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PAGE 1 OF
1. REQUISITION NO.
2. CONTRACT NO.
3. AWARD/EFFECTIVE DATE
4. ORDER NO.
5. SOLICITATION NUMBER
6. SOLICITATION ISSUE DATE
a. NAME
b. TELEPHONE NO. (No Collect Calls)
8. OFFER DUE DATE/LOCAL
TIME
9. ISSUED BY
CODE
10. THIS ACQUISITION IS
UNRESTRICTED OR
SET ASIDE:
% FOR:
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
WOMEN-OWNED SMALL BUSINESS
(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
EDWOSB
8(A)
NAICS:
SIZE STANDARD:
11. DELIVERY FOR FOB DESTINA-
TION UNLESS BLOCK IS
MARKED
SEE SCHEDULE
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER
DPAS (15 CFR 700)
13b. RATING
14. METHOD OF SOLICITATION
RFQ
IFB
RFP
15. DELIVER TO
CODE
16. ADMINISTERED BY
CODE
17a. CONTRACTOR/OFFEROR
CODE
FACILITY CODE
18a. PAYMENT WILL BE MADE BY
CODE
TELEPHONE NO.
DUNS:
DUNS+4:
PHONE:
FAX:
17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED
SEE ADDENDUM
19.
20.
21.
22.
23.
24.
ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
(Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA
26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED.
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________
29. AWARD OF CONTRACT: REF. ___________________________________ OFFER
COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND
DATED ________________________________. YOUR OFFER ON SOLICITATION
DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY
(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE
ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED
SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:
30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
(REV. 2/2012)
PREVIOUS EDITION IS NOT USABLE
Prescribed by GSA - FAR (48 CFR) 53.212
7. FOR SOLICITATION
INFORMATION CALL:
STANDARD FORM 1449
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
730-18-3-3036-0004
36C77718Q0012 02-07-2018 William J. Singleton 314-894-6656 X65108 02-22-2018 10:00 00776 Department of Veteran Affairs
PCAC-ST. LOUIS
11152 South Towne Square Saint Louis MO 63123
X
541990 $15 Million
X
N/A
See Attached Department of Veteran Affairs Employee Education System (EES) 11152 South Towne Square
Saint Louis MO 63123 00776 Department of Veterans Affairs
PCAC-ST. LOUIS
11152 South Towne Square St. Louis MO 63123
Department of Veterans Affairs Financial Services Center Invoices To Be Submitted Electronically www.ob10.com/us/en/veterans-affairs/ e-Invoice Setup Info Phone 877-489-6135
PHONE: 877-353-9791
FAX: 512-460-5429
See CONTINUATION Page eInsurance Healthcare Clearing House (HCH) to Support Eligibility Transactions (EDI)
See CONTINUATION Page
Table of Contents
| SECTION A | 1 |
| A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS | 1 |
| SECTION B - CONTINUATION OF SF 1449 BLOCKS | 3 |
| B.1 CONTRACT ADMINISTRATION DATA | 3 |
| B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011) | 4 |
| B.3 PRICE/COST SCHEDULE | 21 |
| ITEM INFORMATION | 21 |
| B.4 DELIVERY SCHEDULE | 24 |
| SECTION C - CONTRACT CLAUSES | 25 |
| C.1 52.216-18 ORDERING (OCT 1995) | 25 |
| C.2 52.216-21 REQUIREMENTS (OCT 1995) | 25 |
| C.3 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) | 26 |
| C.4 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) | 26 |
| C.5 52.237-3 CONTINUITY OF SERVICES (JAN 1991) | 26 |
| C.6 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) | 27 |
| C.7 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS SET-ASIDE (JUL 2016)(DEVIATION) | 27 |
| C.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012) | 28 |
| C.9 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) | 29 |
| C.10 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) | 29 |
| C.11 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (NOV 2017) | 30 |
| SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS | 37 |
| SECTION E - SOLICITATION PROVISIONS | 42 |
| E.1 52.216-1 TYPE OF CONTRACT (APR 1984) | 42 |
| E.2 52.233-2 SERVICE OF PROTEST (SEP 2006) | 42 |
| E.3 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) | 43 |
| E.4 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) | 43 |
| E.5 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (NOV 2017) | 51 |
SECTION B - CONTINUATION OF SF 1449 BLOCKS
B.1 CONTRACT ADMINISTRATION DATA
(continuation from Standard Form 1449, block 18A.)
1. Contract Administration: All contract administration matters will be handled by the following individuals:
a. CONTRACTOR:
b. GOVERNMENT: Contracting Officer 36C776 Linda G. Robertson Department of Veteran Affairs
PCAC-ST. LOUIS
11152 South Towne Square Saint Louis MO 63123
2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:
| [X] |
| 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or |
| [] |
| 52.232-36, Payment by Third Party |
3. INVOICES: Invoices shall be submitted in arrears:
| a. Quarterly | [] |
| b. Semi-Annually | [] |
| c. Other | [X] Monthly |
4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.
Department of Veterans Affairs Financial Services Center Invoices To Be Submitted Electronically www.ob10.com/us/en/veterans-affairs/ e-Invoice Setup Info Phone 877-489-6135 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:
| AMENDMENT NO |
| DATE |
B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)
This solicitation includes VAAR 852.219-10 VA Notice of Total Service- Disabled Veteran-Owned Small Business Set-Aside. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.
36C77718Q0012
Page 1 of Page 1 of
Performance Work Statement (PWS) Department of Veterans Affairs
1. Title of Contract: eInsurance Healthcare Clearing House (HCH) to Support Eligibility Transactions (EDI)
2. Scope of Work: The Department of Veterans Affairs Veterans Health Administration (VHA) has a requirement to support the HIPAA 270/271 and 278 transactions in real-time. All incoming and outgoing transactions enter and exit from VA AITC in Austin, TX utilizing point- to-point VPN connection and meet all HIPAA compliance requirements and industry standards. Internal to VA, health care inquiries are sent as an individual or batch requests from individual VA medical centers to CFD, which CFD translates into HIPAA 270 transactions for external VA transmission to the Contractor. The HCH shall receive the 270 transaction from VA, transmit the data as required by the information source/payer or their authorized agent/clearinghouse (Payer), and ensure delivery. Additionally, the HCH shall transmit the 271 transaction received from the Payer, or if necessary, translate the electronic data into the standard HIPAA 271 format and ensure delivery to VA.
The Contractor is also required to support and transmit MCCF and non-MCCF HIPAA compliant X12 transactions via batch and real-time transfer and translate proprietary formats to and from HIPAA compliant transactions on behalf of VHA. And support any future industry standards that may be released (i.e. such as HL7)
3. Background:
In June 2003, the Department of Veterans Affairs (VA) implemented an electronic insurance verification (eIV) system for Medical Care Collection Fund (MCCF) and non-MCCF revenue collections. The eIV system provides a standard, automated method for verifying eligibility, utilizing the Health Insurance Portability and Accountability Act (HIPAA) mandated eligibility 270 (Eligibility, Coverage, or Benefit Inquiry) and 271 (Eligibility, Coverage, or Benefit Information/Response) transactions. Currently VA utilizes one of the largest healthcare clearinghouses (HCH) in the industry for 270/271 transactions. While this HCH provides VA access to approximately 250 payers, VA does not have access to a number of its top payers. VA is seeking an additional HCH to expand its access (total unknown) to significant payers. VA intends to use a HCH to route and, if needed, translate HIPAA ASC X12N 270/271 Eligibility Inquiry and Response transactions to and from payers.
In January 2017, the Department of Veterans Affairs (VA) implemented an electronic referral certification and health care authorization system. The new system provides a standard, automated method for obtaining third party referral certifications and health care authorizations for Veterans’ care in VA, utilizing the Health Insurance Portability and Accountability Act (HIPAA) Health Care Services Review – Request for Review and Response (HIPAA X12N 278x217) and the Health Care Services Review – Inquiry and Response (HIPAA X12N 278x215) transactions. Currently VA utilizes one of the largest healthcare clearinghouses (HCH) in the industry for 278 transactions. While this HCH provides VA access to 2 payers, VA is seeking access to additional payers (total unknown).
VA intends to investigate the use of a second HCH to route and, if needed, translate HIPAA ASC X12N 278x217 Health Care Services Review – Request for Review and Response and HIPAA ASC X12N 278x217 Health Care Services Review – Inquiry and Response transactions to and from payers.
4. Period of Performance: The period of performance shall be for seven month from the award date of the contract heretofore called the base period. In addition to the base period, this contract will also include one (1) twelve month option period, which may be unilaterally exercised by the Government.
5. Type of Contract: The Government anticipates award of a Firm Fixed Price, Service Contract.
6. Contracting Officer’s Representative (COR) and Program Manager
COR:
Crystal L. Pryor Department of Veterans Affairs, VHA eBusiness Solutions 10D1E2 810 Vermont Ave, NW Washington, DC 20420
(937) 267-7620
Program Manager:
David Grezak Department of Veterans Affairs, VHA eBusiness Solutions 10D1E2 810 Vermont Ave, NW Washington, DC 20420
(303) 372-4643
7. Place of Performance: The Contractor shall support this effort at Contractor facilities.
8. Government Recognized Holidays: Unless specifically authorized in writing by the Contracting Officer, no services will be provided and no charges will be incurred and/or billed to any order on this contract on any of the Federal Holidays listed below.
| New Years Day | Labor Day |
| Martin Luther King Day | Columbus Day |
| Presidents' Day | Veterans' Day |
| Memorial Day | Thanksgiving Day |
| Independence Day | Christmas Day |
9. CONTRACT AWARD MEETING
The contractor shall not commence performance on the tasks in this PWS until the Contracting Officer has conducted a kick off meeting, or has advised the contractor that a kick off meeting is waived.
10. GENERAL REQUIREMENTS
The contractor shall provide the specific services and a virtual environment system with the capabilities described below within the performance period business days stated in this PWS. If for any reason, any deliverable cannot be provided on time according to the below schedule, the contractor shall provide a written explanation to the COR five (5) business days prior to deliverable due date. This written transmittal shall include a firm commitment of when the work shall be completed. This transmittal to the COR shall cite the reasons for the delay, and the impact on the overall project. The impact of the delay shall be recorded in the Project Management Plan.
1. For every task, the contractor shall identify in writing all necessary subtasks (if any), associated costs by task together with associated sub-milestone dates. The contractor's subtask structure shall be reflected in the technical proposal and detailed project management plan.
2. All written deliverables will be phrased in layperson language. Statistical and other technical terminology will not be used without providing a glossary of terms.
3. Where a written milestone deliverable is required, the VHA will complete their review of the deliverable within 31 business days from date of receipt. The contractor shall have 15 business days to deliver the final deliverable from date of receipt of the government’s comments.
4. Shall be a fully at the time of contract award “Accredited Healthcare Network” (HNAP-EHN and ePAP-EHN accredited) by the Electronic Healthcare Network Accreditation Commission (EHNAC) (https://www.ehnac.org/) at the time of proposal submission and maintain accreditation for the duration of the Contract.
5. Shall be certified by the Council for Affordable and Quality Healthcare (CAQH); per Section 104 of the Patient Protection and Affordable Care Act as following the Phase I & II CAQH CORE Operating Rules for HIPAA Eligibility & Claim Status (270/271) at the time of award and maintain certification for the duration of the Contract.
6. All “Days” reference in the PWS are to be interpreted as Business Days
7. Electronic Healthcare Network Accreditation Commission (EHNAC) and Council for Affordable and Quality Healthcare (CAQH CORE) certifications are both required at the time of contract award and maintain certification for the duration of the Contract.
11. SPECIFIC MANDATORY TASKS AND ASSOCIATED DELIVERABLES
Description of Tasks and Associated Deliverables: The contractor shall perform the mandatory tasks and provide the specific deliverables described below within the performance period stated in Section A.4 of this Performance Work Statement.
Task 1: Expand VA’s electronic reach to payers’ extraction, transformation and loading of data.
Deliverable 1
The Contractor shall provide, in one month or less, electronic data exchange access to approximately 250 payers, including, but not limited to the following top payers:
Colonial Penn Cigna Behavioral Health Bankers Life Independent Health
Task 2: Supply and maintain a master payer list and provide access to payers.
Deliverables 2
Deliverable 2.1 - The Contractor shall provide an appropriate transmission vehicle to ensure the delivery of HIPAA 270 inquiries from the Contractor's site to each responsible Payer or their contracted representative. VA shall provide the Contractor with a list of payers VA deems most important to access for initial implementation. The Contractor shall initiate a dialog with each responsible Payer to establish an understanding of the requirements associated with and to fulfill the obligation of relaying VA inquiries to and from Payers.
Deliverable 2.2 - The Contractor shall maintain an accurate master list of payers with their associated identification numbers available to VA through either direct connections or through other clearinghouses. The Contractor shall assist in establishment of a mechanism to keep VA's Payer list synchronized with the Contractor's list. The Contractor shall maintain the accuracy of its lists and update the Contractor's payer dictionary, website, companion guide, and any other form used for communication about requirements/specifications within 5 business days of receiving a change from a payer.
Task 3: Provide Real-Time data exchange services
Deliverables 3
Deliverable 3.1 - The Contractor shall respond to each HIPAA 270 real-time inquiry in less than one minute. The response to the HIPAA 270 shall be either a HIPAA 271 or an acknowledgement from the Payer. The acknowledgement shall be either a TA1 (ISA/IEA interchange rejection) or a 997 (functional group or transaction set rejection).
Deliverable 3.2 - The Contractor shall develop a mutually agreed upon resubmission policy with VA. In cases where the Payer does not send a timely HIPAA 271 response or times out, the Contractor shall invoke the resubmission methodology.
Task 4: Monitor transactions for compliance
Deliverable 4
The Contractor shall monitor (i.e. at a minimum, every other week) all inbound transactions for HIPAA compliance and notify VA of payers which are sending non-compliant transactions. The Contractor shall also work with the payer to submit compliant transactions.
Task 5: Provide enrollment support.
Deliverable 5
The Contractor shall conduct and publish enrollment requirements for all payers it has access to as well as facilitate and coordinate enrollment with payers. This may include, but is not limited to, completion of appropriate authorization forms and letters as required by Payer specific guidelines.
Task 6: Provide Routine Reports.
Deliverable 6
The Contractor shall provide a proposal for reports to be used in monitoring the transmission and success/failure of the HIPAA 270/271 transaction.
The Contractor and VA shall decide on mutually agreed upon reports, formats and reporting frequencies, which shall include, at a minimum those reports listed below. The reports outlined in this document should be itemized by payer and by VA Medical Center. To the extent possible, reporting shall be electronic data sets and provided to CFD for disbursement.
VA periodic and/or monthly reporting minimum for payer entities:
· Total number of inquiries processed by the Contractor
· Total number and percentage of inquiries accepted, rejected and timed-out by each payer
· Provide report(s) on inbound and outbound data exchanges to identify exceptions in timing and content
· Provide management reporting to support audit trail and reconciliation
· Other reports and technical documents may be developed as required throughout the project
Task 7: Offer capability to test and supply edit messages.
Deliverable 7
The Contractor shall partner with VA to test capability to ensure that the HIPAA 270/271 transactions are processed in accordance with the terms and conditions of this Performance Work Statement. The Contractor shall have the ability to test inquiries for completeness and create a set of edit conditions with corresponding edit messages to be returned with rejected inquiries in compliance with HIPAA and VA requirements.
Task 8: Provide implementation support and documentation.
Deliverable 8 - The Contractor shall:
· Coordinate with VA for delivery of system documentation
· Provide documentation on proposed system and/or process changes prior to implementation
· Modify the processes for any VA-specific anomalies related to implementation for a payer
· Add other transaction sets as deemed appropriate by VA. Such as:
· Creation of a unique PAYERID for health care payers that shall eventually be converted to the national PAYERID
Task 9: Provide operational support.
Deliverables 9
Deliverable 9.1 - The Contractor shall provide services, including, but not limited to:
· Dedicated staff contact that shall provide technical and help desk support for day-to-day operational activities.
· Technical support during normal business hours covering Eastern, Central, Mountain and Pacific Time Zones.
· Monitoring of inbound and outbound data exchanges to identify exceptions (total unknown) in timing and content.
· Maintenance of ongoing Payer connections as necessary to support data exchange.
· Hardware and software maintenance as necessary to support ongoing delivery of consistent services with minimal interruption.
· Backups as necessary to support recovery for failed equipment within 24 hours or less and problem research.
· A secure environment that prevents access from unauthorized physical or electronic sources.
· Reformatting, routing and other data transaction management processes as may be necessary to help ensure proper application of data.
· Maintenance of production environment where all internal processes occur.
· Monitor Payer communications and industry developments to determine changes that are applicable to the scope of services.
Deliverable 9.2 - The Contractor shall establish a schedule that allows unattended operations for the transmission and receipt of the data/transactions. The Contractor shall obtain VA approval of the operations schedule and any subsequent changes to the schedule. Additionally, the Contractor shall provide VA technical points of contact for coordination activities associated with the development and implementation phase. These contacts shall be provided to VA at no additional charge since those services shall be required to assure smooth implementation.
Task 10: Archive, Retrieve and Manage transactional documents.
Deliverable 10 - The Contractor shall:
· Capture and archive transactional documents as necessary to support document collation and routing
· Submit transactions by or for VA to Payers or other transaction switch organizations via electronic means with appropriate editing and tracking controls to help assure data integrity
· Demand retrieval of documents from archives
· Archive all correspondences between VA and the Contractor in a support database
Task 11: Provide Customer Support.
Deliverable 11 - The Contractor shall provide customer support services, including, but not limited to:
· On line problem and transaction submission/response tracking system.
· Published information on enhancement releases and systems changes.
Task 12: Assist with Special Projects.
Deliverable 12 - The Contractor shall assist VA with enhancements or process expansions, including, but not limited to the following:
· Incorporation of new mandated standards, e.g., the Contractor shall assist VA with conversion from legacy IDs to NPIs.
· Marketing/educational efforts to convert non-electronic payers to electronic.
Task 13: The contractor will be asked to perform additional tasks related to healthcare EDI and insurance coverage discovery. For insurance coverage discovery VA seeks to find 3rd party insurance information when VA does not already have the information on file. The contractor will receive Government furnished patient demographics in HIPAA standard formatting to perform insurance coverage discovery activities with results being sent back to VA in HIPAA standard formatting.
Deliverables
Deliverable 13.1 – Supply and maintain a payer list where insurance coverage may be searched by using patient demographics only.
Deliverable 13.2 – Provide the initial capability for real-time or batch services with transactions for insurance coverage discovery.
Optional Task 14: Access to HIPAA ASC X12N 278x217 & HIPAA ASC X12N 278x217 payers
Deliverable 14.1 – Supply and maintain a master payer list and provide access to payers.
Deliverable 14.2 - Provide Companion guides that detail the 278 transaction fields required for electronic transactions for each Payer.
Deliverable 14.3 - Submit Payer sheets to the project lead and the Financial Services Center (FSC) in electronic machine readable code, in electronic format for our 278 transactions and Payers.
Optional Task 15: Provide Real-Time data exchange services for HIPAA ASC X12N 278x217 & HIPAA ASC X12N payers Deliverable 15.1 - The Contractor shall publish enrollment requirements for all payers it has access to as well as facilitate and coordinate enrollment with payers. This may include, but is not limited to, completion of appropriate authorization forms and letters as required by Payer specific guidelines.
Deliverable 15.2 - The Contractor shall develop a mutually agreed upon submission policy with VA.
Deliverable 15.3 - The Contractor shall develop a mutually agreed upon resubmission policy with VA. In cases where the Payer does not send a timely HIPAA response or times out, the Contractor shall invoke the resubmission methodology.
Deliverable 15.4 - Provide ongoing support to ensure payers and utilization management organizations are supporting the use of the HIPAA X12 278 transaction. This includes establishing new payer and UMO connectivity, facilitating relationship building between HCCH, payer and VA, and resolution of issues with payers related to 278 processing.
Optional Task 16: Provide batch and/or real-time data exchange services for insurance coverage discovery.
Deliverable 16.1 - The Contractor shall respond to each insurance coverage discovery inquiry within 20 business days. The response to the insurance coverage discovery inquiry shall be either a HIPAA 271 or an acknowledgement from the Payer. The acknowledgement shall be either a TA1 (ISA/IEA interchange rejection) or a 997 (functional group or transaction set rejection).
Task 17: Additional Tasks.
Deliverable 17.1: Perform Additional Tasks. The contractor will be asked to perform additional tasks related to healthcare EDI and its’ associated emerging technologies. In the event the contractor is requested to perform tasks not included in the Performance Work Statement, the amount of each task shall be negotiated and a task order issued.
B. SCHEDULE FOR DELIVERABLES
1. The contractor shall meet the Delivery Schedule for each deliverable specified.
2. Unless otherwise specified an electronic copy shall be placed in the designated CBO SharePoint site or other CBO-designated site.
| Deliverable |
| Item |
| Qty |
| Delivery Date |
| 1 |
| Payer List |
| 1 |
| Within 1 month of contract start up |
| 2 |
| Payer List |
| 1 |
| Within 1 month of contract start up |
| 3 |
| Response to real-time inquires |
| Ongoing as needed |
| Within 1 minute of submission |
| 4 |
| Compliant Payer Monitoring |
| Ongoing as needed |
| Report will be delivered to COR in real time |
| 5 |
| Enrollment Support |
| Ongoing as needed |
| On an as needed basis |
| 6 |
| Payer Reports |
| 1 |
| Within 1 month of contract start up |
| 7 |
| Testing Capability |
| 1 |
| With-in 30 business days upon announcing new payer availability |
| 8 |
| Implementation Support and Documentation |
| 1 |
| With-in 30 business days upon announcing new payer availability |
| 9 |
| Operational Support |
| Ongoing as needed |
| On an as needed basis |
| 10 |
| Archived Document List |
| Ongoing as needed |
| On an as needed basis |
| 11 |
| Customer Support |
| Ongoing as needed |
| On an as needed basis |
| 12 |
| Special Projects |
| Ongoing as needed |
| On an as needed basis |
| 13 |
| Insurance Coverage Discovery initial capability. |
| 1 |
| Within 6 months of contract start up |
| 14 |
| Access to HIPAA ASC X12N 278x217 |
| As required |
| As requested |
| 15 |
| Provide Real-Time data exchange services for HIPAA ASC X12N 278x217 & HIPAA ASC X12N payers |
| As required, ongoing as needed |
| As requested, ongoing as needed |
| 16 |
| Insurance coverage discovery data exchange services |
| as required, ongoing as needed |
| as requested, ongoing as needed |
| 17 |
| Additional tasks |
| Ongoing as needed |
| Ongoing as needed |
C. INSPECTION AND ACCEPTANCE CRITERIA
Final inspection and acceptance of all work performed, reports and deliverables will occur at the place of delivery by the COR. Final approval and acceptance of documentation required herein shall be by letter of approval and acceptance by the COR. The Contractor shall not construe any letter of acknowledgment of receipt material as a waiver of review, or as an acknowledgment that the material is in conformance with this PWS.
The Government shall monitor performance and review deliverables utilizing solicited and unsolicited feedback from all applicable resources as follows:
| Deliverable |
| Performance Standard |
| Minimum |
Acceptable Standard Method of Surveillance Frequency
| 1 |
| VA’s electronic reach to new payers Extraction, transformation and loading of data |
| Vendor is electronically connected to each VA payer. |
| Successful transactions |
| Real-time |
| 3 |
| Provide Real-Time data exchange services |
| Vendor will exchange data with payers in real time. |
| Successful transactions |
| Real-time |
| 4 |
| Monitor transactions for compliance |
| All transactions will meet compliance standards |
| Meets X12 HIPAA Standards |
| Real-time |
| 5 |
| Provide enrollment support. |
| All payers are enrolled in an agreed upon time period. |
| Payer enrollment documents completed |
| Upon request |
| 6 |
| Provide Routine Reports. |
| - Reports are complete, accurate and timely |
- Content reflects progress of task
| Transaction reports |
| Upon request |
| 7 |
| Offer capability to test and supply edit messages. |
| Edit messages are clear and concise and |
address the payer’s question or issue
| Meets X12 HIPAA Standards |
| Real time |
| 8 |
| Provide implementation support and documentation. |
| - Documentation is complete, accurate and timely |
- Content reflects progress of task
| Supplies payer enrolment and/or Companion guides |
| Upon request |
| 9 |
| Provide operational support. |
| - Payer is able to reach vendor when support is required. |
| Contact via phone or email is initiated |
| Upon request |
| 10 |
| Archive, Retrieve and Manage transactional documents. |
| Transaction documentation is archived and managed in an agreed upon format. |
| Archives successful |
| Upon request |
| 11 |
| Provide Customer Support. |
| Payers are able to communicate with the vendor in a timely manner. |
| Successful issue follow-up |
| Upon request |
| 12 |
| Assist with Special Projects |
| - Vendor completes projects as assigned. |
| Projects completed |
| Upon request |
| 13 |
| Provide insurance coverage discovery initial capability |
| Vendor will be able to provide capability. |
| Project completed |
| Upon request |
| 14 |
| Access to HIPAA ASC X12N 278x217 |
| Vendor will be able to provide capability |
| Project completed |
| Upon request |
| 15 |
| Provide real-time or batch data exchange services for HIPAA ASC X12N 278x217 |
| Vendor will exchange data with payer in real time or batch. |
| Successful transactions |
| Real time or batch |
| 16 |
| Provide real-time or batch data exchange services for insurance coverage discovery |
| Vendor will exchange data with payer in real time or batch. |
| Successful transactions |
| Real time or batch |
| 17 |
| Perform Additional Tasks. |
| Responsive to VA requests. |
| Ongoing as needed by COR |
| Ongoing as needed |
E. TRANSMISSION REQUIREMENTS:
The Contractor shall work closely with VA as an expert resource in developing new connections and a robust electronic solution for insurance verification. The current electronic transmission requirements include the items below:
1.0 XI2 Capability. The Contractor shall possess the capability to send and receive the ASC X12 270/271 and 278 transactions, version 5010 or higher. The Contractor shall work with VA to develop plans to transition to future X12 versions well before the deadlines imposed by HIPAA. The transition process shall allow ample time for adequate testing of the new version to ensure that deadlines are met without compromising success or accuracy of electronic commerce transmissions. The Contractor shall provide forward services as well as value-added services such as translation to proprietary carrier formats, electronic transaction confirmation, and management reports.
2.1 Communications. The proposed system shall interface with VA Corporate Franchise Data Center's operating environment utilizing point-to-point VPN connection and comply with its connectivity and security policies and requirements. The Contractor shall also establish connectivity to the VA CBO disaster recovery sites located in:
· Hines, IL
· Philadelphia, PA
· Waco, Texas
3.0 Certifications. The Contractor shall be CORE certified as well as EHNAC accredited at the time of contract award and maintain certification for the duration of the Contract.
F. GENERAL SECURITY REQUIREMENTS:
1.0 VHA has determined that all information and records it provides to the Contractor, in whatever medium, as well as all information and documents, including drafts, emails, back-up copies, hand- written notes, and copies that contain such information and records gathered or created by Contractor (collectively referred to as "VA information") in the performance of this contract, regardless of storage media, is transferred voluntarily, is disclosed for legitimate purposes under authority of the Privacy Act (5 U.S.C. §552a) and the Health Insurance Portability and Accountability Act (HIPAA, P.L.104-191), and that data ownership is passed from one HIPAA- Covered Entity (VHA) to another HIPAA-Covered Entity: the Contractor. As such, the Contractor shall comply with all HIPAA requirements, including requisite Security and HITECH Act reporting requirements. The data being transferred is Protected Health Information (PHI) and shall be protected under HIPAA. Because the Contractor is a HIPAA-Covered Entity and is subject to compliance with HIPAA and HITECH Act requirements, and since data ownership is being passed from VA to the Contractor, VA has determined that security of the PHI provided to the Contractor is the Contractor’s obligation under HIPAA and the HITECH Act. If the Contractor fails to maintain PHI security according to HIPAA standards for Covered Entities and thereby causes a breach of said data, VHA retains the discretion to terminate this contract for default (T4D) and to pursue other remedies as may be appropriate.
2.0 Prior to termination or completion of this contract, Contractor shall not destroy VHA information received from VHA or gathered or created by Contractor in the course of performing this contract without prior written approval by VHA.
3.0 The contractor/subcontractor shall be able to receive VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated and are approved for use by VHA between VHA and the Contractor’s internal processing environment(s).
4.0 Prior to any disclosure pursuant to a court order, the Contractor shall promptly notify VA of the court order upon its receipt by the Contractor, provide VHA with a copy by fax or email, whichever is faster, and notify by telephone the VHA individual designated in advance to receive such notices. If the Contractor cannot notify VHA before being compelled to produce the information under court order, the Contractor shall notify VHA of the disclosure as soon as practical and provide a copy of the court order, including a copy of the court order, a description of the records provided pursuant to the court order, and to whom the Contractor provided the records under the court order. The notice will include the following information to the extent that the Contractor knows it, if it does not show on the face of the court order: the records disclosed pursuant to the order, to whom, where, when, and for what purpose, and any other information that the Contractor reasonably believes is relevant to the disclosure. If VHA determines that it is appropriate to seek retrieval of information released pursuant to a court order before Contractor notified VHA of the court order, Contractor shall assist VHA in attempting to retrieve the VHA information involved.
5.0 VHA will provide the Contractor with the name, title, telephone number, fax number and email address of the VHA official to whom the Contractor will provide all notices required by this Contract.
6.0 If anyone performing this contract, including employees of subcontractors, accesses VHA computer systems or data in the performance of the contract, VHA may monitor and record all such access activity. If VHA monitoring reveals any information of suspected or potential criminal law violations, VHA will refer the matter to the appropriate law enforcement authorities for investigation.
7.0 Contractor shall inform its employees and other individuals performing any part of this contract that VHA may monitor their actions in accessing or attempting to access VHA computer systems and the possible consequences to them for improper access, whether successful or not. The Contractor shall ensure that any subcontractors or others acting on behalf of or for the Contractor, in performing any part of this contract inform their employees, associates or others acting on their behalf, that VHA may monitor their access activities within the VHA owned and managed systems. Execution of this contract and any subcontract or agreement constitutes consent to VHA monitoring.
8.0 To the extent practicable, Contractor shall mitigate any harmful effect on individuals whose VHA information was accessed or disclosed in an incident.
B.3 PRICE/COST SCHEDULE
ITEM INFORMATION
| ITEM NUMBER |
| DESCRIPTION OF SUPPLIES/SERVICES |
| QUANTITY |
| UNIT |
| UNIT PRICE |
| AMOUNT |
| 0001 |
| E-Insurance Healthcare Clearinghouse HCH Support Eligibility IAW the performance work statement (PWS). |
Contract Period: Base POP Begin: 04-01-2018 POP End: 10-31-2018
0.00
| ________________ |
| ________________ |
| 0001AA |
| Participating payers transaction volume. |
*** NOTE: ALL QUANTITIES ARE ESTIMATED.
Contract Period: Base POP Begin: 04-01-2018 POP End: 10-31-2018
| 420,000.00 |
| EA |
| ________________ |
| ________________ |
| 0001AB |
| Standard payers transaction volume. |
*** NOTE: ALL QUANTITIES ARE ESTIMATED.
Contract Period: Base POP Begin: 04-01-2018 POP End: 10-31-2018
| 1,680,000.00 |
| EA |
| ________________ |
| ________________ |
| 0001AC |
| Non-participating payers transaction volume. |
*** NOTE: ALL QUANTITIES ARE ESTIMATED.
Contract Period: Base POP Begin: 04-01-2018 POP End: 10-31-2018
| 105,000.00 |
| EA |
| ________________ |
| ________________ |
| 0001AD |
| Monthly operational support. |
Contract Period: Base POP Begin: 04-01-2018 POP End: 10-31-2018
| 7.00 |
| MO |
| ________________ |
| ________________ |
| 0001AE |
| Transaction document management |
Contract Period: Base POP Begin: 04-01-2018 POP End: 10-31-2018
| 7.00 |
| MO |
| ________________ |
| ________________ |
| 0001AF |
| Insurance coverage discovery initial capability. |
Contract Period: Base POP Begin: 04-01-2018 POP End: 10-31-2018
| 1.00 |
| JB |
| ________________ |
| ________________ |
| 1001 |
| E-Insurance Healthcare Clearinghouse HCH Support Eligibility IAW the performance work statement (PWS). |
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
0.00
| ________________ |
| ________________ |
| 1001AA |
| Participating payers transaction volume. |
*** NOTE: ALL QUANTITIES ARE ESTIMATED.
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
| 720,000.00 |
| EA |
| ________________ |
| ________________ |
| 1001AB |
| Standard payers transaction volume. |
*** NOTE: ALL QUANTITIES ARE ESTIMATED.
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
| 2,880,000.00 |
| EA |
| ________________ |
| ________________ |
| 1001AC |
| Non-participating payers transaction volume. |
*** NOTE: ALL QUANTITIES ARE ESTIMATED.
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
| 180,000.00 |
| EA |
| ________________ |
| ________________ |
| 1001AD |
| Monthly operational support |
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
| 12.00 |
| MO |
| ________________ |
| ________________ |
| 1001AE |
| Transaction document management |
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
| 12.00 |
| MO |
| ________________ |
| ________________ |
| 1001AF |
| Insurance coverage discovery found transactions. |
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
| 360,000.00 |
| EA |
| ________________ |
| ________________ |
| 1001AG |
| Insurance coverage discovery non-found transactions. |
Contract Period: Option 1 POP Begin: 11-01-2018 POP End: 10-31-2019
| 36,000.00 |
| EA |
| ________________ |
| ________________ |
| GRAND TOTAL |
| ________________ |
SECTION C - CONTRACT CLAUSES
C.1 52.216-18 ORDERING (OCT 1995)
(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from March 19, 2018 through the end of the effective period..
(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.
(c) If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.
(End of Clause)
C.2 52.216-21 REQUIREMENTS (OCT 1995)
(a) This is a requirements contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies or services specified in the Schedule are estimates only and are not purchased by this contract. Except as this contract may otherwise provide, if the Government's requirements do not result in orders in the quantities described as "estimated" or "maximum" in the Schedule, that fact shall not constitute the basis for an equitable price adjustment.
(b) Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. Subject to any limitations in the Order Limitations clause or elsewhere in this contract, the Contractor shall furnish to the Government all supplies or services specified in the Schedule and called for by orders issued in accordance with the Ordering clause. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations.
(c) Except as this contract otherwise provides, the Government shall order from the Contractor all the supplies or services specified in the Schedule that are required to be purchased by the Government activity or activities specified in the Schedule.
(d) The Government is not required to purchase from the Contractor requirements in excess of any limit on total orders under this contract.
(e) If the Government urgently requires delivery of any quantity of an item before the earliest date that delivery may be specified under this contract, and if the Contractor will not accept an order providing for the accelerated delivery, the Government may acquire the urgently required goods or services from another source.
(f) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after March 18, 2022.
(End of Clause) ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.
The following clauses are incorporated into 52.212-4 as an addendum to this contract:
C.3 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)
The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days.
(End of Clause)
C.4 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)
(a) The Government may extend the term of this contract by written notice to the Contractor within 30 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension.
(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.
(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed Two Years and 1 month.
(End of Clause)
C.5 52.237-3 CONTINUITY OF SERVICES (JAN 1991)
(a) The Contractor recognizes that the services under this contract are vital to the Government and must be continued without interruption and that, upon contract expiration, a successor, either the Government or another contractor, may continue them. The Contractor agrees to (1) furnish phase-in training and (2) exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.
(b) The Contractor shall, upon the Contracting Officer's written notice, (1) furnish phase-in, phase-out services for up to 90 days after this contract expires and (2) negotiate in good faith a plan with a successor to determine the nature and extent of phase-in, phase-out services required. The plan shall specify a training program and a date for transferring responsibilities for each division of work described in the plan, and shall be subject to the Contracting Officer's approval. The Contractor shall provide sufficient experienced personnel during the phase-in, phase-out period to ensure that the services called for by this contract are maintained at the required level of proficiency.
(c) The Contractor shall allow as many personnel as practicable to remain on the job to help the successor maintain the continuity and consistency of the services required by this contract. The Contractor also shall disclose necessary personnel records and allow the successor to conduct on-site interviews with these employees. If selected employees are agreeable to the change, the Contractor shall release them at a mutually agreeable date and negotiate transfer of their earned fringe benefits to the successor.
(d) The Contractor shall be reimbursed for all reasonable phase-in, phase-out costs (i.e., costs incurred within the agreed period after contract expiration that result from phase-in, phase-out operations) and a fee (profit) not to exceed a pro rata portion of the fee (profit) under this contract.
(End of Clause)
C.6 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)
The bidder or offeror agrees that if a contract is awarded to him/her, as a result of this solicitation, he/she will not advertise the award of the contract in his/her commercial advertising in such a manner as to state or imply that the Department of Veterans Affairs endorses a product, project or commercial line of endeavor.
(End of Clause) C.7 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS SET-ASIDE (JUL 2016)(DEVIATION)
(a) Definition. For the Department of Veterans Affairs, “Service-disabled veteran-owned small business concern or SDVSOB”:
(1) Means a small business concern:
(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans or eligible surviving spouses (see VAAR 802.201 Surviving Spouse definition);
(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans (or eligible surviving spouses) or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran;
(iii) The business meets Federal small business size standards for the applicable North American Industry Classification System (NAICS) code identified in the solicitation document;
(iv) The business has been verified for ownership and control pursuant to 38 CFR 74 and is so listed in the Vendor Information Pages database, (https://www.vip.vetbiz.gov); and
(v) The business will comply with subcontracting limitations in 13 CFR 125.6, as applicable
(2) “Service-disabled veteran” means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).
(b) General.
(1) Offers are solicited only from verified service-disabled veteran-owned small business concerns. Offers received from concerns that are not verified service-disabled veteran-owned small business concerns shall not be considered.
(2) Any award resulting from this solicitation shall be made to a verified service-disabled veteran-owned small business concern.
(c) Agreement. A service-disabled veteran-owned small business concern agrees that in the performance of the contract, the concern will comply with the limitation on subcontracting requirements in 13 CFR §125.6.
(d) A joint venture may be considered a service-disabled veteran owned small business concern if the joint venture complies with the requirements in 13 CFR 125.15, provided that any reference therein to SDVO SBC is to be construed to apply to a VA verified SDVOSB as appropriate.
(e) Any service-disabled veteran-owned small business concern (non-manufacturer) must meet the requirements in FAR 19.102(f) of the Federal Acquisition Regulation to receive a benefit under this program.
(End of Clause)
C.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012)
(a) Definitions. As used in this clause—
(1) Contract financing payment has the meaning given in FAR 32.001.
(2) Designated agency office has the meaning given in 5 CFR 1315.2(m).
(3) Electronic form means an automated system transmitting information electronically according to the Accepted electronic data transmission methods and formats identified in paragraph (c) of this…
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