ATTACHMENT 5 - IHS IEE REPRESENTATION FORM.pdf
PDF 129 KB Posted
- Attached to
- Accounts Receivable Services Federal contract opportunity
- Solicitation number
- 75H71324Q00040
About this file
This solicitation is seeking quotes for accounts receivable services to support the Department of Health and Human Services Indian Health Service. The services include reviewing explanation of benefits to understand insurance payments and adjustments, posting medical, dental, optometry, behavioral health and pharmacy payments to the Indian Health Services' patient accounting system, and filing all financial documents. Quotes are due by April 8, 2024 and will be evaluated based on price and the offeror's demonstrated experience with ICD-10 and CPT coding, insurance payment posting, and accounts receivable processes. The requirement is set aside for Indian small businesses. The contract will have a one year base period and four one year options, running from April 15, 2024 to April 14, 2025 with the potential for additional option years.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| ATTACHMENT 7 - FY 2023 WORKLOAD.pdf | ||
| ATTACHMENT 6 - Q-A 75H71324Q00040 REVISED 04042024.docx | DOCX document | |
| ATTACHMENT 6 - Q-A 75H71324Q00040.docx | DOCX document | |
| Exhibit 3 - File for low pmt.docx | DOCX document | |
| Exhibit 2 - Financial Spread Sheet.xlsx | XLSX spreadsheet | |
| Exhibit 1 - Insurance Websites.xlsx | XLSX spreadsheet | |
| ATTACHMENT 4 - WAGE DETERMINATION.pdf | ||
| Exhibit 4 - Batch document example (PI-02032021-3)_Redacted.pdf | ||
| ATTACHMENT 3 - BUSINESS ASSOCIATE AGREEMENT.pdf | ||
| ATTACHMENT 2 - STATEMENT OF WORK.docx | DOCX document | |
| ATTACHMENT 1 - SCHEDULE OF ITEMS.xlsx | XLSX spreadsheet |
Show all 11
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Service
Office of Management Services Division of Acquisition Policy (DAP)
5600 Fishers Lane Rockville, MD 20857
INDIAN HEALTH SERVICE
BUY INDIAN ACT
INDIAN ECONOMIC ENTERPRISE
REPRESENTATION FORM
SOLICITATION/SOURCES SOUGHT/RFI #: _________________________________________________
PROJECT TITLE: ________________________________________________________
DATE: ___________________________________________________________________
In accordance with 25 U.S.C. 47 the Buy Indian Act, the signature below constitutes self-certification that the Offeror meets the definition of an “Indian Economic Enterprise” (HHSAR 326.601) in response to this Sources Sought Notice, Request for Information (RFI) or Solicitation and resultant contract.
The enterprise must meet the definition of “Indian Economic Enterprise” throughout the following time periods:
(1) At the time an offer is made in response to this solicitation;
(2) At the time of contract award; and
(3) During the full term of the contract performance period. At any point during these periods, if the Contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting Officer.
Individual Contracting Officers may require documentation of eligibility before awarding a set-aside or sole source contracts under the Buy Indian Act and awards may be subject to protest if the eligibility of the successful Offeror is in question. In addition to the self-certification requirements, successful Offerors must also be registered with the System of Award Management (SAM).
Any false or misleading information submitted by an enterprise when submitting an offer in consideration of an award set-aside under the authority of the Buy Indian Act is a violation of the law and punishable under 18 U.S.C. 1001.
False claims submitted as part of contract performance are subject to the penalties enumerated in 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.
REPRESENTATION
The Offeror represents as part of its offer that it does _____, does not _____ meet the definition of an “Indian Economic Enterprise” with “Indian Ownership” under the authority of the Buy Indian Act.
Name of the 51% owner of IEE Firm
Certifying Signature
Print Name
Name of Federally Recognized Tribal Entity
Business Name
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
File details come from the government source that posted it. Updated .