The file's text, extracted by GovTribe without its formatting.
Special Notice Special Notice
| SUBJECT* |
| Clearinghouse Services (VA-22-00078220) Stand-Alone Contract |
GENERAL INFORMATION
| CONTRACTING OFFICE’S ZIP CODE* |
| 07724 |
| SOLICITATION NUMBER* |
| 36C10B22R0021 |
| ARCHIVE |
| 15 DAYS AFTER THE RESPONSE DATE |
| PRODUCT SERVICE CODE* |
| 7A21 |
| CONTRACTING OFFICE ADDRESS |
| Department of Veterans Affairs |
Technology Acquisition Center
23 Christopher Way Eatontown NJ 07724
POINT OF CONTACT*
Contract Specialist Joseph Vivolo Joseph.Vivolo1@va.gov 848-377-5105
ADDITIONAL INFORMATION
AGENCY’S URL
URL DESCRIPTION
AGENCY CONTACT’S EMAIL ADDRESS
EMAIL DESCRIPTION
DESCRIPTION
The Purpose of this Modification to the Solicitation is too extend the due date to 8/19/2022 at 1PM EST and post the Q&A Responses.
| Section in Reference |
| Question |
| Answer |
SSI Group
| Section B.5-Price Schedule |
| Could the VA clarify: Should "HCFA UB" be read as UB OCR? The term "HCFA UB" is repeated in the Price Schedule in other requirements sections. |
| Yes, HCFA UB are UB claims that require OCR work. |
| Section B.5-Price Schedule |
| The Price Schedule references ADA Dental forms. Is this ADA Dental form to be OCR? |
| Yes, if a paper ADA form is received, it will require OCR work. |
| If non-ADA Dental form claims are received, does the VA wish the Contractor to reject these claims? |
| Yes. |
| NCPDP is referenced in the PWS but it's not listed in the Price Schedule, Volume Table, or 5.3 Clearinghouse Services. Is NCPDP a transaction to be implemented as part of this contract? |
| Not at this time, but it was included in the PWS in case we add pharmacy claims in the future. |
| If NCPDP is intended to be included, does the VA require pharmacy transactions to be submitted to the VA as real-time transactions or as batch? |
| If NCPDP claims are added in the future, Contractors shall have the ability to send both real-time and batch transactions. |
| 275 is not listed in the Price Schedule, but is listed in 5.3 as an included transaction. Should 275 be included in the Price Schedule, and does the VA want Contractors to include a price for 275 in their responses? |
| 275 transactions should be included in CLIN 0006. |
| Can the VA clarify whether they intend the 275 transaction to be "solicited", where the providers only send attachments in when requested, or if it is to be "unsolicited" and providers can send attachments along with their claims upon initial submission? |
| Providers can send attachments along with their claims upon initial submission. |
| Section 5.3-Clearinghouse Services |
| Can the VA clarify: #9.B. talks about sending paper acknowledgements for each claim received, but this is not in the Pricing Schedule. Is the VA asking for "acknowledgements" to be mailed for every claim received, or is the requirement just to send letters for rejected claims? |
| Acknowledgments should be included in CLIN 0007. |
| As part of the COB requirements of this PWS, is transmission of 837s needed to any destination other than VAFSC? |
| No. |
| Can the VA clarify: Is an ePAP (pharmacy) EHNAC accreditation necessary/required for the clearinghouse since NCPDP does not seem to be included in the Price Schedule or Clearinghouse Service requirements? |
| Yes, it is required. |
| “The Government also reserves the right to review past performance information that is close at hand.” Please clarify what this statement means within the context of the FAR |
| VA may review previous CPARS. |
VTI/Technatomy
| Is your current vendor FISMA certified? |
| Yes |
| Please provide volume numbers |
| Anticipated volumes are in the PWS. |
| What VA lines of business does this RFP include? |
| Medical claims processing. |
| Handbook 6500.6 paragraph 3a states that the VAAR security clause doesn’t apply to healthcare transactions released to the contractor, yet this RFP includes requirements for FISMA security and an ATO. Please explain why this RFP appears to be an exception to paragraph 3a. |
| To establish a connection to the VA network to send/receive files via SFTP, vendors must comply with the FISMA and ATO requirements. |
Change Healthcare
| N/A |
| Is your current vendor FISMA certified? |
| Yes |
| N/A |
| Please provide volume numbers |
| Anticipated volumes are in the PWS. |
| N/A |
| What VA or other government agency lines of business does this RFP include? |
| Medical claims processing. |
| N/A |
| Handbook 6500.6 section 3 paragraph a. states that VA sensitive information properly disclosed by VA to the contractor becomes the contractor’s data and is not subject to the VAAR security clause, that the VAAR security clause should not be added to the contract, and that Handbook 6500 does not apply. However this RFP states that the VA Handbook 6500 must be adhered to and includes requirements like FISMA certification and an ATO that would seemingly apply only to VA data. Please explain why this RFP includes such requirements in apparent contradiction of Handbook 6500.6 section paragraph a. |
| To establish a connection to the VA network to send/receive files via SFTP, vendors must comply with the FISMA and ATO requirements. |
| N/A |
| What is the expected award date? |
| Mid-September |
| N/A |
| An increase in transaction volumes for a prior iteration of this contract (VA118-15-C-0095) was justified partly on the grounds that then-incumbent SSI Claimsnet had a “two-way” secure connection while Emdeon Business Services only had a “one-way” secure connection. The reason given for needing a two-way secure connection was that “the non-VA firm must be capable of receiving secure healthcare claim transactions from the VA and submitting secure healthcare claim transactions to the VA”. Is a two-way secure connection required for this RFP? If so, can VA please explain the reason for the requirement, and identify the communication technology/protocol being used (i.e. SFTP, HTTPS, etc.) that prevents FSC from initiating connections to both transmit and receive claim transactions, i.e. a one-way connection? |
| Two-way communication is required because the Vendor will send transactions (i.e., 837s) to the VA and the VA will send acknowledgments (i.e., 835s). |
Page 28 5.4 paragraph 1 Page 105 E.15 Proposal Submission
| Section 5.4 states that the offeror must have an ATO or a TATO and be able to upgrade a TATO to a permanent ATO within 3 months of award. The submission instructions at (I) VOLUME I – TECHNICAL FACTOR item (3) say the proposal must include the offeror’s approach to obtaining an ATO within six months of award. Which one is correct? |
| The vendor must have an ATO to do any work associated with the contract. It will take vendors who have not started the process 6 months to a year to obtain an approved ATO. If the vendor has started the process and is within 6 months of obtaining their approved ATO, then they may bid on the RFP. |
| Page 25 section 5.3 item #9 |
| Item 9b lists the 824 as a type of acknowledgement, but the 824 is not a mandated transaction under current HIPAA standards; please clarify when the 824 would be used. |
Item 9b lists the 275 transactions yet there is no CLIN for pricing or estimated volumes. Please clarify FSC’s intent with respect to the 275 and, if it will be used, please add a CLIN for pricing and provide expected volumes.
Item 9b appears to be including 270/271, 276/277 and 278 transactions as part of the OCR work. Unlike the 837I/P/D transactions that have paper analogs in the UB-04/1500/ADA claim forms these are real-time transactions that don’t necessarily have a paper analog. Please clarify FSC’s intent with respect to how paper documents relate to these real-time EDI transactions.
824 are acknowledgment transactions. We included them in the PWS for when they become mandated.
275s may be invoiced in CLIN 0006.
The VA receives paper claims…those claims are scanned as a TIFF image and send to the Contractor via SFTP. The Contractor will then perform OCR work and convert the claim to an ANSI X12 compliant standard and send it back to the VA via SFTP.
| N/A |
| Is your current vendor FISMA certified? |
| Yes |
| N/A |
| Please provide volume numbers |
| Anticipated volumes are in the PWS. |
| N/A |
| What VA or other government agency lines of business does this RFP include? |
| Medical claims processing. |
| N/A |
| Handbook 6500.6 section 3 paragraph a. states that VA sensitive information properly disclosed by VA to the contractor becomes the contractor’s data and is not subject to the VAAR security clause, that the VAAR security clause should not be added to the contract, and that Handbook 6500 does not apply. However this RFP states that the VA Handbook 6500 must be adhered to and includes requirements like FISMA certification and an ATO that would seemingly apply only to VA data. Please explain why this RFP includes such requirements in apparent contradiction of Handbook 6500.6 section paragraph a. |
| To establish a connection to the VA network to send/receive files via SFTP, vendors must comply with the FISMA and ATO requirements. |
Availity
| Can you please provide the name of the current vendor providing services? |
| SSI Group |
| What happens when the claims maximum threshold is reached? |
| We will modify to the contract add additional transactions until we meet the annual ceiling. |
| If selected, what would be the start dates for this contract? |
| On/about 1 Nov 22 |
| What programs does this cover? (CCN,CHAMP, etc.) |
| Currently for VHA, the following programs will be covered: PC3, National Dialysis Service Contract, and Camp Lejeune Family Member Program. This will also cover medical claims for our Other Government Agency partner. |
Misc. Vendor
| N/A |
| Who is the incumbent currently performing this effort? |
| SSI Group |
| N/A |
| What is the expected award date? |
| On/about 15 Sep 22 |
| N/A |
| What is the expected Period of Performance start date? |
| On/about 1 Nov 22 |
| N/A |
| Will this contract cover the receipt and transmission of Pharmacy Claims? B5 price schedule does not include that line item/CLIN but NCPDP is mentioned a few times throughout the RFP document. |
| Not at this time, but it was included in the PWS in case we add pharmacy claims in the future. |
| 5.1.2 Reporting Requirements |
| · In what format would VA like to receive the daily, weekly and monthly reports? |
· Are these reports meant to be sent over email?
· Would VA like access to a self-service portal that provides all of this information 24/7?
- Excel or other Office product will suffice.
- Yes
- Not required; however, you are welcome to include it in your proposal if you wish.
| 5.1.2 Reporting Requirements- Rendered Images |
| · The conversion of 837 to an image is on adjudicated claims, correct? |
· Can VA provide additional requirements on the image output? PDF?
· How does VA make the requests to Contractor on which claims to convert?
· How often is this done throughout the year or is it all at once?
· How soon after request should the images be created and delivered to the VA?
How should the images be delivered to VA?
· Yes
· PDF or other image format (.png, .tif, .jpg, ect.)
· VA will send an e-mail with document identifiers for those claims throughout the year.
· Done throughout the year.
· 1 week
· Via SFTP.
| 5.3 Clearinghouse Services, #2 |
| What types of edits does the FSC require the Contractor to apply to electronic claims? |
| In addition to Workgroup for Electronic Data Interchange (WEDI) Strategic National Implementation Process (SNIP) up to WEDI-SNIP level 5 edits, it depends on the program and/or claim type. The VA will provide specific edits upon contract award. |
| 5.3 Clearinghouse Services, #3 |
| For inbound electronic transaction files from FSC, Clearinghouses, Providers and other constituents, will contractor receive electronic files in a format other than ANSI X12 compliant 837 that will need to be converted? |
| The VA receives paper claims…those claims are scanned as a TIFF image and send to the Contractor via SFTP. The Contractor will then perform OCR work and convert the claim to an ANSI X12 compliant 837 and send it back to the VA via SFTP. |
| 5.3 Clearinghouse Services, #6 |
| Will the FSC create a 277CA transaction on paper claims converted and sent from Contractor to FSC? |
| Yes, and these will need to be forwarded back to the submitting provider. |
| 5.3 Clearinghouse Services, #5 |
| Does the 999/277CA received from the FSC need to be sent back to providers that submit paper claims? |
| Yes. |
| 5.3 Clearinghouse Services, #9 |
| What will the 824 transactions be used for? |
| 824 are acknowledgment transactions. |
| 5.3 Clearinghouse Services, #9 |
| For the Coordination of Benefits (COB), can the VA provide the list of payers they want the contractor to provide connectivity to? |
| Will be provided at contract award. |
| 5.3 Clearinghouse Services, #9 |
| Will the 275 transaction be electronic, paper, or both? If this is paper, will this require conversion to an electronic 275 transaction? |
| 275 will be electronic. |
| 5.3 Clearinghouse Services, #9 |
| Where would the contractor check eligibility (270/271) and claims status inquiry (276/277)? |
| Contractor will forward those transactions to the VA and the VA will process them accordingly and send out the responses to the Contractor, who when forward the responses to the Provider. |
| 5.3 Clearinghouse Services, #9 |
| How many Clearinghouses, Providers and other FSC constituents does VA expect to have to connect with contractor? Could VA provide a list? |
| Will be provided at Contract award. |
| 5.3 Clearinghouse Services, #11 |
| What are the SNIP level codes the contractor is required to apply on submitted claims? |
| SNIP level codes are industry-standard code for clearinghouses and the Contractor should be able to apply up to Level 5. |
| 5.3 Clearinghouse Services, #11 |
| How does the contractor communicate to the provider that there were errors with the paper claim (after conversion and submission to FSC) and that a claim has been accepted? |
| VA will mail out Explanation of Payments to submitting providers. |
| 5.3 Clearinghouse Services, #11 |
| How does the contractor communicate to the submitter that the claim needs to be fixed and resubmitted if the FSC and/or Payer determines any errors? Is it through a rejection letter? |
| For electronic claims, this will be done through the 835 transactions. For paper claims, the VA will mail out Explanation of Payments to submitting providers. |
| 5.4 TATO/ATO |
| · How will VA work with the Contractor to complete Assessment & Accreditation and receive a TATO/ATO? |
What is the process and when would it begin?
The process is outlined in the PWS. If you don’t have a TATO/ATO, you will not be able to perform any work on the contract until you get one. This is a 6-month to a year process.
| 5.4 TATO/ATO |
| Can VA confirm when a permanent ATO needs to be obtained by? 3 (page 28) or 6 months (page 89)? |
| The ATO needs to be obtained before performing any work on the contract. |
| E.15 Proposal Submission. Volume I Technical |
| The technical volume requests the approach for Clearinghouse Services in accordance with Performance Work Statement (PWS) Paragraph 5.2 and Key Requirements in PWS Paragraph 5.1.4 (this section does not exist). The sections in the PWS for Clearinghouse Services and Key Requirements are 5.3 and 5.2 respectively. Please confirm the section number and name that needs to be included in Volume I- Technical. |
| We will update the technical volume requirements to match the PWS. |
| E.15 Proposal Submission. Volume II Past Performance |
| Does the contractor have to provide up to 2 past performance highlighting electronic clearinghouse services or does the FSC also want past performance for the Paper to EDI conversion component? |
| We recommend both be included. |
| Page 26, question 9 b. |
| How is postage paid for acknowledgements for paper claims to the billing providers-is the cost to be part of our pricing or do we charge it as a pass through? |
| VA recommends pass-through. |
| Page 26, question 11 |
| What are the acceptable methods of notifying claim submitters that a claim has been rejected for failing to meet the edit requirements? |
| The appropriate transaction acknowledgment. |
| Page 26, question 13 |
| Can you confirm that claim reprocessing would be invoiced at the same rate as the original claim that was processed? |
Yes
| Page 26, question 14. |
| What constitutes a duplicate claim? i.e. everything on the claim is the same; same dates of services, etc. |
| Yes, everything is the same. |
| N/A |
| How will paper claims be received? Directly to one facility or PO Box or will several distinct PO Boxes be needed? |
The VA receives paper claims…those claims are scanned as a TIFF image and send to the Contractor via SFTP. The Contractor will then perform OCR work and convert the claim to an ANSI X12 compliant 837 and send it back to the VA via SFTP.
| Claim pricing B.5. page 9. |
| For CMS 1500 HCFA CLIN1003, 2003, 3003 etc. , please confirm that this refers to all HCFA claims not just those that are OCRable. |
These are the OCR claims only. Electronic claims will be invoiced on the 837 CLIN.
| Claim pricing B.5. page 9 |
| What percent of these claims are “black” vs “red”. For CMS 1450 UB claims it refers to HCFA UB, we assume you mean UB only? |
| Since Sep 2021, we received approx. 75K paper claims that require OCR work; and of those claims, approx. 15%-20% will be UB claims. |
Claim pricing B.5. page 9.
| What percent of these claims for each year are red vs black? |
| Since Sep 2021, we received approx. 75K paper claims that require OCR work; and of those claims, approx. 15%-20% will be UB claims. |
| Claim pricing B.5. page 9 |
| For both CLINs please specify scan resolution and confirm vendor receipt of both normal scan and “red dropout” TIFF for efficient vendor processing. |
| Not sure what the vendor is asking. |
| Page 26, para 9 |
| Acknowledgement letter. We assume this letter will be sent for all paper claims processed. If claim is rejected we assume a reject letter is sent by mail so, should we also assume that acknowledgement letters are only mailed for claims that are NOT rejected. i.e. either one letter or the other is sent, not both. Will any written correspondence be required for “reprocessed” claims? |
| Yes. |
| *= Required Field |
| Special Notice |
Special Notice
