RFQ Questions_Claims Management Services 6.12.26final.pdf
PDF 76 KB Posted
- Solicitation number
- 75H70926BAO-031-RFQ
About this file
This is a Questions & Answers document for Solicitation No. 75H70926BAO-031-RFQ issued by the Indian Health Service (IHS) Fort Belknap Service Unit. The procurement represents a new requirement to combine Medicare and Private insurance claims management and revenue cycle management services. The Service Unit previously utilized two contractors: Inovalon Provider, Inc. (contract 75H70924P00084, July 3, 2024 – July 31, 2025) and Tyrula, LLC (contract GS35F246GA/75H70926F80018, May 20, 2026 – September 30, 2026).
The Fort Belknap Service Unit operates two facility locations: the Agency facility at 669 Agency Main Street, Harlem, Montana, and the Hays Satellite Eagle Child Clinic in Hays, Montana. The Service Unit employs 23 healthcare providers with 2 National Provider Identifiers and manages approximately 4,112 monthly patient encounters across multiple insurance types: 2,878 active Medicare accounts, 2,013 active Medicaid accounts, 2,957 active Commercial Insurance accounts, and 855 active VA accounts. The Statement of Work identifies approximately 3,720 Medicare claims and 4,320 private insurance claims annually. The Fort Belknap Service Unit currently maintains an in-house Revenue Cycle Management team managing patient registration, claims management, billing technology, and accounts receivable functions but is experiencing staffing shortages with a pending Billing Technician position selection. The Service Unit utilizes an Electronic Health Record system capable of generating batch claim files and requires integration with the Indian Health Service EHR and RPMS environments. The procurement requests 1 user license, with the licensing model (enterprise-wide unlimited versus site-specific) currently undetermined.
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Other files
| File | Type | Posted |
|---|---|---|
| B11 - IEE Representation.pdf | ||
| B01 - SOW FBSU Claims Management Services.pdf | ||
| B01 - Price Schedule.xlsx | XLSX spreadsheet | |
| B01 - 75H70926BAO-031-RFQ.pdf |
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Questions & Answers for Solicitation No. 75H70926BAO-031-RFQ
1. Is this a new requirement, an expansion of scope, or is it a continuation of previously awarded contracts?
75H70924P00084
a. Inovalon Provider, Inc.
b. 7/3/2024 - 7/31/2025
GS35F246GA/ 75H70926F80018
c. Tyrula, LLC
d. 5/20/2026 – 9/30/2026
This is a new requirement as the Service Unit will be combining both Medicare and Private insurance.
2. Does this separate IHS office currently use a Practice Management (PM) or EHR (Electronic Health Records) system today? Another way to ask, does this office currently have the ability to generate a batch claim file?
a. FBSU utilizes an Electronic Health Record system fully. The Business Office could generate a batch claim file.
3. Facility Structure
Please provide the number of Fort Belknap Service Unit facilities and any associated satellite, subregional, or outreach clinic locations that will require access to the proposed solution.
a. There are (2) locations
i. Agency – Located at 669 Agency Main Street, Harlem, MT
ii. Hays Satellite – Eagle Child Clinic – located in Hays, MT
4. Provider Count Please provide the number of healthcare providers, including the number of National Provider Identifiers (NPIs), by Service Unit facility and each associated clinic location.
a. # Of Healthcare Providers = 23
b. # of NPIs = 2
5. User Licenses
The Statement of Work references support for unlimited users. Please provide the anticipated number of user licenses required by facility and service unit location.
Additionally, please clarify whether the Government intends to procure enterprise-wide (unlimited) licensing or site-specific licensing.
a. # of Licenses = 1
b. Will Government procure unlimited licenses or site-specific? Don’t know
6. Revenue Cycle Management Staffing Does the Fort Belknap Service Unit currently maintain an in-house Revenue Cycle Management (RCM) team? If so, please provide a high-level overview of the current staffing structure and responsibilities.
The Revenue Cycle Team manages the financial process from patient registration through payment collection. The team includes Patient Registration, Claims Management, Billing Technology, and Accounts Receivable (A/R) functions, working together to ensure accurate patient information, timely claim submission, efficient billing operations, and effective collection Medicare, Medicaid, and Commercial insurance. Their primary objective is to optimize reimbursement, improve cash flow, and maintain compliance.
Currently, the Fort Belknap Service Unit is experiencing a staffing shortage in the Department. Human Resources has advertised for a Billing Tech position,however, a selection in pending.
7. Electronic Health Record (EHR) Environment
The Statement of Work indicates the solution must integrate with the Indian Health Service EHR and RPMS environments. Please identify the Electronic Health Record (EHR) and/or Electronic Medical Record (EMR) systems currently utilized by the Fort Belknap Service Unit, as well as any existing claims management, eligibility verification, clearinghouse, or revenue cycle management software currently in use.
https://www.ihs.gov/RPMS/ https://www.ihs.gov/EHR/ See question #1
8. Historical Workload Data
Beyond the estimated annual claim volumes identified in the Statement of Work, please provide the average monthly patient encounters and the number of active Medicare, Medicaid, VA, and Commercial Insurance accounts managed by the Service Units to support our submission of an accurate pricing schedule. The SOW identifies approximately 3,720 Medicare claims and 4,320 private insurance claims annually.
a. Average Monthly Patient = 4112
b. Active Medicare =2878
c. Active Medicaid =2013
d. Active Commercial Insurance =2957
e. Active VA =855 https://www.ihs.gov/RPMS/ https://www.ihs.gov/EHR/
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