and must have margins of at least one inch on all sides. Page headers and footers may fall within the margins. Tables, diagrams and footnotes may use smaller font sizes. You must number all pages. | ||
| Does OPM have a case sample you would like contractors to write to for the Medical Review Attachment 2 form? | Medical Review Writing Samples: This section of your proposal does not count toward the 60-page limit. The offeror must provide five medical review writing samples/medical reports, with accompanied questions as addressed to a medical specialist at the time of their review, in the following areas: |
| • | Psychiatry; |
| • | Hematology/oncology; |
| • | Physical medicine, rehabilitation, or pain management; |
| • | Reproductive endocrinology; and |
| • | Coding specialist. |
Offerors must use the Medical Review Format (Attachment 3) for this submission.
| Does OPM have specific specialty roles that may support more volume in reviews? | No. Required specialties varies depending on the appeals submitted, which is driven by changes/advancements in the medical and insurance industries. OPM cannot anticipate what specialties will be most in demand. | |
| What is the size of the IDIQ (budget/obligation)? | Solicitation/Contract/Order for Commercial Items | Decline to answer. |
| Please clarify if the OPM intends for this to be a single award IDIQ contract? | Solicitation/Contract/Order for Commercial Items | The Government may accept any item or group of items of an offer, unless |
the offeror qualifies the offer by specific limitations. Unless otherwise provided in the Schedule, offers may not be submitted for quantities less than those specified. The Government reserves the right to make an award on any item for a quantity less than the quantity offered, at the unit prices offered, unless the offeror specifies otherwise in the offer.
| Will OPM provide contractor with all required information/documentation needed for the record review? | PWS | All medical records will be provided but reviewer will need to perform research and obtain their own references. | |
| Will OPM please confirm that if subcontracted staff become necessary to fulfill the contract requirements, bidders will have the opportunity to onboard subcontract staff during the period of contract performance? | PWS | Contractor may propose a contract mod to the contracting officer in that scenario. | |
| Could you clarify if the review timelines or SLAs will be provided with each task order? The listed medical review times (7 days for standard and 3 days for expedited) appear only in the pricing spreadsheet— are these intended as examples or the actual time frames we are expected to meet? | FPR Pricing | These are actual time frames the contractor is required to meet. | |
| The SOW requires “A list of all medical doctors who will perform the services, under this contract, must be provided and include at a minimum, the medical doctor’s name, specialty/sub-specialty, and professional license renewal certification number, state(s) of issue, and dates of renewal and expiration (for each specialty/subspecialty); When would we be required to submit this list? How often would we need to update this list? | PWS | The list of medical doctors who will perform services must be provided with the response to the solicitation. If the bid is successful and a contract is signed, the contractor should updated the list as required or at a minimum quarterly. | |
| In accordance with FAR 52.219-9, will a Small Business Subcontracting Plan be required. If so, can we be provided with an agency specific plan template that outlines the agency goals? | Clauses | This is an oversight, and a plan will be required. Please see amendment | |
| Are there any specific reporting requirements as they relate to the evaluation of a prime contractor's utilization of small businesses? | Clauses | This is explained in the clause. | |
| Will the contractor be required to provide our own medical review processing technology? | Performance Work Statement | Contractor is required to provide their own equipment. Medical review documents will be transmitted and communication will be conducted through FDC, OPM's centralized platform used to manage and resolve disputed health insurance claim appeals. | |
| Will the contractor need to be able to link to OPM technology? | Performance Work Statement | Yes. | |
| If the contractor identifies requested medical specialist is not available and submits for approval of alternate specialist, does the claim review timeframe stop until approval is received by the OPM? | N/A | No. Obtaining a specialist is included in the review timeframe. | |
| Does the OPM notify beneficiaries of the review results? Does the contractor need to account for issuing review results? Would beneficiary written information need to be logged to a specific reading level for age, etc.? | N/A | Yes. No. OPM fully supports the Plain Language initiative, whenever possible, reviews should be written to this standard. | |
| From Section D.3.5 Other assigned work, is there a timeframe required between work order issuance and agreement between both parties identified to identify maximum hours and work start? | Performance Work Statement | After agreement between both parties, the COR will specify the maximum number of hours allowed at the time that the work order is issued. This is specific to CLINs for consultation services, special projects and coding specialists. | |
| What are the notification requirements for this section? And what are considered justifiable reasons? | Performance Work Statement | The Contracting Officer will designate a COR. Under this section (D.7), notice must be provided to the COR within 24 hours. Justifiable reasons are at the discretion of the CO, but broadly include circumstances outside of the contractors control that could not be reasonably anticipated or planned for. | |
| Who is the current vendor performing consultation and review services for the Federal and Postal Employee Health Benefits Program? | 1 | Schedule of Supplies/Services | The Medical Review contract type is IDIQ for Solicitation 24322625Q0020. The incumbent for the Medical Review labor hour contract 24322624F0246 is J29, Inc. |
| Can OPM specify an award date for this contract and confirm that 9/30/2025 is the contract start date? | 2 | Schedule of Supplies/Services | Yes, 9/30/25 is the start date. We anticipate an award date of early September. |
| Is the Offeror required to respond to any requirements set forth in the Clauses section on pages 19/56 to 30/56, or are the clauses only applicable upon contract award with the selected Contractor? | 19-30 | Clauses | The clauses do not require a response. |
| Does the reviewer require a PIV card or just contracted employees? | 29 | Clauses | The reviewer does not/should not have OPM system access, only contracted employees. |
| What is the process for obtaining a PIV card? | 29 | Clauses | PIV is not required for this contract. Refer to D.9.6 Security Cleance in the PWS. |
| Should the Offeror submit a stand-alone Technical Capability Summary of the 10 mandatory requirements or can they include it as the first section in their proposal? | 33-34 | Clauses | Please see solicitation amendment. |
| What is the current contract pricing? | 36 | Current pricing is labor hour--proposals to this effect will not be considered, this is an IDIQ contract type solicitation. | |
| Will Offerors be provided with a case scenario to use for the medical review writing sample? | 36 | Medical Review Writing Samples: This section of your proposal does not count toward the 60-page limit. The offeror must provide five medical review writing samples/medical reports, with accompanied questions as addressed to a medical specialist at the time of their review, in the following areas: |
| • | Psychiatry; |
| • | Hematology/oncology; |
| • | Physical medicine, rehabilitation, or pain management; |
| • | Reproductive endocrinology; and |
| • | Coding specialist. |
Offerors must use the Medical Review Format (Attachment 3) for this submission.
| Does the Offeror need to submit the entire 52.212-3 provision, or can the Offeror just submit paragraph (b) of the provision with its proposal? | 37-54 | The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v) of this provision. | |
| Is the Offeror required to provide any type of response in its proposal to provision 52.225-25 (Iran-Representations and Certifications)? | 54 | By submission of its offer, the offeror ipso facto certifies compliance with the referenced clause. | |
| Can OPM provide an example of a special project? | 2 | PWS | D.9.3 of PWS. pg. 9. A special project may be needed if a trend of disputed claims on a particular interest is identified, with inconsistent medical opinions which require thorough review of credible medical/scientific literature and clinical practice guidelines. |
| What are the top five medical specialties required for review of disputed claims? | As mentioned, the most used specalist varies depending on changes/advancements in the medical and insurance industries. | ||
| Is the physician required to be licensed in more than one State in the US? | PWS D.4.2 Licensure | Pg. 6. No it is not required to be licensed in more than one state and all other licensure requirements need to be met as outlined. | |
| The pricing spreadsheet requests pricing of each of the above types. Can you please verify that pricing should be provided for 150 cases for each category? | Pricing for the IDIQ is provided as outlined in the FPR Pricing Spreadsheet. Pricing should be submitted for each CLIN. | ||
| Will the Offeror be able to use their own portal for case reviews? If not, what portal or system will the selected Contractor be using? | Page(s): 7/10 | Contractor will use the FDC system to receive cases and upload medical reviews. It is also used for communicating with OPM regarding active cases. The contractor must have the ability to deliver the product electronically, and in accordance with Executive Order 14028 ‘Improving the Nations’ Cybersecurity’. The contractor must be compliant with HIPPA requirements. 1752.224-75 | |
| If in-person will be required, where should the Offeror include pricing for the medical director/expert witness in-person expenditure/s? | PWS D.8 Transmission of Work Orders | Pricing for this scenario does not need to be submitted with your proposal. | |
| Can OPM please describe the secure FEHB Disputed Claims system? | Page(s): 7/10 | FEHB Disputed Claims system also known as FDC is a centralized platform used within the Federal Employees Health Benefits (FEHB) program and the Postal Service Health Benefits (PSHB) Program to manage and resolve disputed health insurance claims. It allows federal agencies, carriers, and designated nurse consultants or medical reviewers to review, track, and communicate decisions regarding claim denials or coverage disputes. The system ensures consistency, transparency, and adherence to FEHB regulations by facilitating detailed documentation, timely case processing, and coordinated review workflows between stakeholders. It plays a critical role in supporting fair outcomes and upholding member rights under the FEHB program. | |
| Will the government consider a multiple awards' approach from different offerors or a multiple-award IDIQ approach that would provide more competitive pricing and better quality? Successful vendors' work assignments could be performance and price-based, providing OPM with the best options. | 32 | Solicitation, 52.212-1(h) | We plan for the proposed contract to be an indefinite-delivery/indefinite-quantity contract and include fixed prices for each contract line item. We will monitor contractor performance subject to a Performance Requirements Summary with defined deliverables, performance standards, acceptable quality levels, monitoring methods, incentives for outstanding performance, and price reductions for less than satisfactory performance. The performance period for the proposed contract is expected to be twelve (12) months for the base period plus four (4) one (1) year options. We will include the OPM-specific Section 508 Standards Clause in the RFP and resulting contract. Additional questions relating to contract approach can be addressed to the Contracting Officer. |
| Can you please clarify the NAICS code? The contract document cover page has a NAICS 524298, which is "all other insurance processing" which is confusing based on the scope. The SAM posting has NAICS 541611, which is a BPO catch-all and much more typical of these types of projects. | 1 | Solicitation | Per SAM.Gov NAICS Code: 541611 - Administrative Management and General Management Consulting Services. However in previous contract they used Original Set Aside: |
Product Service Code: R - SUPPORT SVCS (PROF, ADMIN, MGMT) NAICS Code:
524298 - All Other Insurance Related Activities Place of Performance:
Description 24361819D0001 IDIQ Contract Awarded 24361819F0035 Task Order in the amount of $77,000 awarded, partially funding base year Contract is for a base year plus four option years Award date 3/04/2019 Effective date 03/08/2019
| Please confirm that the volumes listed in the Solicitation/Contract/Order for Commercial Items in Column #21 are the expected volumes for the period of performance: 09/30/2025 to 09/29/2026. | 2 to 18 | Solicitation | The period of performance is 9/30/25 to 9/29/26, however quatity is dependent upon appeal submissions and agency needs. As an IDIQ contract there is no guaranteed minimum quantity. | |
| Please provide specific requirements to meet OPM’s security safeguards requirement referenced in the Initial Evaluation Process, requirement #10. | 34 | Solicitation, 52.212-2 Evaluation (b)(10) | Please see solicitation amendment. | |
| Such medical review typically requires the contractor to possess URAC IRO Accreditation, per federal regulation 75 FR 43330; see also 45 CFR § 147.136. URAC is the national accreditation required for a company to perform external medical review for disputes between members and health insurance carriers. Can OPM confirm that a prime contractor must possess this certification to perform this work? Offeror notes that all requirements listed under the QASP also must be satisfied to posses URAC IRO accreditation, which would furnish OPM with only best in class vendors | 35 | Solicitation, 52.212-2 Evaluation (c), Technical Factor 1: Experience | ||
| QASP | yes the contractor must process the URAC IRO accreditation | |||
| As a URAC-Accredited IRO performing External Review, we must remain independent. As such, for bidding purposes, the names of the physician reviewers on our panel are confidential. For bids, will OPM allow submission of a de-identified reviewer panel with redacted names and license numbers, while including all other requested information such as specialty, states of licensure, and expiration dates. | 6 | Performance Work Statement, D.4.2 Licensure | Yes, for bids OPM will allow submission with redacted names and license number | |
| Offeror wishes to confirm Coding specialist reviews are only required hourly rates. | N/A | Pricing Spreadsheet | Yes the coder reviews are priced under hourly rates | |
| Who is the incumbent? | N/A | General | The Medical Review contract type is IDIQ for Solicitation 24322625Q0020. The incumbent for the Medical Review labor hour contract 24322624F0246 is J29, Inc. | |
| What is the annual contract value for the past 5 years? | N/A | General | Likely decline to answer. CO or RMO should respond this questions | |
| Can OPM furnish the current line item pricing? | N/A | General | Current pricing is labor hour-proposals to this effect will not be considered, this is an IDIQ contract type solicitation. | |
| Is this activity considered a new requirement or a follow-on to an existing contract? If there is an incumbent, would you be able to share the vendor’s name and the contract number so that I may identify it in FPDS? | The Medical Review contract type is IDIQ for Solicitation 24322625Q0020. The incumbent for the Medical Review labor hour contract 24322624F0246 is J29, Inc. |
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