36C79118R0009-0004001.docx

1. Please define C4 and how it relates to Choice Claims

Community Care Contact Center (C4) – handles claims, billing and other issues associated with VA referred community care. Currently handles residual Choice calls related to the sunset of Health Net out of the VA health care system. C4 also handles Choice calls if the care was issued by the VAMC under Choice. C4 also handles calls about traditional community care issues. If it's a provider and the calls are related to community care and that care was not processed by one of the third party administrators for Choice, the contractor should receive those calls and be able to address them.

2. Please define ACR and how it relates to Choice Claims

Adverse Credit Reporting (ACR) – handles primarily calls from Veterans who may have received, or pending receipt, of an adverse credit action based on VA referred community care (this care can be "traditional community care" or via Choice). Currently handles residual Choice calls from Veterans or VA employees on behalf of Veterans related to the sunset of Health Net out of the VA health care system.

3. What is the difference between C4 and ACR data?

ACR is focused on resolving credit issues associated with outstanding VA billing. C4 is more broad in scope and handles billing, claims, errors, general questions, etc. associated with the community care programs.

4. What is a VISN rollout?

VISN rollout relating to call center is when the Community Care claim offices in a VISN transitions their customer service calls to the Call Center.

5. What is the impact of VISN rollout on Provider calls?

Impact on Call Center will be additional call volumes.

6. On Tab C4, Column I – Provider IVR Survey Csat – is the percent indicating the number of callers that completed the survey? Is the percent indicating a survey score?

The percentage is the survey score.

7. On Tab C4, Notes: Is 75K additional calls per month or per year? On Tab ACR, Notes, all additional calls are a monthly value, but no indication is written on Tab C4 Notes. If the 75K additional calls are a per month value, that would be a large number of additional calls – 900,000 - and would greatly impact our pricing if we calculate without this requested information.

The 75K additional calls are per month. All additional call volumes on C4 and ACR are per month.

8. Is the Government aware of a direct relationship between the aged (backlog) claims and the number of provider calls? If yes, please provide the aged claims inquiries as a percent of total number of calls.

The Government is aware there is a relationship but it will take several days compile that data and conduct the analysis. Due to time constraints in the procurement schedule this data cannot be made available.

9. On Tab ACR – Outbound calls – what is the number of outbound calls attributed to Providers? What is the nature of the outbound calls?

Outbound calls are associated with a Casework issue.

10. On Tab ACR – Define Casework calls and what impact do Casework calls have on Provider calls?

Casework is not a call. Casework is non-demand offline research, work and coordination that must be completed to resolve the issue. Case work may result in an outbound call.

11. Are the 1,100,000 aged claims (backlog) noted on page 23 of 116 the solicitation all OCC/Choice claims? 30% are noted as Authorized, are the 70% Unauthorized? Are any of the aged (backlog) claims CHAMPVA?

These aged claims are Office of Community Care claims, not CHAMPVA.

12. Would the Government consider extending the due date for proposals? If not, would the Government amend the delivery of the proposals from hard copy to electronic transmission?

No further extension will be granted.

13. Would you be able to clarify what section of the proposal response should include the required JV/Mentor-Protégé documentation?

Section E.7 Specific Instructions to Offerors Regarding Proposal Preparation, paragraph 4.1.2 Subfactor 2: Experience and Section E.10 Evaluation Factors for Award, paragraph 3.2.2 Subfactor 2: Experience, which were amended in Amendment 0003, describe the technical subfactor of Experience. See all of Section E.7 Specific Instructions to Offerors Regarding Proposal Preparation, paragraphs 3 and 4. Also see all of Section E.10 Evaluation Factors for Award, paragraphs 2 and 3.

14. Thank you for the information on the Joint Venture and Mentor Protégé documentation per modification #3. Can this documentation be provided within Volume IV or elsewhere within the response, as the information we are required to send is between 13-15 pages in length and it will be too long to include within the 50 page limitations of Volume I.

The Volume I page limitation is not changed. Documentation for the purpose of responding to the JV agreement and mentor-protégé agreement requirements added to Section E.7 Specific Instructions to Offerors Regarding Proposal Preparation, paragraph 4.1.2 Subfactor 2: Experience and Section E.10 Evaluation Factors for Award, paragraph 3.2.2 Subfactor 2: Experience, by Amendment 0003, is excluded from the page limitation.

15. Would the VA consider a one-day extension to allow time to repackage responses to accommodate this modification?

No further extension will be granted.

16. 90. On page 15 under 3.7.3 CHAMPVA Claims Processing Training, it identifies trainers for the train-the-trainer requirement. On page 21 under 3.9 CLIN 0007:Training it identifies up to 15 total Employees to participate in the train-the-trainer in the chart at the bottom of the page with "Up to 5" under three different multiple PWS Tasks. On page 26 under 10.0 Key Personnel/Contractor Staff it states "At a minimum, the contractor's Project or Operations Manager, Contract Manager, and the participants in the 'Train The Trainer' program are considered "Key Personnel" for this contract". Because of this, it is possible to have up to 17 Key Personnel. Resumes for Key Personnel would add value to the VA reviewers but could take up 34 of the Maximum of 50 pages for the Technical Factor on page 81. Would the VA consider exempting the Key Personnel Resumes from the page limit maximum?

See responses to questions 75 and 76.

On page 21, the following is stated:

“This training will include one week of virtual/online training, to be completed at the contractor’s site, and two weeks each for the Community Care Program (Sections 3.3; 3.4; 3.5; 3.6), and Customer Service (Section 3.8) to be completed on-site at a VA facility and up to four weeks for CHAMPVA (Section 3.7) at a VA Facility. This training shall be provided to no more than five contractor employees for each of the training types following contract award. Training for claims processing and customer service can be held concurrently if different contractor employees are identified to participate in claims processing and customer service training.”

When we submitted our question we were assuming that there would be 15 total employees trained because of the statement “two weeks each for the Community Care Program (Sections 3.3; 3.4; 3.5;3.6) and Customer Service (Section 3.8) to be completed on-site” It then goes on to say that the training can be held concurrently if different employees are identified to participate in claims processing and customer service training.

The clarification we are seeking is that the chart on page 21 appears to refer to a maximum of 10 total employees instead of the 15 we included in our question. Additionally, the chart only lists 2 consecutive weeks for both Community Care and Customer Services instead of two weeks each.

Does this mean it is only 2 weeks for both Community Care and Customer Services or 2 weeks each and if it is two weeks each does it mean that we can send 5 to each or 5 total between both within the PWS Tasks of 3.3;3.4;3.5;3.6;3.8.

Sections 3.3-3.6 are the same training, Community Care claims (2 weeks). 3.8 is Call Center training (2 weeks) and 3.7 CHAMPVA is up to 4 weeks.

5 attendees per session, to include key personnel attending one or more of the training sessions.

Resumes are not requested with the proposal.