Attachment D Question and Answers.xlsx
XLSX spreadsheet 26 KB Posted
- Solicitation number
- 36C10G23R0004
About this file
This solicitation seeks proposals for Electronic Data Interchange and Paper to Electronic transaction services. The Department of Veterans Affairs requires a Health Care Clearinghouse contractor to provide connectivity with community providers to support payments for care provided to Veterans and Veteran Families. Services include incoming and outgoing batch and real-time EDI transactions using HIPAA ASC X12N 5010 standards as well as Paper to Electronic conversion. The solicitation is unrestricted with a deadline for questions on January 25th, 2023 and proposals due on February 17th, 2023. The associated NAICS code is 518210 with a size standard of $40M.
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Other files
| File | Type | Posted |
|---|---|---|
| UPDATED Solicitation 36C10G23R0004 Amendment 0002.pdf | ||
| 36C10G23R0004 0002_2.docx | DOCX document | |
| Amendment 0001 Solicitation 36C10G23R0004 VA HCCH EDIP2E Services .pdf | ||
| Amendment 0001 UPDATED Attachment B Pricing.xlsx | XLSX spreadsheet | |
| 36C10G23R0001 0001 Combined Synopsis Amendment 0001.pdf | ||
| Attachment E Quality Assurance Surveillance Plan.pdf | ||
| Amendment 0001 Updated Attachment A Performance Work Statement EDIP2E.pdf | ||
| 36C10G23R0004 0001_1.docx | DOCX document | |
| Solicitation 36C10G23R0004 VA HCCH EDIP2E Services.pdf | ||
| Attachment A Performance Work Statement EDIP2E .pdf | ||
| Attachment B Pricing.xlsx | XLSX spreadsheet | |
| Attachment C Past Performance Questionnaire.docx | DOCX document | |
| Attachment D Questions.xlsx | XLSX spreadsheet | |
| 36C10G23R0004_1.docx | DOCX document |
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Sheet 1
| Page # | RFP Section Reference | Question | Answer |
| 2 | 2 | Can VA differentiate volume for FY2021 and FY2022 for P2E in terms of how many HCFA, UB, and Dental claims were received, specifically CMS-1500, CMS-1450 and ADA Dental Form? | FY21 FY22 |
HCFA Total Claim Volume: 1,508,165 2,461,805 UB Total Claim Volume 336,294 664,747 Dental Total Claim Volume 83,973 208,186
2 2 What is Receipt and Upload volumes refer to and why did this volume increase exponentially? What does that entail? Receipt and Upload volumes refers to claim and/or Medical documentation received by KTR that once scanned in cannot be converted to a an 835 or 275 but, the KTR has already scanned.
Receipt and Upload entails all types of claims and medical documentation.
| 2 | 2 | What is the difference between 278 Veteran and VFMP? Do both go to the same endpoint? Where is that endpoint? | Veteran and VFMP are two different programs within VA. The 278 will go to the same end point within VA. |
| 2 | 2 | Does VA have a hosted environment for contractor to send 270/271 and 276/277? | No, the requirement is for the Contractor to setup the hosted environment. |
| 2 | 2 | Can contractor pass the cost of mailing P2E rejections to VA? | See CLIN X014 |
| 5 | 5.2.4 | Is contractor expected to have a mailroom to receive paper claims and convert them to EDI or will VA receive the paper claims and convert them to a TIFF file and then send the contractor a TIFF file for conversion into EDI? | Yes, the contractor expected to have a mailroom to receive paper claims and convert them to EDI |
| 4&5 | 5.2.3 | What types of payer specific edits is the contractor required to apply to the following transactions: 270/271, 278, 837, 837COB? | Payer specific edits related to HIPAA compliance. |
| 2 | 2 | What is the projected volume for the 278 transaction as it pertains to x216, x215 and x217? | TBD at this time as to the split between x216, x215, and x217. |
| 2 | 2 | Will contractor be responsible for moving 270/271 (VFMP), 276/277 and 278 (VFMP) from hosted to direct? What does that mean and entail? Is VA looking for contractor to have it's own hosted envinronment on behalf of VA or will these transactions go directly to the VA and Payer community? | Yes, contractor be responsible for moving 270/271 (VFMP), 276/277 and 278 (VFMP) from hosted to direct. |
What does that mean and entail? This is part of the Technical Proposal.
Yes, VA looking for contractor to have it's own hosted envinronment on behalf of VA.
| 3 | 4 | Can VA provide a list of all providers and Trading Partners which would connect to the contractor? | No, the providers and trading partners change over time and connecting to them is the responsibility of the contractor. | |
| 3 | 4 | Can VA provide a list of Payers that contractor would have to send EDI transactions to? | VA is the Payer. | |
| 5 | 5.2.4.7 | Will the originator of the claims attachments include a control number on both attachment and claim so that contractor can validate it? | Yes | |
| 2 | 2 | what percentage of Paper to Electronic represents paper claims attachments (or additional information) if any? | 92% | |
| 7 | 5.2.6 | Is VA looking for contractor to connect with CMS HETS for eligibility and through a MAC for coordination of benefits? If yes, which MAC will the contractor connect with? | No, VA is not looking for a contractor to connect with CMS HETS for eligibility and through a MAC for coordination of benefits | |
| 9 | 5.3.2.15 | Can VA provide more detail around this requirement? | Receipt and Upload volumes refers to claim and/or Medical documentation received by KTR that once scanned in cannot be converted to a an 835 or 275 but, the KTR has already scanned. | |
| 10 | 5.3.3 NOTE | Are pharmacy transactions (NCPDP) part of the requirements? How should they be priced out and what is the volume? | No, NCPDP transactions are not part of this requirement. PWS Section 5.3.3 NOTE has been updated. | |
| 73 | Submission Requirements, Volume II Technical | Is the VA looking for a response to all the sub-sections under section 5, or only specific sections? | Yes, in order to be determined responsive all requirements of the solicitation shall be met. | |
| 74 | Submission Requirements, Volume III Past Performance | How many contracts needs to be included in the past performance. On page 74, it states 3 contracts are required, but on the table in page 71, it says that the page limit is "3 pages max each for a total of 15 pages" which leads us to believe 5 contracts are needed for past performance | ||
| The table on page 71 has been updated to reflect a total of 9 pages. | ||||
| 74 | Submission Requirements, Volume III Past Performance | Is a narrative required for each past performance contract? If so, what data elements should be included in the narrative? | Yes, per the solicitation provide a summary of each PPQ submitted. | |
| 2 | Volumes | Can you provide the volume breakdown for FY2021 and FY2022 for Paper to Electronic as to what percentage of HCFA and UB claims were red? | VA does not have this information. | |
| 2 | Volumes | Does the VA want a letter and a copy of the claim sent to the Provider when a claim is rejected? | Yes, VA needs access to the claim and rejection letters. PWS Section 5.2.4.5 has been updated. | |
| 5 | 5.2.4.2 | What is the average time it takes to receive written approval to shred stored claims after a shred approval is requested? | 10 Business days. | |
| 5 | 5.2.4.8 | What item number would we use on the pricing spreadsheet to price illegible and inappropriate paper that is to be returned to sender? | CLIN X014 covers illegible and inappropriate paper that is to be returned to sender? | |
| 6 | 5.2.4.16 | What is average number of pages per claim, including attachments for all P2E claims? | The average number of pages per claim including attachments is 31 pages | |
| 1 | Attachment B - Pricing | For the Paper to EDI services the PWS outlines the need to process (1) Paper Claims and (2) Medical documentation. However, the pricing spreadsheet has only one CLIN for these two different services. Will the VA be providing an updated pricing sheet for each of these different services? Can respondents’ price these differently if not? | CLIN X013 has been updated to reflect per page. | |
| 6 | Attachment D - PWS | Is the “Receipt and upload to Database” CLIN related to section 5.2.4.16 in the PWS? | Yes | |
| 5 | 5.2.4 | Is there a process to verify that the claims are valid including unique claims (non duplicated), validity or is it part of the requirements for Contractor to provide these services? | This is a requirement for the contractor. | |
| 5.2.4.2 | 1) This requirement appears to be a manual approval basis. What happens if the COR fails to authorize, is there an automated process? | No, Contractor is required to receive approval IAW the PWS. | ||
| 5.2.4.3 | 1) Who defines the transaction start and end? Meaning if the transaction contains sub-transactions | |||
| 2) Is there a transaction verification process to avoid double billing, duplicated transactions, re-order transactions information? | 1. Transaction start is defined by X12. |
2. This is not a requirement of this PWS.
| 18 | 6.1 | Is this Govt provided location, or contractor's operation approved site? | Contractor's operation approved site |
| 19 | 9 | What is the budget for the base period? | VA does not provide the budget to contractors. Contractors provide a price proposal IAW the solicitation. |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | The PWS states "5.2.4.4 The contractor shall convert ninety-eight percent (98%) of all clean paper-based claims and supporting documentation to HIPAA compliant EDI transactions within two (2) business day of receipt and one hundred percent (100%) of all paper-based forms within five (5) business days." What is the reason for delay for the 2% of the work that doesn't uploaded within two (2) business days? | This is a minimum quality requirement that shall be met by the Contractor as part of this contract. |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | What does the support material look like? | Any documentation that supports claims. |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | How much of the data seen is handwritten? | VA does not have this information. |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | Can the Shred process be performed by third party vendor? If so, which approved list of vendors can be used? | The contractor may propose any solution that meets the requirements of the solicitation package. |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | What are the image quality standards to be utilized (ie. 300 DPI – Fadgi equivalent, etc.) ? | IAW PWS Section 5.2.4.12 |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | How many mailings equates to 2.1M claim pages per month? Is there an understanding of the type of mail coming in (sizes, shapes, etc.)? | VA does not impose requirements on providers on how claims are mailed. |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | Is a PO Box necessary? | This is for the Offeror to propose. VA does not have a requirement for a P.O. Box. VA requires a single mailing address for receiving claims and medical documentation. |
| 5 | 5.2.4 Specifications for Paper to EDI (P2E) | Are these mailing coming direct from Veterans, or from ROs, VSOs – what other types of offices do they come from? | All claims and mailings are received from Providers. |
| Solicitation 36C10G23R0004 | Price/Cost Schedule | Throughout the schedule the 277RFAI transaction is repeatedlly referred to as "Health Care Claim Status Request and Response", however its correct title is "Health Care Claim Request for Additional Information". We suggest making the title changes where appropriate to be consistent. | CLIN X009 has been updated on the Price Schedule to "Health Care Claim Status Request for Additional Information 277RFAI" |
| Solicitation 36C10G23R0004 | Price/Cost Schedule | Throughout the schedule the 277CA is listed as a real-time transaction alongside the 276/277 real-time transcations. The 277CA is a batch transaction the VA will return in response to receipt of an 837 batch claim transaction, and as such offerors will typically price it differently from the real-time 276/277 request/response transactions; please separate the 277CA from the 276/277 for appropriate pricing. | CLIN X002 has been updated on the Price Schedule to "Health Care Claim (includes Institutional, Professional, and Dental) 837 batches transactions (includes acknowledgements, 999/277CA)" |
CLIN X003 has been updated on the Price Schedule to "Health Care Claim (includes Institutional and Professional) 837 Medicare Crossover batch transactions (includes acknowledgements, 999/277CA)"
CLIN X007 has been updated on the Price Schedule to "Health Care Claim Status Request and Response 276/277 (includes acknowledgements) Hosted Transactions"
CLIN X008 has been updated on the Price Schedule to "Health Care Claim Status Request and Response 276/277 (includes acknowledgements) Direct Real-Time transactions"
| Attachment A, Page 2 | You mention the 277CA , 277RFAI, and 276/277 does the VA intend to use the 277 X228 Pend transaction as well? | Yes | |
| Attachment A, Page 2 | The VA mentions utilizing all of the 278 transaction types in a direct connect, is it also the VA's intent to use the associatedattachment transaction. 275 Additional Information to Support Health Care Services Review? | Yes | |
| Attachment A, Page 5 | 5.2.4.1 | Does the implementation timeline include migration of existing PO Boxes / physical mailing addresses? | There is no migration of current mailing addresses. Contractor shall provide the single mailing address during implementation. |
| Attachment A, Page 5 | 5.2.4.1 | Will return mail services need to be performed (e.g., loose documents with no associated claim or cover sheet)? | Yes, IAW PWS Section 5.2.4.8. |
| Attachment A, Page 5 | 5.2.4.1 | Will contractor receive physical documents via PO BOX or direct mail or both? | VA requires a single mailing address for receiving claims and medical documentation. |
| Attachment A, Page 5 | 5.2.4.2 | Will Implementaiton include migration any records or images from legacy VA or contractor system(s) / Application(s)? If so, what is the allotted migration timeline? | No |
| Attachment A, Page 5 | 5.2.4.2 | Will box storage be in scope of the solicitation? If so, how much physical sqaure footage will be required? | IAW PWS Section 5.2.4.2, Contractor shall keep documents for 6 weeks. Estimated quantites have been provided refer to Attachment B Pricing. |
| Attachment A, Page 5 | 5.2.4.3 | Will Technical Paper to EDI specifications be provided? Will the VA make the specifications available to all bidders? | The technical paper to EDI specifications fall under HIPAA X12 and are available for commercial purchase. VA cannot provide the specifications. |
| Attachment A, Page 5 | 5.2.4.4 | Will expedited processing be required for any document types? If so, what are the turn around time requirements? Will volume information able to be provided to bidders by document type? | No |
| Attachment A, Page 5 | 5.2.4.5 | Will contractor be required to store images of deficienct claim notifications? | Yes, PWS Section 5.2.4.5 has been updated. |
| Attachment A, Page 5 | 5.2.4.8 | For claims with deficiencies deemed errant by the VA post paper to EDI conversion; will contractor be required to integrate images / records of deficient claims notifications into a central repository? | No, contractor is not required to integrate images / records of deficient claims notifications into a central repository for claims with deficiencies deemed errant by the VA post paper to EDI conversion. |
| Attachment A, Page 5 | 5.2.4.8 | Will contractor be required to notifiy providers in forms other than writing of deficienct claims (eg phone calls; electronic notifications)? | No, Notifications shall be provided IAW PWS Section 5.2.4.5 |
| Attachment A, Page 5 | 5.2.4.8 | Will VA providers require access to contractor's Paper to EDI System(s); Application(s); portal(s)? | Yes, IAW PWS Section 5.2.4.15 |
| Attachment A, Page 5 | 5.2.4.8 | Will the contractors be required to furnish online claims resubmission system(s); Application(s); Portal(s) for errant or deficient paper claims? | No |
| Attachment A, Page 6 | 5.2.4.11 | Will 999 reconcilation / reporting be required? | No |
| Attachment A, Page 6 | 5.2.4.15 | Will VA system access be provided to contractor(s) to view status of the claim(s) to support customer inquiries ? | No, customer support is not required for P2E; customer support is only required for EDI. |
| Attachment A, Page 6 | 5.2.4.15 | What is the extent of VA provider customer support to be managed by contractor? Will ticketing systems or portal be required to support VA customer support channels? | No, customer support is not required for P2E; customer support is only required for EDI. |
| Attachment A, Page 6 | 5.2.4.16 | 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? | Offerors shall propose IAW with the solicitation. |
| Attachment A, Page 6 | 5.2.5 | Will a sample of the required implementation status reports be provided? | No, offerors shall propose IAW with the solicitation. |
| Attachment A, Page 7 | Deliverable 5.2.10 | Payer ID 12117 is listed under "VAFEE - Hosted and direct transactions", however this section seems to be more about programs not transaction types - shouldn't 12117 be listed under Non-VA Medical Care Program as a third payer ID rather than as a transaction type ("hosted and direct")? Did you mean not to add VAFEE as the real-time hosted and direct payer ID for VA FEE Basis Progams as a currently used payer ID? | PWS Section 5.2.10 is correct as written. |
| Attachment A, Page 8 | 5.2.11.2 Provider Communication System | What are the requirements/specifications for this system? | PWS Section 5.2.11.2 is correct as written. |
| Attachment A, Page 8 | What aspects of FISMA II apply to a ticket/reporting system? | All FISMA II aspects that apply to EDI P2E apply to this requirement. | |
| Attachment A, Page 9 | For 278, VA does x215 and x217 today. What is timeline for implementing x216? | TBD at this time. | |
| Attachment A, Page 9 | For 277 RFAI, what are requirements and workflow? | The requirements are as stated and the workflow shall be proposed by the Offeror. | |
| Attachment A, Page 9 | For 278 x216, what are requirements and workflow? | The requirements are as stated and the workflow shall be proposed by the Offeror. | |
| Attachment A, Page 9 | 5.3.2.13 | Requirement 5.3.2.13 Refers to Appendix D, however there is no Appendix D. It appears this is a reference to an Appendix D that existed in a prior solicitation for this business which has now been relocated to Deliverable 5.2.4. Is this correct or should a Section D be present with additional information? | PWS Section 5.3.2.13 has been updated to remove "(Reference Appendix D)" All P2E requirements are included in PWS Section 5.2.4. |
| Attachment A, Page 9 | 5.3.2.12 | 5.3.2.12 reference to the Healthcare Claim Attachment 275 says "(includes acknowledgements)”. At this time 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? | No, only the 999. |
| Attachment A, Pages 11, 12, 16 | Deliverables 5.4.5, 5.4.6 | Reporting of the 277CA and 277RFAI transactions is included along with reporting of real-time 270/271 and 276/277 "request/response" transactions. However page 2 lists the 277CA and 277RFAI as batch transactions consistent with their industry standard usage, and neither of them is used as a response to a request from a provider. It would be our recomendation to remove references to the 277CA and 277RFAI from all sections related to real-time transactions. | CLIN X002 has been updated on the Price Schedule to "Health Care Claim (includes Institutional, Professional, and Dental) 837 batches transactions (includes acknowledgements, 999/277CA)" |
CLIN X003 has been updated on the Price Schedule to "Health Care Claim (includes Institutional and Professional) 837 Medicare Crossover batch transactions (includes acknowledgements, 999/277CA)"
CLIN X007 has been updated on the Price Schedule to "Health Care Claim Status Request and Response 276/277 (includes acknowledgements) Hosted Transactions"
CLIN X008 has been updated on the Price Schedule to "Health Care Claim Status Request and Response 276/277 (includes acknowledgements) Direct Real-Time transactions"
| Attachment A, Page 13 | 5.4.11 Ad Hoc Reports | We are reading this as transactions is actually meant to be specifically for claims or is it the VA's intent to have these adhoc reports for other transaction types and if so which ones. Some of the status examples provided are not normally shared with the clearinghouse such as closing of adjusted attachments. Is it the intent of the VA to start sharing this data with the clearinghouse? | No, ad hoc reports are related to claims and medical documentation only. |
| Attachment A, Page 12/13 | 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? | PWS Sections 5.4.7 and 5.4.8 are correct as written. | |
| Attachment A, Section 13 | Section 13 | The paragraph begins "As stated in the Quality Assurance Plan (QASP)...", but no QASP has been provided. Wil the QASP be included in the solicitation materials or after award? | QASP has been included as Attachment E of this solicitation. |
| 6 | Performance Work Statement (PWS) - 5.2.4.9 | ANSI 275 Transaction would be created only when an attachment is submitted along with the Claim. Scenarios where only attachments are received without Claims, Can we give the output as image (Tiff/pdf) and meta data as XML (Properitory - Mutually agreed) | Contractor shall comply with X12 275 transaction standards. |
| 1 | PWS 1. | Does the VA already have the Clearinghouse connection, meaning would bidder send EDI to Clearinghouse or to VHA IVC for submission to Clearinghouse? | The requirement is for the offeror to proved a healthcare clearinghouse. |
| 5 | PWS 5.2.2.4 | 2% of work will take more than 2 days to upload, why? What are the reasons for delay? | This is a minimum quality requirement that shall be met by the Contractor as part of this contract. |
| 6 | PWS 5.2.4.12 | How much of the data seen is handwritten? | VA does not have this information. |
| Can Shred process be performed by third party vendor? If so, which approved list of vendors can be used? | The contractor may propose any solution that meets the requirements of the solicitation package. | ||
| Hopefully there is no need to log into ICN system, but that we can connect to ICN with uploaded DOR data? | ICN is a Contractor generated number. | ||
| What are the image quality standards to be utilized (ie. 300 DPI – Fadgi equivalent, etc.) ? | IAW PWS Section 5.2.4.12 | ||
| How many mailings equates to 2.1M claim pages per month? Is there an understanding of the type of mail coming in (sizes, shapes, etc.)? | VA does not impose requirements on providers on how claims are mailed. | ||
| Is a PO Box necessary? | This is for the Offeror to propose. VA does not have a requirement for a P.O. Box. VA requires a single mailing address for receiving claims and medical documentation. | ||
| Are these mailing coming direct from Veterans, or from ROs, VSOs – what other types of offices do they come from? | All claims and mailings are received from Providers. | ||
| What does the support material look like? | Any documentation that supports claims. | ||
| Is the government looking for the vendor to provide services such as: |
Claims denial management?
Providing reimbursement back to the payer for inappropriate paid claims?
Collections process?
Will The gov’t allow alternate solution for services? No, VA is only soliciting the requirements of the PWS.
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