36C77625Q0264 0001 (1).docx

Consolidated Patient Account Center (CPAC) Third Party Billing

GENERAL INFORMATION

SET-ASIDE

Program Contracting Activity Central

6100 Oak Tree Blvd, Suite 490 Independence OH 44131

POINT OF CONTACT*

CONTRACT SPECIALIST

Heather Allen AND heather.allen3@va.gov Alan Willingham Alan.Willingham@va.gov

PLACE OF PERFORMANCE

ADDRESS

POSTAL CODE

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

Sources Sought Notice Sources Sought Notice

DESCRIPTION

Sources Sought Notice

Department of Veterans Affairs Program Contracting Activity Central

SOURCES SOUGHT 36C77625Q0264

Thursday, August 14, 2025 **IMPORTANT: Please read this notice in full BEFORE responding! **

THIS IS A SOURCES SOUGHT (SS) FOR MARKET RESEARCH PURPOSES ONLY.

This Request for Information (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.

The Department of Veteran’s Affairs (VA) - Consolidated Patient Account Center (CPAC) has a requirement to purchase all labor and equipment required for generation of VA and Non-VA outpatient claims to third party healthcare insurance carriers for CPAC sites nationwide with an authorized vendor.

The VA is conducting market research and is seeking written responses with information to assist with identifying potential sources that are interested in, and capable of, providing the services described. Please review the information contained herein and identify whether your company has the capability and interest to provide the services as described in the Performance Work Statement (PWS) (below). Please see section titled “SUBMITTAL OF RFI RESPONSE” below for what information to include in your company’s response.

GOVERNMENT QUESTIONS

The VA is requesting vendors answer the following questions in response to this notice.

1. Company Overview:

0. Provide a brief history of your company, including year of establishment and ownership structure.

0. Describe your primary business focus and areas of specialization.

1. Industry Experience:

1. How many years has your company been providing medical billing services?

1. Manager

1. Does your company have on staff a Manager with comprehensive knowledge of the principles, practices, laws, rules, and regulations related to billing for healthcare services and the submission of healthcare claims. Provides management oversight, guidance, corrective measures, and direction for monitoring activities designed to ensure the integrity and accuracy of healthcare claims. If no, briefly describe how your company would fill this role.

1. Supervisor

2. Does your company have on staff a Supervisor who is responsible for the timely and accurate preparation and submission of claims for healthcare services, equipment, and/or medication. The Supervisor makes assignments based on the complexity of healthcare services, procedures, equipment, etc., provided, establishing deadlines and quality requirements. Comprehensive knowledge of framework of regulatory material regarding healthcare billing such as Medicare, TRICARE, and CHAMPVA guidelines, Sharing Agreements, Worker’s Compensation, appropriate Public Laws, HIPPA rules and regulations. Knowledge of coding of diseases and procedures using ICD-10, CPT, and HCPCS coding systems. If no, briefly describe how your company would fill this role.

1. Provide and briefly describe the full scope of medical billing services your company provides. including but not limited to inpatient, outpatient, dental, Durable Medical Equipment.

1. Briefly describe the process your company uses for handling denied claims and billing disputes.

1. Does your company have the capability of processing an average of 250,000-300,000 VA claim and 200,000 – 300,000 non-VA claim encounters per month? If no, how long (days/weeks/months) would it take for your company scale up to this capacity?

1. Briefly describe how your company ensures adequate staffing numbers are maintained to meet the demands of your clients?

1. Briefly describe your company’s scalability to meet fluctuations in medical billing workload.

1. Could you please clarify how your company is compensated for the billing services it provides? Additionally, could you explain the standard methodologies used in the industry for such compensation?

1. Compliance and Security:

2. Do you have protocols in place to maintain Health Insurance Portability and Accountability Act (HIPAA) compliance as well as Personally Identifiable Information (PII) and Protected Health Information (PHI) protocol?

1. Key Performance Indicators (KPIs):

3. What KPIs does your company track to measure the performance and success of its billing services?

3. How does your company report these KPIs to your clients?

1. Staffing and Training:

4. How often do you provide training updates to your staff on new regulations and practices?

1. Claims Processing:

5. On average how quickly are claims processed? (Number of Days)

1. Innovation and Improvements:

6. How does your company stay updated with the latest trends and innovations in medical billing?

SET-ASIDE

Complete responses to this notice will assist the VA in determining any potential set-aside for the requirement. Not providing all information requested in response to this notice may result in the VA being unable to determine a vendor potentially capable of satisfying the requirement and, subsequently, if the “rule of two” criteria is not met, a specific set-aside category may not be decided by the Contracting Officer.

SUBMITTAL OF RFI RESPONSE – Responses Due Date If your company is interested and capable of meeting this requirement, please provide a complete response no later than Monday September 1, 2025, at 11 am Eastern. Responses must be sent to BOTH heather.allen3@va.gov AND alan.willingham@va.gov. A complete response satisfies the information requested below.

The Government requests potential vendors to provide the following information with their response:

· Company information

· Name

· Address

· Point of Contact

· UEID/DUNS

· Identify which of the following NAICS codes your company uses when providing Third Party Billing Services:

· What is your company's primary NAICS code of operation?

· Does your company currently have an active GSA FSS contract for Third-Party Provider (TPP) Claims Billing Services? If so, what is the contract number(s)?

· Is your company currently providing Third-Party Provider (TPP) Claims Billing Services support to (Federal or State) government agencies? If so, to whom?

· Please indicate the industry areas for which your company has performed Third-Party Provider (TPP) Claims Billing Services and the type of customer(s):

· Answers to all government questions (see above)

NOTE:

This notice is being posted solely for information and planning purposes and does not constitute a solicitation or obligation on the part of the Government. Per FAR 15.201(e), responses to this notice are not considered offers, shall not be used as a proposal, and cannot be accepted by the Government to form a binding contract. Neither unsolicited proposals nor any other kinds of offers will be considered in response to this notice. No evaluation letters and/or results will be issued to the respondents; however, the Government does reserve the right to contact any respondent and/or respondent reference to obtain additional information. Interested parties shall have a current Systems for Award Management (SAM) (www.sam.gov) active registration. The registration shall be kept active throughout the contract's life if issued.

At this time, no solicitation exists; therefore, please do not request a copy of the solicitation. Any resulting procurement action will be the subject of a separate, future announcement. The information is provided for discussion purposes and any potential strategy for this acquisition may change prior to any solicitation release. The acquisition strategy, evaluation methodology, contract type, and any other acquisition decisions are to be determined.

VA’s Veterans First Contracting Program: The Veterans First Contracting Program applies to VA contracts only. VA has a preference to award contracts to verified Service Disabled Veteran-Owned Small Businesses (SDVOSBs) first then to verified Veteran-Owned Small Businesses (VOSBs) when market research indicates provides a reasonable expectation that the VA will receive two or more offers from eligible SDVOSB/VOSB firms at a fair and reasonable price. To be eligible for a VA SDVOSB or VOSB set-aside, the firm must be verified in the VA’s Office of Small Business Utilization’s (OSDBU) Veteran Information Pages (VIP) database as an SDVOSB or VOSB at the time the firm submits its offer to the VA. Additional information on VA’s Veterans First Contracting Program can be found on OSDBU’s website at https://www.va.gov/osdbu/verification/. In addition, the SDVOSB/VOSB must qualify as a small business under SBA’s regulations.

/END OF NOTICE/

Performance Work Statement (PWS) Consolidated Patient Account Center (CPAC) Revenue Operations (RO)

1. SCOPE

The Contractor shall provide all labor and equipment required for generation of Veteran Affairs (VA) and Non-VA outpatient claims to third party healthcare insurance carriers for CPAC sites nationwide.

2. BACKGROUND

The Department of Veterans Affairs (VA) has historically relied on contract services to improve collections through timely and accurate billing of third-party claims. VA’s CPACs are responsible for billing and collecting from insurance companie’s for medical treatment provided to veterans for NSC conditions.

a. There are 7 regional CPACs located as follows:

Station 730, Asheville, NC- Mid-Atlantic CPAC (MACPAC) Station 731, Smyrna, TN- Mid-South CPAC (MSCPAC) Station 732, Middleton, WI- North Central CPAC (NCCPAC) Station 733, Orlando, FL- Florida Caribbean CPAC (FCCPAC) Station 734, Lebanon, PA- Northeast CPAC (NECPAC) Station 735, Leavenworth, KS- Central Plains CPAC (CPCPAC) Station 736, Las Vegas, NV- West CPAC (WCPAC)

b. Public Law 99-272 gave VA authority to seek reimbursement from third party health insurers for the cost of medical care furnished to an insured non-service connected (NSC) veteran. Public Law 101-508 expanded VA's recovery program by providing authorities to seek reimbursement from third party payers for the cost of medical care provided to insured service-connected veterans treated for their NSC conditions.

3. OBJECTIVES

The primary objective of this Performance Work Statement (PWS) is to outline the need for vendor services to generate accurate and timely third-party claims for CPAC sites nationwide.

The primary objective is for a third-party contractor to provide medical billing services for VA Care and VA Community Care

4. TASKS and DELIVERABLES- Medical Billing Services-VA Care Contractors shall provide services to establish and authorize outpatient medical claims to third party insurance carriers in the VA Veterans Health Information Systems and Technology Architecture (VistA) information system or the most current system in accordance with VA established guidelines. Medical billing is to be performed within industry standards and in accordance with VA Guidebooks and policies, which will be provided following award. The estimated timeframe to complete one authorization is approximately 3 minutes. Timely completion: Medical claims are generated within 2 business days of receipt of information from CPAC

a. Billing Accuracy: Medical claims are authorized and released in accordance with CPAC guidebooks and VA policy and directives

b. Resolving claim rejections: Rejected claims will be resolved within 5 business days

c. Accurate canceling claims and assigning correct RNBs: Claims are appropriately canceled in VistA or most current system and correct RNB is assigned in Claims Tracking

d. Resolving billing related questions and concerns: Open lines of communication are always maintained between Contractor and CPAC

e. Conference call participation: Contractor participates in conference calls, as needed, to improve billing performance

f. Maintain VistA access – or current system: Contractor shall log onto the VistA system for each CPAC Medical Center at least once every 30 days to maintain this access

g. Confidentiality: Contractor shall ensure all claims are released in compliance with VA specific requirements

h. Monthly Itemized Statement

4.8.1 The Contractor shall provide an itemized statement monthly outlining the expenditures, billings, and any access problems/issues encountered in the performance of this task.

Monthly reports (by the fifth day of each month) on the billing activity shall include, but are not limited to:

4.8.1.1 Summary of quantity of claims processed per facility per reporting period, and cumulative for entire contract to date.

4.8.1.2 Number of claims authorized and released

4.8.1.3 Total dollar value of claims authorized and released

4.8.1.4 Number of claims canceled

4.8.1.5 Total dollar value of claims canceled

4.8.1.6 Number of claims per CPAC station

5. TASKS and DELIVERABLES- Monthly Staffing Report

a. The Contractor shall develop and submit a Monthly Staffing Report (due by the fifth day of each month). The report should include the name of staff hired for performance under this contract. The report should also include staff no longer working under this contract. The report shall include an anticipated start date or termination date and assigned primary CPAC facility.

6. FORMAL ACCEPTANCE or REJECTION of DELIVERABLES All written deliverables shall be phrased in layperson language. Statistical and other technical terminology shall not be used without providing a glossary of terms. The COR will have the right to reject or require correction of any deficiencies found in the deliverables that are contrary to the information contained in the Contractor’s accepted quote. In the event of a rejected deliverable, the Contractor shall be notified in writing by the COR of the specific reasons for rejection. The Contractor shall have five (5) workdays to correct the rejected deliverable and return it per delivery instructions.

7. Quality Performance Standards

a. Coordination Direct communication regarding billing issues should be addressed to the Billing Manager or Supervisor. Names and contact information will be provided after the award

b. Delivery Electronic copies shall be delivered using Microsoft 365 Office suite of tools, unless otherwise specified by the COR. Electronic submission shall be made via email, unless otherwise agreed to by the COR.

If for any reason any deliverable cannot be delivered within the scheduled timeframe, the Contractor is required to explain why in writing to the COR by the delivery due date, including a firm commitment of when work shall be completed.

This notice to the COR shall cite the reasons for the delay, and the impact on the overall project. The COR will forward the notice and reasons for the delay to the CO with comments. The CO will then review the facts and issue a response, in accordance with applicable regulations.

8. INSPECTION and ACCEPTANCE The Contracting Officer’s Representative (COR) for the Contract is a government official who has been delegated specific technical, functional and oversight responsibilities for this contract. The COR is designated in the COR appointment letter, issued by the Contracting Officer, and is responsible for inspection and acceptance of all services and documents

a. Acceptance Criteria Certification by the Government of satisfactory services provided is contingent upon the Contractor performing in accordance with the performance standards contained in the Performance Requirements Summary Matrix (Section 18) and all terms and conditions of this contract including all modifications

b. Government Acceptance Period The COR will have ten (10) business days to review draft deliverables and make comments. The Contractor shall have five (5) business days to make corrections. Upon receipt of the final deliverables, the COR will have two (2) business days for final review prior to acceptance or providing documented reasons for non-acceptance. Should the Government fail to complete the review within the review period the deliverable will become acceptable by default, unless prior to the expiration of the ten (10) business days the Government notifies the Contractor in writing to the contrary. The final submission should be deemed approved if the Government has not rejected it in thirty (30) calendar days

9. PERFORMANCE DETAILS

Period of Performance: Sixty (60) months ordering period There are eleven (11) Federal holidays set by law (U.S.C. Title 5 Section 6103):

If any of the above falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if one falls on a Sunday, then Monday shall be observed as a holiday.

The other six are set by a day of the week and month:

10. PLACE OF PERFORMANCE

The physical location of performance of work activity will be the responsibility of the Contractor. No space will be provided by the CPAC. Contractors shall provide a remote and secure business setting for healthcare billing. Patient confidentiality and database security must be always maintained.

Hours of Operation The normal operating hours for the Federal Government are Monday – Friday, 8:00am – 4:30pm local area time. VA and CPAC employees must be able to communicate with the Contractor’s key personnel from 8:30 am to 5:00 pm ET during all federal workdays.

11. OTHER TERMS, CONDITIONS, AND PROVISIONS

a. Non-billable If an outpatient medical care encounter is determined to be not billable the Contractor shall cancel the claim and/or enter a reason not billable (RNB) in the Veteran Health Information Systems and Technology (VistA), Web VistA Integration Reporting and Revenue (Web VIRR), or most current system Integrated Billing Software Package at no charge to the VA. VA estimates 10% of daily workload will be determined not billable

b. Non-Disclosure/Non-Use Agreement The Contractor shall ensure that a Non-Disclosure Statement is signed before performing any work. The Non-Disclosure / Non-Use statement shall be cosigned by a corporate official (Contractor Task Manager or higher).

12. INFORMATION ASSURANCE

a. General Security Requirements The Contractor shall establish appropriate administrative, technical, and physical safeguards to protect any and all Government data, to ensure the confidentiality, integrity, and availability of government data. As a minimum, this shall include provisions for personnel security, electronic security, and physical security as listed in the sections that follow.

b. Health Insurance Portability and Accountability Act (HIPAA) The Contractor shall comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (P.L. 104-191) requirements, specifically the administrative simplification provisions of the law and the associated rules and regulations published by the Secretary, Health and Human Services (HHS). This includes the Standards for Electronic Transactions, the Standards for Privacy of Individually Identifiable Health Information and the Security Standards. It is expected that the contractor shall comply with all HIPAA-related rules and regulations as they are published (including identifiers for providers, employers, health plans, and individuals, and standards for claims attachment transactions).

13. PROTECTION of INFORMATION

a. Dissemination of Information/Publishing There shall be no dissemination or publication, except within and between the Contractor and any subcontractors. This includes VA Guidebooks, Standard Operating Procedures (SOPs), job aids, and other tools to support billing third-party payers, as well as insurance policy information or third-party payer agreements retained by VA. VA approval for publication will require provisions which protect the intellectual property and patent rights of both VA and the Contractor.

b. Personally Identifiable Information (PII) and Protected Health Information (PHI) Contractors collecting, storing, or disseminating personal identifiable information (PII) or protected health information (PHI) data must conform to all pertinent regulations, laws, and VA directives related to privacy. Contractors must provide access for VA privacy reviews and assessments and provide appropriate documentation as directed.

14. CONTRACTOR EMPLOYEES

a. Key Personnel Skilled experience in managing insurance billing office with similar volumes and work projected in this PWS. These “Key personnel” are the individuals whose resumes were submitted and marked by the vendor as “Key Personnel”. The Contracting Officer (CO) may notify the Contractor and request immediate removal of any personnel assigned to the contract by the Contractor that are deemed to have a conflict of interest with the government or if the performance is deemed to be unsatisfactory. The reason for the removal will be documented and replacement personnel shall be identified within three business days of the notification. Employment and staffing difficulties shall not be justification for failure to meet established schedules.

b. Substitution of Key Personnel All Contractor requests for approval of substitutions hereunder shall be submitted in writing to the COR and the Contracting Officer at least thirty (30) calendar days in advance of the effective date, whenever possible, and shall provide a detailed explanation of the circumstances necessitating the proposed substitution, a complete resume for the proposed substitute, and any other information requested by the Contracting Officer necessary to approve or disapprove the proposed substitution. New personnel shall not commence work until all necessary security requirements, as defined in Section J, have been fulfilled and resumes provided and accepted. The COR and the Contracting Officer will evaluate such requests and promptly notify the Contractor of approval or disapproval in writing.

15. MANAGEMENT and OVERSIGHT The Contractor shall be responsible for managing and overseeing the activities of all Contractor and subcontractor personnel, used in performance of this effort. The Contractor’s management responsibilities shall include all activities necessary to ensure the accomplishment of timely and effective support, performed in accordance with the requirements contained in the performance work statement.

16. DOMAIN KNOWLEDGE

The Contractors shall present domain knowledge of outpatient healthcare third party billing. Domain knowledge criteria are specified below:

Proposed personnel shall have an in-depth knowledge of health care revenue third party billing in the following areas:

Knowledge and experience in authorizing and releasing claims to third party carriers for outpatient services.

Knowledge of and ability to apply third party insurance and Medicare guidelines to claims.

17. STAFF QUALIFICATIONS

General Experience: Contractor personnel assigned to this contract shall have expertise in performing outpatient medical billing.

Manager Comprehensive knowledge of the principles, practices, laws, rules, and regulations related to billing for healthcare services and the submission of healthcare claims. Provides management oversight, guidance, corrective measures, and direction for monitoring activities designed to ensure the integrity and accuracy of healthcare claims. The Incumbent serves as CPAC’s expert technical authority on matters relating to VHA’s Consolidated Billing departments and the interface with process drivers at the medical centers for which the individual CPAC supports. Exercises management responsibility for complex billing activities for all the facilities assigned to the CPAC. Implement and manage all aspects of billing activities for CPAC clients and a wide range of stakeholders.

Supervisor Incumbent serves as Billing Supervisor responsible for the timely and accurate preparation and submission of claims for healthcare services, equipment, and/or medication. The Supervisor makes assignments based on the complexity of healthcare services, procedures, equipment, etc., provided, stabling deadlines and quality requirements. Comprehensive knowledge of framework of regulatory material regarding healthcare billing such as Medicare, TRICARE, and CHAMPVA guidelines, Sharing Agreements, Worker’s Compensation, appropriate Public Laws, HIPPA rules and regulations. Knowledge of coding of diseases and procedures using ICD-10, CPT, and HCPCS coding systems.

18. QUALITY ASSURANCE

The Government will review Monthly Itemized Statements and will attend regular task performance review meetings with the Contractor to survey the quality of products and services.

Quality Assurance Surveillance Plan (QASP) The Government intends to utilize a Quality Assurance Surveillance Plan (QASP) to monitor the quality of the Contractor’s performance. The oversight provided for QASP will help to ensure that service levels reach and maintain the required levels throughout the contract term. Further, the QASP provides the COR with a proactive way to avoid unacceptable or deficient performance and provides verifiable input for the required Past Performance Information Assessments. The QASP will be finalized immediately following the award and a copy provided to the Contractor afterward. The QASP is a living document and may be updated by the Government as necessary.

Performance Requirements Summary Matrix By monitoring the Contractor, the COR will determine whether the performance levels set forth in the order have been attained. Performance standards are specified in the following Performance Requirements Summary Matrix in the Standard and Acceptable Quality Level columns.

Timely completion of outpatient medical claims

Written confirmation from Contractor that billing has been completed within 10 business days or explanation for any delays

Billing accuracy

Bi-weekly quality reviews

Resolving claim rejections

CSA and MRW

Accurate canceling claims and assigning correct RNBs

Conference call participation

100% of contractor billing leadership attend conference call – and score 100% on final test Periodic Inspection Of list of training participants and when training was completed

19. INFORMATION SYSTEM SECURITY

The Contractor shall ensure adequate LAN/Internet, data, information, and system security in accordance with VA standard operating procedures and standard contract language, conditions laws, and regulations. The Contractor’s firewall and web server shall meet or exceed the government minimum requirements for security. All government data shall be protected behind an approved firewall. Any security violations or attempted violations shall be reported to the VA project manager and the VHA Headquarters Information Security Officer as soon as possible. The Contractor shall follow all applicable VA policies and procedures governing information security, especially those that pertain to certification accreditation. See VAAR clause 852.273-75 included in this contract.

20. SECURITY CONTROLS COMPLIANCE TESTING

On a periodic basis, VA, including the Office of Inspector General, reserves the right to evaluate any or all the security controls and privacy practices implemented by the Contractor under the clauses contained within the contract. With 10 working days’ notice, at the request of the Government, the Contractor will fully cooperate and assist in a government-sponsored security controls assessment at each location wherein VA information is processed or stored, or information systems are developed, operated, maintained, or used on behalf of VA, including those initiated by the Office of Inspector General. The Government may conduct a security control assessment on shorter notice (to include unannounced assessments) determined by VA in the event of a security incident or at any other time.

21. SECURITY TRAINING

All Contractor employees and Sub-Contractor employees requiring access to VA sensitive information and/or VA information systems shall complete the following before being granted access to VA networks or sensitive information:

Sign and acknowledge understanding of and responsibilities for compliance with the Contractor Rules of Behavior relating to access to VA information and information systems.

Successfully complete Privacy and HIPAA Training and annual refresher training as required.

Successfully complete VA Privacy and Information Security Awareness and Rules of Behavior and annual refresher training as required; and successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document – e.g., any role-based information security training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.

The Contractor shall provide to the Contracting Officer a copy of the training certificates for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required. These online courses are located at the following web site: https://www.tms.va.gov/SecureAuth35/ Failure to complete this mandatory training within the timeframe required will be grounds for suspension or termination of all physical and/or electronic access privileges and removal from work on the contract until such time as the training is completed.

22. CONTRACTOR PERSONNEL SECURITY

All Contractor employees who require access to the Department of Veterans Affairs' computer systems shall be the subject of a background investigation and must receive a favorable adjudication from the VA Security and Investigations Center (07C). The contractor is responsible for the cost of all background investigations. The level of background security investigation shall be in accordance with VA Directive 0710 dated May 2, 2016, and is available at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=832&FType=2 (VA Handbook 0710, Appendix A, Tables 1 - 2). Appropriate Background Investigation (BI) forms shall be provided upon contract (or task order) award and are to be completed and returned to the VA Security and Investigations Center (07C) within 3 days for processing. Contractors shall be notified by 07C when the BI has been completed and adjudicated. These requirements are applicable to all Sub-Contractor personnel requiring the same access. If the security clearance investigation is not completed prior to the start date of the contract, the employee shall not work on the contract while the security clearance is being processed. Work will commence as soon as the Contractor and Contractor employee receives and email message that states the following: We show that background investigation request on the individual listed below has been completed and the case has been initiated by the Security Investigations Center. When the case is completed, all adjudicative paperwork will be returned to the requested office. You can provide this email to the Station ISO as proof the investigation has been initiated, and access can be granted. This notice does not ensure completion of VetPro or other required security training. Those individuals that require VetPro Credentialing or additional security training must receive those completion notifications from the proper authority prior to starting date.

The investigation history for Contractor personnel working under this contract must be maintained in the databases of either the Office of Personnel Management (OPM) or the Defense Industrial Security Clearance Organization (DISCO). Should the Contractor use a vendor other than OPM or Defense Security Service (DSS) to conduct investigations, the investigative company must be certified by OPM/DSS to conduct Contractor investigations.

23. BACKGROUND INVESTIGATION

The position sensitivity impact for this effort has been designated as low risk and the level of background investigation is Tier 1/Low Risk.

Contractor Responsibility The Contractor must provide all equipment required for generation of VA and Non-VA outpatient claims to third party healthcare insurance carriers for CPAC sites nationwide.

The Contractor shall ensure staff are available to attend VA specific training on the dates and times specified by the CPAC.

The Contractor shall request other VA documentation deemed pertinent to the work accomplishment directly from the COR. The Contractor is expected to use common knowledge and resourcefulness in securing all other reference materials, standard industry publications, and related materials that are pertinent to the work.

The Contractor shall submit claims to payers electronically via a clearinghouse.

The Contractor shall provide automated secondary billing services provided the electronic (835) Medicare Remittance Advise (MRA) or Remittance Advise (RA) is supplied.

The Contractor shall ensure no paper claims are printed or mailed from any location other than a CPAC. Contractors will be provided with printing instructions after the award.

The Contractor shall make no decision(s) regarding whether a veteran’s treatment was service connected. The Contractor shall refer to all questions related to a veteran’s service-connected treatment, following the appropriate CPAC process The Contractor shall utilize client specific software currently in place to communicate with the different sections for additional information or clarification prior to cancelling a claim.

The Contractor shall use the Re-code/Reject function of the current coding compliance software to refer encounters back to the applicable medical center Heath Information Management Section (HIMS) for additional coding/medical records information.

The Contractor shall retrieve workload from a shared drive – this workload will be generated by the CPAC utilizing the Coding Compliance software daily.

The Contract staff shall fully utilize the Coding Compliance Claim Scrubber software as applicable. All edits will be reviewed and corrected as appropriate Government Responsibilities The COR will ensure all deliverables are reviewed and accepted/rejected within contract terms and conditions.

The CPAC Billing Manager or designee will monitor productivity (bills authorized, reasons not billable, and bill cancelations) on a weekly basis.

24. ELECTRONIC and INFORAMTION TECHNOLOGY STANDARDS Internet/Intranet The Contractor shall comply with Department of Veterans Affairs (VA) Directive 6102 and VA Handbook 6102 (Internet/Intranet Services).

VA Directive 6102 sets forth policies and responsibilities for the planning, design, maintenance support, and any other functions related to the administration of a VA Internet/Intranet Service Site or related service (hereinafter referred to as Internet). This directive applies to all organizational elements in the Department. This policy applies to all individuals designing and/or maintaining VA Internet Service Sites; including but not limited to full time and part time employees, Contractors, interns, and volunteers. This policy applies to all VA Internet/Intranet domains and servers that utilize VA resources. This includes but is not limited to va.gov and other extensions such as, “.com, .edu, .mil, .net, .org”, and personal Internet service pages managed from individual workstations.

VA Handbook 6102 establishes Department-wide procedures for managing, maintaining, establishing, and presenting VA Internet/Intranet Service Sites or related services (hereafter referred to as “Internet”). The handbook implements the policies contained in VA Directive 6102, Internet/Intranet Services. This includes, but is not limited to, File Transfer Protocol (FTP), Hypertext Markup Language (HTML), Simple Mail Transfer Protocol (SMTP), Web pages, Active Server Pages (ASP), e-mail forums, and list servers.

VA Directive 6102 and VA Handbook 6102 are available at:

Internet/Intranet Services Directive 6102 file:///C:/Users/VHACOB~1/AppData/Local/Temp/1/MicrosoftEdgeDownloads/a26b65da-5fab-4704-8d14-94bcd9a16e41/Handbook_6102_5_Aug_2019.pdf https://design.va.gov/content-style-guide/web-policies-and-directives In addition, any technologies that enable a Network Delivered Application (NDA) to access or modify resources of the local machine that are outside of the browser’s” sand box" are strictly prohibited. Specifically, this prohibition includes signed applets, or any ActiveX controls delivered through a browser's session. ActiveX is expressly forbidden within the VA while .NET is allowed only when granted a waiver by the VA CIO *PRIOR* to use.

JavaScript is the preferred language standard for developing relatively simple interactions (i.e., forms validation, interactive menus, etc.) and Applets (J2SE APIs and Java Language) for complex network delivered applications

25. COMPLIANCE DOCUMENTS

The following documents provide specifications, standards, or guidelines that must be complied with to meet the requirements of this order:

VA Directive 6102 and VA Handbook 6102 The Billing Guidebook will be provided by the CPAC The CPAC Billing Guidebook is available electronically via VA’s Knowledge Management (KM) portal and the link to the Guidebook will be shared with the Contractor after the award. This Guidebook outlines step-by-step processes for billing third-party payers on behalf of VA. The contractor is expected to follow the Guidebook in performance of billing functions.

End of Document