Performance Work Statement

Crownpoint Healthcare Facility, Crownpoint, NM

Navajo Area Indian Health Service

Public Health Service

Department of Health and Human Service

1. INTRODUCTION

The contractor shall provide a secure, web-based software solution that streamlines Medicare, Medicaid, Private Insurance, and Veterans Administration claims processing and eligibility verification for Crownpoint Healthcare Facility, Crownpoint, New Mexico.

As payer requirements evolve and paper claim submission is phased out, the facility must maintain efficient electronic claims processing to ensure timely reimbursement. Increasing enrollment of patients in Medicare, Medicaid, and managed care programs requires real-time eligibility verification to reduce claim denials, improve workflow efficiency, and maximize third-party revenue.

Implementation of real-time eligibility verification and electronic claims submission has demonstrated measurable improvements in reimbursement timelines, reduced administrative burden, and increased revenue capture.

2. PURPOSE

Crownpoint Healthcare Facility requires continued use of a secure, compliant software application that provides electronic claims submission and real-time eligibility verification for all patient encounters.

The system must comply with HIPAA requirements and Indian Health Service (IHS) mandates to ensure all transactions are secure, managed, and exchanged in accordance with federal standards.

3. DESCRIPTION OF SERVICES/SUPPLIES:

The contractor shall provide electronic claims processing and eligibility verification services delivered through a secure, web-based Software-as-a-Service (SaaS) platform. These services shall enable the secure exchange of third-party patient insurance claims and eligibility information while ensuring confidentiality, authentication, integrity, and non-repudiation.

The services shall support:

• Electronic submission of claims to Medicare, Medicaid, commercial payers, and the Veterans Administration

• Real-time patient eligibility verification

• Secure access through a web-based portal for authorized users

• Compliance with HIPAA 837 transaction standards and all applicable federal requirements

The contractor’s services shall enhance revenue cycle performance by improving claim submission efficiency, reducing denials, supporting timely reimbursement, and maximizing third-party revenue collection activities.

The SaaS platform used to deliver these services shall:

• Provide secure, web-based access without requiring installation within IHS systems

• Support multiple users with workstation-independent access

• Maintain compliance with applicable certifications and security standards

(e.g., EHNAC, HNAP, CEAP, FedRAMP or equivalent)

4. SCOPE

The contractor shall furnish all labor, materials, supervision, and software necessary to provide secure electronic claims processing and eligibility verification services for Crownpoint Healthcare Facility.

The solution shall support Medicare, Medicaid, Private Insurance, and Veterans Administration billing workflows in accordance with this Performance Work Statement.

5. GENERAL REQUIREMENTS

This section describes the general requirements for this effort. The following sub-sections provide details of various considerations on this effort. The contractor shall abide by Section 508 Standard for information and communication technology (ICT) products and services.

This product must conform to the Revised Section 508 (https://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines) and WCAG 2.0 Level AA standards as outlined below.

352.239-73 Electronic Information and Technology Accessibility Notice.

(a) As prescribed in HHSAR 339.203-70(a), the Contracting Officer shall insert the following provision:

Electronic and Information Technology Accessibility Notice (December 18, 2015)

(a) Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998 and the Architectural and Transportation Barriers Compliance Board Electronic and Information (EIT) Accessibility Standards (36 CFR part 1194), require that when Federal agencies develop, procure, maintain, or use electronic and information technology, Federal employees with disabilities have access to and use of information and data that is comparable to the access and use by Federal employees who are not individuals with disabilities, unless an undue burden would be imposed on the agency. Section 508 also requires that individuals with disabilities, who are members of the public seeking information or services from a Federal agency, have access to and use of information and data that is comparable to that provided to the public who are not individuals https://urldefense.us/v3/__https:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pB1t_X5jg$ https://urldefense.us/v3/__https:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pB1t_X5jg$ https://urldefense.us/v3/__https:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pB1t_X5jg$ with disabilities, unless an undue burden is imposed on the agency.

(b) Accordingly, any offeror responding to this solicitation must comply with established HHS EIT accessibility standards. Information about Section 508 is available at http://www.hhs.gov/web/508. The complete text of the Section 508 Final Provisions can be accessed at http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards.

(c) The Section 508 accessibility standards applicable to this solicitation are stated in the clause at 352.239-74, Electronic and Information Technology Accessibility.

To facilitate the Government’s determination whether proposed EIT supplies meet applicable Section 508 accessibility standards, offerors must submit an HHS Section 508 Product Assessment Template, in accordance with its completion instructions. The purpose of the template is to assist HHS acquisition and program officials in determining whether proposed EIT supplies conform to applicable Section 508 accessibility standards. The template allows offerors or developers to self-evaluate their supplies and document—in detail—whether they conform to a specific Section 508 accessibility standard, and any underway remediation efforts addressing conformance issues. Instructions for preparing the HHS Section 508 Evaluation Template are available under Section 508 policy on the HHS website http://www.hhs.gov/web/508.

In order to facilitate the Government’s determination whether proposed EIT services meet applicable Section 508 accessibility standards, offerors must provide enough information to assist the Government in determining that the EIT services conform to Section 508 accessibility standards, including any underway remediation efforts addressing conformance issues.

(d) Respondents to this solicitation must identify any exception to Section 508 requirements. If a offeror claims its supplies or services meet applicable Section 508 accessibility standards, and it is later determined by the Government, i.e., after award of a contract or order, that supplies or services delivered do not conform to the described accessibility standards, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its expense.

Standards

The included standards that must be met for this contract are taken from the following two resources. Compliance with these standards is mandatory for Federal agencies subject to Section 508 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794d).

https://urldefense.us/v3/__http:/www.hhs.gov/web/508__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pC1Qri9_w$ https://urldefense.us/v3/__http:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pC0RHDTag$ https://urldefense.us/v3/__http:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pC0RHDTag$ https://urldefense.us/v3/__http:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pC0RHDTag$ https://urldefense.us/v3/__http:/www.hhs.gov/web/508__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pC1Qri9_w$

• Section 508 Standards and Guidelines: https://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines

• Web Content Accessibility Guidelines (WCAG) 2.0: https://www.w3.org/TR/WCAG20/

Electronic content must be accessible to HHS acceptance criteria

Checklist for various formats are available at http://508.hhs.gov, or from the IHS Section 508 Coordinator listed at https://www.hhs.gov/web/section-508/additional-resources/section-508-contacts/index.html, (email: IHSSection508@ihs.gov). Materials that are final items for delivery should be accompanied by the appropriate checklist, except upon approval of the Contracting Officer or Representative.

Electronic Content Accessibility - Web Based

• 602 Support Documentation

• 603 Support Services

• All WCAG A & AA Success Criteria

Software Accessibility - Web Based

• All WCAG A & AA Success Criteria

• 502 Interoperability with Assistive Technology

• 503 Application

• 602 Support Documentation

• 603 Support Services

• 302 All Functional Performance Criteria - Note: Applies when Chapter 5 does not address one or more functions of ICT (E204), or when an agency invokes "equivalent facilitation" (E101.2)

For Software that is an authoring tool include

• 504 Authoring Tools

Support Documentation Accessibility

• E602.1 General - Documentation that supports the use of ICT shall conform to 602.

• E602.2 Accessibility and Compatibility Features - Documentation shall list and explain how to use the accessibility and compatibility features required by Chapters 4 and 5. Documentation shall include accessibility features that are built-in and accessibility features that provide compatibility with assistive technology.

https://urldefense.us/v3/__https:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pB1t_X5jg$ https://urldefense.us/v3/__https:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pB1t_X5jg$ https://urldefense.us/v3/__https:/www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-ict-refresh/final-rule/text-of-the-standards-and-guidelines__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pB1t_X5jg$ https://urldefense.us/v3/__https:/www.w3.org/TR/WCAG20/__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pCX-yUJeg$ https://urldefense.us/v3/__http:/508.hhs.gov/__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pDPBskKUA$ https://urldefense.us/v3/__https:/www.hhs.gov/web/section-508/additional-resources/section-508-contacts/index.html__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pAHEhZ6Mw$ https://urldefense.us/v3/__https:/www.hhs.gov/web/section-508/additional-resources/section-508-contacts/index.html__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pAHEhZ6Mw$ mailto:IHSSection508@ihs.gov

• E602.3 Electronic Support Documentation - Documentation in electronic format, including Web-based self-service support, shall conform to Level A and Level AA Success Criteria and Conformance Requirements in WCAG 2.0 (incorporated by reference, see 702.10.1).

• E602.4 Alternate Formats for Non-Electronic Support Documentation - Where support documentation is only provided in non-electronic formats, alternate formats usable by individuals with disabilities shall be provided upon request.

• E602.3 Electronic Support Documentation - Documentation in electronic format, including Web-based self-service support, shall conform to Level A and Level AA Success Criteria and Conformance Requirements in WCAG 2.0 (incorporated by reference, see 702.10.1).

• E602.4 Alternate Formats for Non-Electronic Support Documentation - Where support documentation is only provided in non-electronic formats, alternate formats usable by individuals with disabilities shall be provided upon request.

• E603.1 General - ICT support services including, but not limited to, help desks, call centers, training services, and automated self-service technical support, shall conform to 603.

• E603.2 Information on Accessibility and Compatibility Features - ICT support services shall include information on the accessibility and compatibility features required by 602.2.

• E603.3 Accommodation of Communication Needs - Support services shall be provided directly to the user or through a referral to a point of contact. Such ICT support services shall accommodate the communication needs of individuals with disabilities.

• WCAG – All WCAG 2.0 A & AA Success Criteria

EXCEPTION:

• Non-Web documents shall not be required to conform to the following four WCAG 2.0 Success Criteria: 2.4.1 Bypass Blocks, 2.4.5 Multiple Ways, 3.2.3 Consistent Navigation, and 3.2.4 Consistent Identification.

• E205.4.1 Word Substitution when Applying WCAG to Non-Web Documents. For non-Web documents, wherever the term "Web page" or "page" appears in WCAG 2.0 Level A and AA Success Criteria and Conformance Requirements, the term "document" shall be substituted for the terms "Web page" and "page". In addition, in Success Criterion in 1.4.2, the phrase "in a document" shall be substituted for the phrase "on a Web page".

• Appendix A – Section 508 of the Rehabilitation Act: Application and Scoping Requirements

• E208 Support Documentation and Services

• Appendix C – Functional Performance Criteria and Technical Requirements

• 302 - Functional Performance Criteria

• 602 – Support Documentation

• 603 – Support Services

Functional Performance Criteria

• 301.1 Scope - The requirements of Chapter 3 shall apply to ICT where required by 508 Chapter 2 (Scoping Requirements), 255 Chapter 2 (Scoping Requirements), and where otherwise referenced in any other chapter of the Revised 508 Standards or Revised 255 Guidelines.

• 302.1 Without Vision - Where a visual mode of operation is provided, ICT shall provide at least one mode of operation that does not require user vision.

• 302.2 With Limited Vision - Where a visual mode of operation is provided, ICT shall provide at least one mode of operation that enables users to make use of limited vision.

• 302.3 Without Perception of Color - Where a visual mode of operation is provided, ICT shall provide at least one visual mode of operation that does not require user perception of color.

• 302.4 Without Hearing - Where an audible mode of operation is provided, ICT shall provide at least one mode of operation that does not require user hearing.

• 302.5 With Limited Hearing - Where an audible mode of operation is provided, ICT shall provide at least one mode of operation that enables users to make use of limited hearing.

• 302.6 Without Speech - Where speech is used for input, control, or operation, ICT shall provide at least one mode of operation that does not require user speech.

• 302.7 With Limited Manipulation - Where a manual mode of operation is provided, ICT shall provide at least one mode of operation that does not require fine motor control or simultaneous manual operations.

• 302.8 With Limited Reach and Strength - Where a manual mode of operation is provided, ICT shall provide at least one mode of operation that is operable with limited reach and limited strength.

• 302.9 With Limited Language, Cognitive, and Learning Abilities - ICT shall provide features making its use by individuals with limited cognitive, language, and learning abilities simpler and easier.

• Solicitations for supplies and services shall require the submission of a

Section 508 Product Assessment Template. The template can be found at https://www.itic.org/policy/accessibility/vpat.

6. SCHEDULE:

Contractor will not be operating at Crownpoint Healthcare Facility.

ADDITIONAL REQUIREMENTS:

A monthly invoice shall be generated by the vendor.

It will detail the monthly fees. Usage reports can be requested by Crownpoint Healthcare Facility.

Installation Services: Crownpoint Healthcare Facility is responsible for configuration of all display units in accordance with the prepared design plans and product installation requirements of the software application. Contractor will provide required support for the software as a service.

Safety: The Contractor is responsible for ensuring all Federal, State and local safety procedures are followed and adhered to by their technicians or any sub-contractor in the performance of this contract.

7. MINIMUM CONTRACTOR QUALIFICATIONS:

Task #1 – Vendor shall or software shall provide a secure data transport service between Crownpoint Healthcare, Medicare, Medicaid, Private Insurance, Veterans https://urldefense.us/v3/__https:/www.itic.org/policy/accessibility/vpat__;!!Og_tST9LxTiQE1I!sBtnec_0AEiCejU2sA-eU5pxHJaO_Hi3F1pjr0ta8OT6wl15aQLMyhlgkbrqnEaNAsmd6cbs5rAq7lZwuv_R0pDpzhgymQ$

Administration and clearinghouses. This service shall comply with the following constraints:

1.1 The service shall not require Crownpoint Healthcare Facility to install contractor software with the Crownpoint Healthcare Facility environment.

1.2 The service shall enable Crownpoint Healthcare Facility payer data /exchanges utilizing Vendor shall or software shall provide as approved by the Indian Health Service Office of Information Technology.

1.3 The service shall support 837/835, 270/271 EDI transactions.

1.4 The service shall support multiple users, access and access shall be workstation independent.

1.5 The service shall not entail development of HIPAA transaction set translation or claims mapping processes, non-IHS generated data or messages, or data reformatting.

1.6 The service shall conform to a business associate agreement already established between Crownpoint Comprehensive Health Care and the contractor.

Task #2 – Maintenance and Support – Vendor shall support end-to-end communication testing, implementation and daily operations of the data transfers from payers to Crownpoint Healthcare Facility, which shall include, at a minimum:

1.1 The contractor shall provide routine technical support to implement corrections to service occurring because of errors, flaws or other failures within their service.

1.2 The contractor shall notify a designated Crownpoint Healthcare Facility point of contact or Contracting Officer’s Representative (COR) of any scheduled maintenance that shall result in downtime at least (2) days prior to the maintenance period.

1.3 The contractor shall notify a designated Crownpoint Healthcare Facility point of contact of any issues at the Crownpoint Healthcare Facility that result in a disruption of data exchange capabilities. This notification shall occur as soon as the disruption is identified.

1.4 The contractor shall provide customer service support for reporting, documenting, tracking and resolving service problems, which should be available via telephone and email to Crownpoint Healthcare Facility technical staff during the period of 7:00 a.m. through 7:00 p.m.

8. QUALITY ASSURANCE: N/A

9. GOVERNMENT-FURNISHED PROPERTY: N/A

10. PROJECT OFFICER:

Brenda Tahe, Business Office Manager, is hereby designated as Project Officer for this service. The Project Officer’s responsibility will be to coordinate with the contractor the technical aspects of this service and the review of performance hereunder. The Project Officer does not have the authority to change or alter the order amount, terms and conditions.

The Project Officer’s responsibilities include ensuring contractor accountability, monitoring the contractor's technical progress- including the surveillance and assessment of performance and recommending to the Contracting Officer changes in requirements assisting the contractor in the resolution of technical problems encountered during performance and receiving.

11. DELIVERABLES:

Vendor shall provide internet-based connectivity for 837 electronic claim submission and provide real-time, point-of-service eligibility data from HIPAA Eligibility Transaction System (HETS) along with other payers through secured web portal along with necessary training and support. All information will be secured and available for reference to all credentialed users. The Business Office will maintain user list and restrict personnel to need to know functions within the software.

12. PERIOD OF PERFORMANCE

Base (01/01/2026 – 12/31/2026) Option Year One (01/01/2027 – 12/31/2027) Option Year Two (01/01/2028 – 12/31/2028)

13. Location, Hours of Work, and Work Restrictions

Work shall be performed remotely. Support shall be available during standard business hours, with flexibility for extended support as needed; Monday through Friday 8:00 am to 4.30 pm.

9. GOVERNMENT-FURNISHED PROPERTY: N/A