Solicitation 36C10G20Q0003 Question and Answers.pdf

QUESTIONS PWS

SEC/Clause/Provision/ Attachment

ANSWERS

1 Soft Copy of the Tender Document through email. Not accepting soft copies. Refer to Attachment E, ADDENDUM to

FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS,

(a), 1. PROPOSAL FILES.

2 Names of countries that will be eligible to participate in this tender.

This solicitation and services to be rendered are subject to FAR Part 25.

3 Any Extension of Bidding Deadline? No.

4 Any Addendum or Pre Bid meeting Minutes? No.

5 Do the requirements in this PWS (e.g., EHNAC and CORE I, II and III) pertain to both Prime and sub-contractors? Prime only? Major sub-contractors?

Any prime or sub-contractor who specifically conducts EDI transactions must be certified.

6 What percent of claims have attachments? What is the average number of pages per attachment?

Currently the majority of attachments are coming in through P2E Approximately 40% of HCFA’s have attachments, Approximately 49% of UB’s have attachments and Approximately 1% of Dental Claims have attachments for P2E claims Average # of pages for HCFA attachments 9, Average # of pages for UB attachments 29, Average # of pages for Dental attachments 1 for P2E.

7 HCFA1500

• What is past fiscal year percentage HCFA of total claims?

• What is past fiscal year percentage of HCFA claims that are red?

• What is past fiscal year percentage of HCFA claims that are handwritten?

CY19 HCFAs were 80% of Total Claims; Approximately 56% of Claims are Black and White; no data on handwritten.

8 UB04

• What is past fiscal year percentage UB04 of total claims?

• What is past fiscal year percentage of UB04 claims that are red?

• What is past fiscal year percentage of UB04 claims that are handwritten?

CY19 UBs were 20% of Total Claims 56% of Claims are Black and White; no data on handwritten.

9 ADA

• What is past fiscal year percentage ADA of total claims?

• What is past fiscal year percentage of ADA claims that are red?

• What is past fiscal year percentage of ADA claims that are handwritten?

May 2020 ADA approximately 2% of Total claims.

10 With respect to “inappropriate paper” that needs to be returned to the provider, are those items considered to be part of the Rejection volume? If so, what percent of Rejects are Exceptions?

Section 5.2.4.8 If it is returned to a provider it is part of the rejection volume, A small amount of exceptions don’t go back as rejects approximately less than 1%.

11 The requirement states the following:

“The contractor shall provide a user-friendly process for VHA/OCC providers to enroll for EDI transactions.”

To provide for an efficient and user-friendly process for the more than one million providers enrolled to exchange EDI transactions with the VHA/OCC, will the contractor have access to the existing database of enrolled providers with all the data used today to enroll and/or credential them for EDI data exchange?

Will the contractor need to have all Providers enrolled at time of offer submission or can the contractor enroll them during the transition period?

Will the contractor need to enroll all Providers, or can contractor leverage existing connections through partner relationships?

Section 5.3.1 The contractor will not have access to the existing database of enrolled providers with all the data used today to enroll and/or credential them for EDI data exchange.

The contractor can enroll all Providers during the transition period.

The contractor can propose any method for enrolling all providers.

12 The requirement states that FISMA, FIPS and NIST need to be demonstrated. Is this needed at the time of award, after the transition period, or during the base year?

Section 14.4.4 These requirements must be met at the time of award.

13 ATTACHMENT E SOLICITATION PROVISIONS Volume III – Price. What is the pricing with the current vendors for these services?

Current pricing will not be disclosed.

14 Would the contractor be able to put in a proposal response as a Prime and another one as a sub-contractor?

Contractors can propose as to how they see it as it relates to the solicitation.

15 The SF1449 wasn’t included in the solicitation. Do you want Contractors to download a template or will the VA provide it? What Volume does this form belong? Is it included in the page count?

Attachment E, E.3 52.212-

1, INSTRUCTIONS TO

OFFERORS—

COMMERCIAL ITEMS (MAR

2020), pg 4

The verbiage has been removed from Section E. The 1449 isn’t required for proposal submission.

16 Will the VA provide all answers to Contractor questions before June 26 so that Contractors can adequately address all concerns in their response?

Attachment E, Addendum to FAR 52-212-1, INSTRUCTIONS TO

OFFERORS—

COMMERCIAL ITEMS (MAR

2020), pg 8, Dates and Times

Yes

17 "To avoid submission of late proposals, the Government recommends transmitting proposal file 24 hours prior to the required proposal due date and time." Will someone at the VA be available to confirm files are received if a Contractor submits on Sunday, July 5, as advised?

Attachment E, pg 8 No, VA will make sure all Proposals are received by date and time specified in Attachment E, pg 8 (a)

18 Finally, due to VA email file size restrictions, contractors may need to logically separate their proposal into separate emails. If this is necessary, contractors should attempt to contain a complete volume within single email transmissions (and not split volumes). Please provide file size limit so that Contractors may logically separate emails as advised.

Attachment E, pg 8 Please refer to Attachment E, pg 8 (a), and pg 9- PROPOSAL FILES

19 Page 8 and 10 list Volume III as Socio-economic Status. Page 13 lists Volume III as Price. Please clarify correct naming of Volume III.

Attachment E, pgs 8/ 10/

Corrections: VOLUME III - Social economic and VOLUME IV -Pricing

20 Page 8 and 10 list Volume IV as Price. Page 13 lists Volume IV as Subcontracting Plan. Please clarify correct naming of Volume IV.

Attachment E, pgs 8/ 10/

Corrections: VOLUME IV - Pricing and VOLUME V -Subcontracting Plan Pricing

21 Page 8 and 10 list Volume V as Subcontracting Plan. Page 14 lists Volume V as Socio-economic Status. Please clarify correct naming of Volume V.

Attachment E, pgs 8/ 10/

Correction: VOLUME III -Socio- economic, VOLUME V - Subcontracting Plan

22 File name for Volume III does not show a file name – only “Contractor(s) Name (included plan)”. What is the desired naming convention for Volume III?

Attachment E, pg 10 VOLUME III pertains to the vendor's Socio economic status, the File name requires the contractor (s) Name and included plan

23 File name for Volume V does not show a file name – only “Contractor(s) Name (includes a completed plan)”. What is the desired naming convention for Volume V?

Attachment E, pg 10 Volume V pertains to the Subcontracting Plan, the File name requires the Contractor(s) Names and requires a complete plan

24 Factor 1 - Technical Approach (15 pages maximum. So that we can adequately address the mandatory tasks and deliverables outlined in the PWS (5.2-5.5), can the page limit be increased to 30 pages? If not, please advise how the Contractor is to address those requirements and the corresponding required subfactors?

Attachment E, pg 15 Factor 1 - Technical Approach has changed to 20 page maximum.

25 Factor 1 - Technical Approach (15 pages maximum; Resumes are not to exceed 2 pages each and do not count against 15 page total; OCI plan not to exceed 3 pages and do not count against 15 page total). Please define “OCI plan” that is not to exceed 3 pages and does not count against page limit?

Also, confirm that E.1 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015) appears to be identical to the Conflict of Interest statement(s) as required by paragraph b. of the VAAR Clause 852.209-70

ORGANIZATIONAL CONFLICT OF INTEREST.

Attachment E, pg 15 Organizational Conflict of Interest (OCI), please refer to FAR Subpart

9.5. E.1 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY

MATTERS (OCT 2015), is certifying responsibilities in order to be within good standings in order to be awarded a Government contract, and OCI paragraph b. of the VAAR Clause 852.209-70 ORGANIZATIONAL CONFLICT OF INTEREST speaks to all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided under this solicitation.

26 Factor 4 – Price Factor Price (In accordance with Price schedule) Excel file. The excel spreadsheet should be comprised of the CLINs from Section B.2 and a breakout worksheet, which details the labor mix per each CLIN. Where is Section B.2 located?

Attachment E, pg 16 Section B.2 is locate in Attachment B - Contract Administration

27 E.6 52.212-3 OFFEROR REPRESENTATIONS AND

CERTIFICATIONS—COMMERCIAL ITEMS (MAR 2020)

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. Please confirm if the SAM certification is current then the Contractor doesn’t have to complete only paragraphs (c) through (v) of this provision

Attachment E, pgs 20-21 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.

28 VA has included 277CA and 277RFAI as being real-time transactions along with 276/277, but industry-standard usage of these reports is batch. Shouldn’t the 277CA and 277RFAI batch transactions be separated out from the 276/277 real-time transactions? The TR3s for both transactions indicate that they are intended to be used in batch mode only, not real-time, though that does not preclude a real-time implementation between willing trading partners. Is it VA’s intent to implement these transactions as real-time?

Multiple, Attachment A pages CLIN 0006, 0007, 1006, 1007, 2006, 2007, 3006, 3007 Attachment D pages 2,8,9,10,13, Attachment H table on page 2

Correct Implementation for 277CA and 277RFAI should be batch. The implementation for the 276/277 will be real-time PWS has been updated.

29 270/271 transactions are identified as batch/real-time, but are currently only real-time transactions. The row for 276/277/277CA gives a type of “batch”, but 276/277 are real-time while 277CA is batch. Does the VA intend to implement these transactions as batch in the future?

Attachment D, pg 2 Some programs are ‘hosted’ so the data for the 276/277 is sent as a batch currently. Other programs are real-time and the HCCH needs to be a pass through.

PWS has been updated.

30 The table has edits checked for all real-time transactions except 276/277. Is this inconsistency an oversight?

Attachment D, pg 2 No.

31 Rejections are identified as a type of transaction with no volume currently, but 17,841/week in FY20. What type of rejections are being identified? Is it EDI or P2E, and if EDI what specific transactions are being rejected?

Attachment D, pg 2 P2E Rejections. If a P2E claims is received that cannot be converted to EDI a rejection letter with rejection letters must be mailed to the provider.

32 VA refers to “the aforementioned certifications and credentialing”, but no certifications or credentials are previously mentioned. What certifications/credentials is the VA referring to?

Attachment D, pg 3 Listed in Section 6. ENHAC, CAQH CORE I,II,III, & Covered Entity.

33 Item 5.2.11.2 refers to section 2, paragraph 4, but there is no such section. What is VA referring to here?

Attachment D, pg 7 Section 2 Paragraph 2 – referring to how vendor will communicate with provider.

34 The list of transactions states “includes acknowledgements”, including for transactions which do not traditionally include acknowledgements (e.g. real-time). What acknowledgements are being referred to? For real-time transactions is the response considered to be the acknowledgement. There is no reference to acknowledgement for 277RFAI, is this an oversight?

Attachment D, pg 8 Acknowledgements was indicative of the type claim status as opposed to Pending and Final status. There will be an acknowledgement for the 277RFAI.

35 277RFAI is listed as Healthcare Claim Status Request and Response, but is a one-way batch transaction from payer to provider. Shouldn’t this transaction be identified as Healthcare Request For Additional Information?

Multiple, Attachment D page 8, Attachment A CLIN 0008, 1008, 2008, 3008

Acknowledgements was indicative of the type claim status as opposed to Pending and Final status. There will be an acknowledgement for the 277RFAI.

36 5.3.2.11 reference to the Healthcare Claim Attachment 275 says "(includes acknowledgements)”. There are no industry-standard acknowledgements for this transaction, other than the 999. Are these acknowledgements by the clearinghouse of transactions received from providers, or VA acknowledgement of transactions received from the clearinghouse? In the case of the 275, does VA contemplate an acknowledgement other than the 999?

Attachment D, pg 8 Currently the 999 is the only acknowledgement we are returning for the 275. Additional transactions will be assessed based on industry guidelines.

37 Section 5.4.5 says VA requires daily real-time reports that include 277CA and 277RFAI, but these are not real-time transactions. The TR3s for both transactions indicate that they are intended to be used in batch mode only, not real-time, though that does not preclude a real-time implementation between willing trading partners. Is it VA’s intent to implement these transactions as real-time?

Attachment D, pg 9 While correct that these are not real-time transactions, we do require daily reports for these transactions.

38 5.4.7, 5.4.8 Daily and Monthly Attachments Transaction Counts request reporting by “Claim Type”, but the 275 Attachments transaction may not include a clear indication of what type of claim the attachment is intended to support.

The Attachments reporting requirements also include 277RFAI volumes, but 277RFAI is not an attachment transaction, it is a payer-initiated request for a provider to submit attachments. Can you explain why this is a required data element on the report when “Claim Type” is situational according to the TR3. Furthermore, if VA requires reporting of 277RFAI transaction volumes and 275 Attachments, shouldn’t they be reported separately vs. combined?

Attachment D, pg 10 The requirement for “Claim Type” has been corrected in the PWS.

277RFAI and 275 should be reported separately.

39 5.4.11 Ad Hoc Reports requires reporting on data which is only available from within a claim adjudication system, and cannot be known to a clearinghouse. This section doesn’t appear to be relevant to this EDI/P2E clearinghouse request and it appears to relate to an adjudication task. Can you confirm and provide direction?

Attachment D, pg 11 This references only data available at the Clearinghouse.

40 The table at 5.6.11 refers to PWS 5.2.1.1 and 5.2.1.2, but no such sections exist. Can the VA provide the missing section or provide direction?

Attachment D, pg 12 This is a typo in PWS, and has been corrected 5.6.1 in the PWS.

41 The table of transaction volumes has a far greater number of P2E rejections than Paper To Electronic (P2E). Are these numbers reversed?

Attachment H, pg 2 Yes – QASP has been updated

42 Section 5 Methods of QA Surveillance includes metrics which do not apply to a clearinghouse, but to medical claim processors data-entering claims at FSC. Can you please update this section with appropriate measures?

Attachment H, pg 5 Performance table in QASP has been updated.

43 277RFAI transaction is missing from the table. Can VA provide volume estimates for 277RFAI?

Attachment H, pg 2 No, we don’t have projected volume for this transaction

44 3 page narrative (References will complete and provide the questionnaire [RFP ATTACHMENT G] to the Government.

PPQs will not be included in page limitation). Since some large clearinghouses are owned by payers, does it represent a conflict of interest for a clearinghouse owner to be also a clearinghouse reference? Will you disqualify those references with equity ownership/stake in the clearinghouse?

Attachment E, F, and G, Att. E, 10, 12

Organizational Conflicts of Interest plan shall be submitted within the Tech Proposal. OCIs will be handled on a case by case basis per consultation with our general counsel.

45 0001, Under UNIT JB. Please define the letters JB. Attachment A Schedule, pg

This was in errors, and has been corrected to reflect EA.

46 The associated North American Industrial Classification System (NAICS) code for this procurement is 518210 and the associated size standard is $35 Million. Please confirm the 35 million ceiling is the maximum order including the EDI and the P2E task in the PWS for the 48- month term.

SSN, pg 2 A size standard, which is usually stated in number of employees or average annual receipts, represents the largest size that a business (including its subsidiaries and affiliates) may be to remain classified as a small business for SBA and federal contracting programs.

47 0012 (P2E) Conversion transactions (837s and 275s), Is VA asking for price by document or by page?

Attachment A, pg 3 The estimated quantities listed in Attachment A- Schedule are listed per transaction.

48 0012 (P2E) Conversion transactions (837s and 275s), Please confirm full mailroom and onshore data verification is required.

Attachment A, pg 3 Yes. Full mailroom and onshore data required per the 5.2.4.;

5.2.4.1-5.2.4.3 and bound by General requirement at 6.1, 6.2, and 6.3

49 Table of Transactions. Does the VA anticipate any spike or decreases in Paper documents volumes over the next 48 months? If so, please outline when the spikes or decreases may manifest themselves on the timeline and describe key drivers if applicable.

Attachment D, pg 2 VA anticipates a steady decrease in paper over the next 48 months as more providers convert to electronic transactions.

50 4. Scope; 5 Mandatory Tasks and Deliverables 5.2.2 Specifications for Direct Transactions (270/271, 278, 277CA, 837, 837COB, 275, 835) 5.2.2 Specifications for Direct Transactions (270/271, 278, 277CA, 837, 837COB, 275, 835) Deliverable 5.2.4 Specification for Paper to EDI (P2E).

Technical Paper to EDI specifications were not provided in the solicitation. Will the VA make the specifications available to all Contractors?

Attachment D, General This is what the contractor provides VA on how they plan to implement X12 standards.

51 4. Scope; 5 Mandatory Tasks and Deliverables 5 Deliverable

5.2.4 Specification for Paper to EDI (P2E). Is there a

preference for bidders to provide web-based applications such as document workflows and repositories? If so what is the approximate number of subscribers?

Attachment D, General To be determined by Vendor.

52 4. Scope; 5 Mandatory Tasks and Deliverables 5 Deliverable

5.2.4 Specification for Paper to EDI (P2E). Will reject letter service be in scope of this solicitation, if so please provide volumes and turnaround time requirements

Attachment D, General Yes, CY19 had approximately 821,690 rejected claims turnaround time requirements are in section 5.2.4.5

53 2. Background Table - Transaction types and average volume for worked performed during fiscal year (FY) 2019: 5.3.2.12 Paper to Electronic (P2E) Conversion (See Appendix D)

5.3.2.13 Rejection Claim plus USPS First Class Postage.

Please provide clarification of the stated rejection rate is assumed at 3%.

Attachment D, 3% is Based from current rejection rate.

54 0014-0016. What does the “Implementation category” apply to?

Attachment A, pg 3 No “Implementation Category”? Size of implementation (small, medium, large).

55 0011. Regarding the 275 category in Attachment A, does this apply to delinked docs or only attachments associated with claims?

Attachment A, pg 2-3 Delinked documents w/approved VA Cover Sheet and Claims

56 0012 Paper to Electronic, 0013 Rejection Claim. Volume numbers in these Attachments are not the same. Please advise on accurate volume numbers by transactions.

Attachment A, Attachment D, Attachment A-all plus Attachment D, pg 2

Attachment D is “Weekly”, and Attachment A is “Annual”.

57 0012 Paper to Electronic, 0013 Rejection Claim. Does the Contractor reserve the right to renegotiate if the volume drops?

Attachment A, Pg 3 The ability to renegotiate is covered with in the contract clauses.

58 4. Scope; 5 Mandatory Tasks and Deliverables. Are mailroom operations in scope for the Paper to Electronic Contractor?

Attachment D, General Yes.

59 5 Deliverable 5.2.4 Specification for Paper to EDI (P2E). Will the mail come to PO box directly or from the VA locations or mix and match scenario?

PWS It will be a transition of delivery of paper from VA to Vendor.

60 2. Background Table - Transaction types and average volume for worked performed during fiscal year (FY) 2019: 5.3.2.12 Paper to Electronic (P2E) Conversion (See Appendix D). Will return mail services need to be performed (e.g., loose documents with no associated claim or delinked cover sheet)?

Attachment D Yes.

61 4. Scope; 5 Mandatory Tasks and Deliverables, 5 Deliverable

5.2.4 Specification for Paper to EDI (P2E). Will delinked

document imaging and data extraction be in scope of this solicitation?

Attachment D, General Yes.

62 4. Scope; 5 Mandatory Tasks and Deliverables, 5 Deliverable

5.2.4 Specification for Paper to EDI (P2E). Will documents

that require special handling such as excessive page documents or bulk service/family member medical records be in scope in this solicitation?

Attachment D, General Yes.

63 4. Scope; 5 Mandatory Tasks and Deliverables 5 Deliverable

5.2.4 Specification for Paper to EDI (P2E). Will box storage be in scope of the solicitation?

Attachment D, General Yes, PWS 5.2.4.2

64 4. Scope; 5 Mandatory Tasks and Deliverables 5 Deliverable

5.2.4 Specification for Paper to EDI (P2E). What is the

retention period for physical and digital document storage?

Attachment D, General Physical Six Weeks PWS Section 5.2.4.3; Digital -Section 14.2.4 and 14.2.5.

65 5.2.6 Implementation Development. The contractor shall implement the capability to support Payer EDI transactions.

The Contractor shall provide full and complete implementation within 180 days of award to ensure no disruption of EDI services between VHA OCC and its trading partners. The contractor shall provide connectivity that is at least compliant to the appropriate CAQH Core “Connectivity Rule” as defined at http://www.caqh.org to all EDI capable providers/submitters of transactions used by VHA/OCC Programs. This capability….. Will integration, connectivity, and processing of invoicing from Community Care Network TPAs be in scope for the EDI Contractor?

Attachment D, pg 5-6 No.

66 Is it the intent for these (claim to 837 and medical doc page to 275) to be priced as a single bundle? Industry standard pricing is typically at the page unit of measure for medical documentation and at the claim or claim form unit of measure for the CMS-1500, UB-04 and ADA forms due to the mailroom labor and conversion costs associated with these services.

Attachment A: Schedule, CLIN 0012 – Paper to Electronic conversion transactions

To be determined by Vendor

67 Is it the intent for these to be priced at the same price but separate (charge for the 837 and charge for the 275)?

Industry standard pricing is typically at the page unit of measure for medical documentation and at the claim or claim form unit of measure for the CMS-1500, UB-04 and ADA forms due to the mailroom labor and conversion costs associated with these services.

Attachment A: Schedule, CLIN 0012 – Paper to Electronic conversion transactions

To be determined by Vendor

68 The quantities of medical documents could vary from 1 page to thousands of pages per 275 transaction, how should contractors price the range? Industry standard pricing is typically at the page unit of measure for medical documentation and at the claim or claim form unit of measure for the CMS-1500, UB-04 and ADA forms due to the mailroom labor and conversion costs associated with these services.

Attachment A: Schedule, CLIN 0012 – Paper to Electronic conversion transactions

To be determined by Vendor

69 Does the VA only want the price for the rejection package or rejection package and first class postage? If first class postage needs to be quoted separately, how would you like the contractor to price that?

Attachment A: Schedule, CLIN 0013 – Rejection Claim

To be determined by Vendor

70 Per Attachment C, “The vendor shall notify VA within 24 hours of the discovery or disclosure of successful exploits of the vulnerability which can compromise the security of the Systems (including the confidentiality or integrity of its data and operations, or the availability of the system). Such issues shall be remediated as quickly as is practical, but in no event longer than _____ days.” Please specify number of days.

Attachment C: Contract Clauses, Section 4

INFORMATION SYSTEM

DESIGN AND

DEVELOPMENT (j).

Contract Clause Current Contract references 30 days

71 Please provide more information on the VA’s definition of a hosted transaction. The PWS scope is for eligibility (270/271) claim status (276/277), and authorization transactions (278).

Is it the expectation of the VA that the contractor will have to host information on behalf of the VA and generate these transaction sets with the data?

Attachment D: PWS, Deliverable 5.2.1 (Hosted Transactions)

Yes.

72 For hosted transactions, will the expectation be that the contractor ingest data files from the VA to support each of these transaction sets?

Attachment D: PWS, Deliverable 5.2.1 (Hosted Transactions)

Yes.

73 What high level data elements will be required to “host” authorization (278) transactions?

Attachment D: PWS, Deliverable 5.2.1 (Hosted Transactions)

Standard X12 data elements.

74 What high level data elements will be required to “host” eligibility (270/271) transactions?

Attachment D: PWS, Deliverable 5.2.1 (Hosted Transactions)

Standard X12 data elements.

75 Will the data elements required to host eligibility be restricted to member/eligibility data or will benefit information also be supplied?

Attachment D: PWS, Deliverable 5.2.1 (Hosted Transactions)

Standard X12 data elements.

76 What are the frequency and delivery methods of the data from VA for the contractor to support hosting services?

Attachment D: PWS, Deliverable 5.2.1 (Hosted Transactions)

Nightly.

77 Links to additional PWS / contract requirements are incorrect / broken. Please provide the updated links that are in scope for this PWS.

Attachment D: PWS, 14.1.2 Access to VA Information and VA Information Systems

Link Updated to https://www.va.gov/vhapublications/index.cfm

78 For claims and medical documentation that cannot be converted and a rejection letter needs to be created, what is the expectation of the VA to be able to retain / view these items as there is no requirement in the PWS to provide copies of these letters to the VA?

Attachment D: PWS, Appendix D: P2E Services

No, rejection letters not required to be provided to VA.

79 What will the contractor need to do to support the VA provider support team which will be answering phone calls from providers for rejected / processed paper transactions?

Attachment D: PWS, Appendix D: P2E Services

To be proposed by Vendor.

80 After the six week period of holding the paper documents as part of the P2E services, what is the expectation of the VA to be able to retain / view original electronic copies of the claim images and associated medical documentation as there is no

Attachment D: PWS, Appendix D: P2E Services

Refer to Sections 14.2.4 and 14.2.5 in PWS.

requirement in the PWS to provide electronic access to these documents after this time period?

81 In which volume should contractors include additional forms/documentation (such as responses to 52.209-5, SF 1449, etc.)?

Attachment E: Solicitation Provisions, Addendum to FAR 52.212-1 Instructions to Offerors -- Commercial Items/

SF 1449 has been removed from the solicitation.

82 In Attachment E, there is a statement that the award date will not start until 10/1/2020. Will the VA select and notify the contractor of choice before 10/1?

Volume III: Price (pg 14) Yes.

83 In Attachment E, there is a statement that the award date will not start until 10/1/2020. What are the key VA milestones between July 6th (the RFP submission date) and October 1st (the estimated award date)?

Attachment E: Solicitation Provisions, Volume III: Price (pg 14)

There are no key milestones that affect the offeror's proposal.

84 "This combined synopsis/solicitation incorporates provisions and clauses in effect through Federal Acquisition Circular (FAC) 2020-05 dated February 27, 2010." FAC 2020-05 is dated April 06, 2020.

Please clarify if this is the correct FAC or if it references a different document.

36C10G20Q0003, Pg 2 The Government apologies for the oversight. Federal Acquisition Circular (FAC) 2020-06 published in the Federal Register May 6, 2020 applies to this solicitation. Reference https://www.federalregister.gov/documents/2020/05/06/2020- 07107/federal-acquisition-regulation-federal-acquisition-circular- 2020-06-introduction remove.

85 "Future growth for FSC product lines may include the processing of all medical claims that will not be part of the VA Community Care Network contract." Is some of the claim volume shown in the Schedule for this contract expected to be carved out over time and to be processed by the CCN contractors? if so, when would that occur, and what percentage of the claims listed in Attachment B are expected to be covered by the VA community Care Network Contract?

36C10G20Q0003, Pg 2 The volume shown in the PWS is the volume expected.

86 In order to ensure that all offerors have the same understanding of the level of effort associated with each size implementation associated with CLINs 0014, 0015, and 0016, please provide a definition of "Small", "Medium", and "Large" implementations.

Att. A-Schedule Refer to PWS Section 5.5.

87 Are any of the estimated quantities of CLINs among those claims that could be processed by VA CCN contractors at some point over the life of this contract (e.g., over the next four years)?

Att. A-Schedule The volume shown in the PWS is the volume expected.

88 The CLINS 0012 and 0013 do not match the numbers indicated in Attachment H-QASP. Can you please clarify?

Att. A-Schedule The QASP is incorrect. P2E conversion is approximately 27.7M and P2E Rejections are approximately 927K.

89 Re: Order Limitations- What do these dollar amounts meant in terms of the number of claims? Please define minimum and maximum orders in terms of the number of claims for each CLIN.

Att. C-Contract Clauses, pg 28, C.7

Order limitations per FAR 52.216-19 are set per the task order amount.

90 While all links to the VAAR clauses are active, none of them are actually checked in the solicitation. Are any of these VAAR clauses applicable to this solicitation?

Att. C-Contract Clauses, pg 45, C.27

Please refer back to Attachment C – Contract Clauses.

91 What is the difference from an evaluation standpoint between "credit" and "consideration"?

Att. C-Contract Clauses, pg 48, C.29

Please refer to Attachment E - Solicitation Provisions, iii. Factor 3 - Socio-economic Status, a), b), 1., and 2.

92 What is the relationship, if any, between this solicitation and Sources Sought 36U10120Q0055? Please describe how the Sources Sought notice could affect this solicitation, and if, so, how, and when.

Att. D-Perf. Work Statement (PWS), pg 1, para 2

The known Sources Sought (SSN)/ Request for Information (RFI) that pertains to this solicitation is #36C10G19Q0128.

93 Re: "*Under development – will be implemented during this contract period of performance." Please specify when each of the services specified will be implemented by option period.

Att. D-Perf. Work Statement (PWS), pg 2, para 2

The implementation needs to be completed in the first 180 days.

94 "The initial implementation should limit the need for programmatic changes on VHA OCC Information Technology (IT) systems and shall not be priced separately. " If the "initiation implementation" is not to be separately priced, please differentiate this from CLINs 0014, 0015, and 0016 in the base year and all option periods. Please clarify.

Att. D-Perf. Work Statement (PWS), pg 2, para 4

“not be priced separately” has been updated in the PWS.

95 The Contractor shall provide all services related to receiving paper claims and/or paper medical documentation from community health care providers and Veteran Family Member Program (VFMP) providers" Is the contractor also responsible for claims from any or all of these programs: 1) CHAMPVA? 2) SB? and 3) CWVV?

Att. D-Perf. Work Statement (PWS), pg 2, para 4

Yes.

96 HCFA1500 - What is the past fiscal year percentage HCFA of total claims?

Att. D-Perf. Work Statement , (PWS), pg 2

CY19 HCFAs were ~80% of Total Claims; Approximately 56% of Claims are Black and White.

97 UB04 - What is the past fiscal year percentage UB04 of total claims?

Att. D-Perf. Work Statement (PWS), pg 2

CY19 UBs were ~20% of Total Claims 56% of Claims are Black and White;

98 ADA - What is past fiscal year percentage ADA of total claims?

Att. D-Perf. Work Statement (PWS), pg 2

Approximately ~2% or less.

99 Claim Attachments – What percent of claims have attachments? What is average pages per attachment?

Att. D-Perf. Work Statement (PWS), pg 2

Currently the majority of attachments are coming in through P2E Approximately 40% of HCFA’s have attachments, approximately 49% of UB’s have attachments and Approximately 1% of Dental Claims have attachments for P2E claims Average # of pages for

HCFA attachments 9, Average # of pages for UB attachments 29, Average # of pages for Dental attachments 1. For P2E.

100 Is "Exception (non-claim related) mail" that needs to be returned to provider also a part of the Rejection volume? If so, what percent of Rejects are Exceptions?

Att. D-Perf. Work Statement (PWS), pg5, para D.5.2.4.8

Estimated less than 1%.

101 "The contractor shall provide one single location for all OCC claims and one single location for all Family Member Program (FMP) claims." Can the P2E for both OCC and FMP claims be the same location? Please provide an approximate number and distribution of P2E claims by: 1) OCC; and by 2)

FMP.

Att. D-Perf. Work Statement (PWS), pg2

Same Physical Location but, Separate PO Box’s.

102 Is offshore data perfection permitted under this contract if no identifiable PHI/PII is visible to the operator and all data remains onshore?

Att. D-Perf. Work Statement (PWS)

Reference above.

103 Is the NACI background check/clearance required for all contractors’ employees that have access (physical or electronic) to VA PHI?

Att. D-Perf. Work Statement (PWS)

Security – however because they handle PHI they are a covered entity and meet HIPAA Regulations. Reference Section 14.1.2 in

PWS.

104 Will enrollment functions be required to be performed by Contractor on behalf of Providers for commercial payers?

Att. D-Perf. Work Statement (PWS)

The enrollment functions required are to enroll providers who need to be reimbursed by VA.

105 Please identify connectivity input source to contractor for EDI claims: VA Medical Center or CPAC?

Att. D-Perf. Work Statement (PWS)

Claims come in from the Provider’s System to Clearinghouse.

106 Payer mix for payers listed in transactions in Attachment + D, are transaction volumes just for the VA umbrella health plans or do they include the OHI’s also?

Att. D-Perf. Work Statement (PWS)

VA Only.

107 Please provide the Numerical breakdown on claim types (red/black/single/multi) of paper claims.

Att. D-Perf. Work Statement (PWS)

56% of claims are Black and White.

108 Will any paper attachments or other non-claim paper forms (e.g. paper EOB’s) need to be converted to electronic? If so, please provide samples of any paper forms to be converted?

Att. D-Perf. Work Statement (PWS)

Only documents required to process healthcare claims.

109 How long is each assessment period? Att. H-QASP The assessment period is based on the stated Period of Performance on the awarded contract and subsequent Task Orders.

110 Were monthly assessments performed on either or both of the current contracts being folded into the new one?

Att. H-QASP As stated in the QASP.