36C10B25Q0371.docx

SUBJECT*

Prepayment Claims Software Editor

GENERAL INFORMATION

SET-ASIDE

PLACE OF PERFORMANCE

POSTAL CODE

COUNTRY

CONTACT INFORMATION

Technology Acquisition Center

23 Christopher Way Eatontown NJ 07724

POINT OF CONTACT*

Contract Specialist Sandra Vargo sandra.vargo@va.gov 848-377-5044

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

DESCRIPTION

Presolicitation Notice Presolicitation Notice Attached RFI is for Prepayment Claims Editor Software

Presolicitation Notice

REQUEST FOR INFORMATION (RFI)

INTRODUCTION: THIS IS NOT A SOLICITATION. This RFI is issued for information and planning purposes only, do not submit a proposal. There is no obligation for the Government to acquire any products or services described in this RFI. No funds have been authorized, appropriated, or received for this effort. The information provided may be used by the Department of Veterans Affairs (VA) in developing its acquisition strategy and Performance Work Statement (PWS). Interested parties are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. The Government does not intend to pay for the information submitted in response to this RFI.

BACKGROUND

The Department of Veterans Affairs (VA), Financial Services Center (FSC) adjudicates and pays healthcare claims from private providers outside of VA's medical facilities. The VA requires a medical claims editing tool or system that identifies potential program integrity issues during adjudication and processing of healthcare claims transactions before payment is issued.

QUESTIONS AND CRITICAL CONSIDERATIONS FOR INTERESTED CONTRACTORS

Responses are solely treated as information for the Government to consider. Direct or indirect costs incurred in response to this RFI are at the expense of the vendor, not the Government. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Any contract that might be awarded based on information received or derived from this RFI will be the outcome of a competitive process. It is requested that all companies interested in participating in this effort to note their interest and respond to the areas identified in the “Capabilities Statement” section below. Provide a summary of your technical approach to meet the stated objective below.

OBJECTIVE

The VA is seeking information on prepayment claims editor software aimed at preventing erroneous payments and enhancing claims accuracy. The software must be capable of applying logic according to VA policy, along with industry and CMS standards and state and federal regulations, to identify potential pre-payment program integrity issues regarding:

· Professional and Facility Claims Audit Rules

· Frequency limits

· Medical Necessity

· Bundling

· Place of service/modifier validation

· Local and national coverage determination

· Clinical Rationale

· Medically Unlikely Edits (MUE) and Correct Coding Initiative

· Coding Crosswalks

CAPABILITIES STATEMENT

1. Please provide Point of Contact information (name, email address, address, telephone, and fax numbers).

1. Please identify your company’s size status based upon the applicable NAICS code of 541519. If in responding to this RFI, you believe another NAICS code should be applicable, please identify the NAICS code you consider appropriate for this effort along with detailed supporting rationale.

1. Please provide details regarding proposed joint ventures, teaming arrangements, strategic alliances or other business arrangements needed to meet Federal Acquisition Register or VA Acquisition Register.

1. What is proposed solution and what are your proposed solution’s capabilities?

1. Will your proposed solution be a commercial-off-the-shelf system, software as a service (SaaS), or a system developed/customized for the VA?

1. If product is SaaS, is it FEDRAMP approved?

1. Based on previous implementations , what is the average implementation time for your proposed solution?

1. Based on previous implementations, what is the average cost structure for your proposed solution?

1. Please provide information if services and products are available under any Federal Contract Vehicle, e.g., GWACs, GSA Federal Supply Schedule, T4NG, etc.

RESPONSE SUBMISSION

Please submit responses via email to Sandra Vargo, Contract Specialist at sandra.vargo@va.gov by 2:00 pm Eastern Daylight Time, June 19, 2025. VA reserves the right to not reply to any emails, responses, and/or materials submitted.

DISCLAIMER

This RFI is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to this RFI that is marked as proprietary will be handled accordingly. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI.