CAF Answers to Questions Amd 1.pdf

Solicitation 75R60222R00001: COVID-19 Coverage Assistance Fund (CAF) Program

Answers to Questions (Amendment 0001)

Question # Section Page Referenced Text Question Program Response

1 SOW 3

Required fields for electronic data interchange (EDI) and Paper claims (claims will be rejected/returne d without these fields populated)

– shall be used for patient verification demographics:

The current program only allows electronic claims.

That is correct.

2 SOW 4

Contact Center shall ask for the following to validate providers who call into the call center:

· Name (First & Last).

· National Provider Identifier (NPI).

· Taxpayer Identification Number (TIN).

Can the government please provide guidance on how TINs will be validated for providers who have not submitted claims yet?

Databases and processes leveraged to validate provider TINs are to be identified and managed by the contractor. See revised PWS at Task 5.1.

3 SOW 4

the Electronic Data Interchange 277CA (claims acknowledgment ) shall be generated (not required by

HIPAA).

Can the government please confirm whether 277CA claims acknowledgment messages will be sent or not?

Yes, the contractor shall send 277CA claims acknowledgment messages for all claims received.

See updated PWS at B. Assumptions.

4 SOW 4

Common Electronic Data Interchange

(CEDI)

Can the government please confirm that CEDI refers to the EDI solution for Medicare DME claims? If so, can the government please clarify the requirement for use of

CEDI?

The reference CEDI is in the general purpose/description. The contractor is expected to possess technical expertise and knowledge of industry standards and best practices in order to propose appropriate solutions and processes to HRSA for approval. See also revised evaluation criteria (Section M).

5 SOW 4

Contractor shall be able to commence reimbursement within 30 days of contract award.

In the RFP F.4 Schedule of Deliverables, many of the deliverables related to the HHS EPLC and ATO process may not be able to be reviewed and approved within 30 days of contract award. Is the government requiring that the proposed solution is already operating under an existing ATO given the aggressive timeframe specified?

If a significant change to the current system occurs under the new contract, an ATO process will have to be started, which can take from 3 to 12 months.

6 SOW 11

Draft and send mass email communications:

o 15 emails to 700,000 recipients

Will the government be providing the email addresses for the mass email communications?

Yes. The contractor is also expected to disseminate program info through their established networks. The program information that needs to be disseminated is detailed in Task

4.1 Strategic Communications Plan and Task 4.2

Provider Outreach. Edits have been made to the

PWS.

7 SOW 14

submit provider and patient rosters for validation to program guidelines

Can the government please provide more details on the validation to be performed on provider and patient rosters submitted through the portal?

Patient rosters are not applicable - this language has been removed from PWS and the below language has been added.

For provider rosters:

• Verify the providers NPI and TIN are valid utilizing contractor supplied systems or databases Verify the Providers status using the following HRSA provided lists:

• Office of Inspector General's List of Excluded Individuals/Entities (LEIE), updated monthly;

• Medicare Revocation List, updated weekly;

• Medicaid Termination List, updated monthly;

• CMS Compliance Hold List, updated monthly;

8 SOW 14

Perform retrospective review of claims reimbursements to ensure that Providers’ claims were compliant with their patients’ defined “Underinsured” status.

Will the Contractor be required to review Explanation of Benefits documents from the primary payer to validate that reimbursement did not reach or exceed Federally mandated amounts?

Yes. Edits have been made to the PWS.

9 SOW 15

For each claim, perform prepayment verification of patients’ insurance coverage status at time of service. This

Does the government have any historical data on the number of claims processed by CAF thus far which were missing Member IDs and may thus require manual verification of insurance coverage?

No. Member IDs would not be missing given that all claims must first be submitted to and fully adjudicated by the patient's primary health plan.

should include comparing submitted information about a patient’s coverage with information in Clearinghouses.

10 SOW 15

issue temporary member IDs for the use of claims submissions and processing.

Can the government please elaborate on this requirement? Will Member IDs need to be mailed to all patients with claims approved by the CAF program (for future testing or vaccine doses)?

No. The contractor shall establish a temporary member ID number to be used by all providers for claims submission. This is not suggesting a physical ID, but an ID number to be used electronically for claim submission/processing.

This value should be replaced with a unique claim identifier on response transactions.

11 SOW 16

defined as having insurance which does not cover vaccine administration, or covers vaccine administration but with patient cost sharing.

Can the government provide a registry of known health plans to date that do not cover Covid-19 vaccine administration or testing or that have patient cost share amounts?

No.

12 SOW 18

shall be made to providers who currently have an ACH account with Contractor’s Bank or who register to start such an account as part of the

Can the government please confirm that providers reimbursed under CAF must have an account with the Contractor's Bank?

Providers reimbursed under CAF do not need to have an account with the contractor's bank.

Vaccine Administration Assistance Fund Program.

13 SOW 20

Return surplus funds received from providers to HHS on a daily basis. Returned funds shall include the principal, interest, total amount, total count and allowance.

Should returns of surplus funds be deposited back to the Tripartite account or returned to the Treasury Department?

Funds shall be returned to HRSA via Program Support Center to be credited back to the CAF fund.

14 SOW 21

Secure interface with other

HHS/HRSA

internal systems and external systems such as US Treasury.

Can the government please provide more details on what interfaces will be required between the Contractor's Financial Accounting System and Federal government systems?

HRSA shall establish and utilize a secure file transfer protocol (SFTP) for the daily financial file.

15 SOW 24

Ensure that all payments are subjected to the Federal Payment Levy Program (FPLP) or non-tax debt withholding in accordance with Treasury policy and procedure.

Please confirm that all payments must be matched against FPLP before being made?

Yes. All payments are subjected to the FPLP, however the contractor is not required to conduct these checks.

16 SOW 24

Ensure that all payments are subjected to the Federal Payment Levy Program (FPLP) or non-tax debt withholding in accordance with Treasury policy and procedure.

Can the government please clarify if payments will be subject to non-tax debt withholding? Our understanding is that this is the Treasury Offset Program Debt Check and access may be restricted?

Yes. All payments are subjected to the FPLP, however the contractor is not required to conduct these checks.

17 SOW 25

no later than December 13

Should this deadline be January 31st following the just completed tax year?

Yes. This information has been corrected in the

PWS.

18 SOW 25

Task 9 – Provider Call Support

Can the government please provide statistics on the average volume of calls and emails received per month?

During the current contract period, approximately 420 phone calls per month.

During the current contract period, approximately 90 emails per month.

19 SOW 43

A security control assessment must be conducted by a FedRAMP third-party assessment organization (3PAO) for the initial ATO and annually thereafter or whenever there is a significant change to the system’s security posture in

Is it the government or the Contractor's responsibility for contracting with a 3PAO?

Should the costs be factored into the Contractor's proposal?

The Contractor seeking FedRAMP certification is responsible for all costs, including 3PAO, to achieve that certification. It is the responsibility of the contractor to determine what is applicable to their cost proposal.

accordance with the FedRAMP Continuous Monitoring Plan.

Backgroun d

Contract number 75R60221C0000 1 was originally awarded to the SSI Group, LLC on December 14, 2020 to meet the needs of the Government.

Is contract 75R60221C00001 still in place?

We see that https://covid19coverageassistance.ssigroup .com is still active.

Yes.

Backgroun d

Contract number 75R60221C0000 1 was originally awarded to the SSI Group, LLC on December 14, 2020 to meet the needs of the Government.

Can SSI Group, LLC bid on this contract? At this time, there are no known conflicts that would prevent the incumbent from submitting a proposal in response to the solicitation.

22 SOW, 9.1 25

Establish the infrastructure to adequately support call volume.

What is the anticipated call volume for the call center?

Approximately 420 phone calls per month.

Approximately 90 emails per month.

23 SOW, 9.1 25

Respond to provider telephone and email (for off-

What is the service level for responding to off hour provider inquiries?

Inquiries shall be acknowledged within 48 hours.

This has been added to the PWS.

hour inquiries) inquiries promptly, clearly, and accurately.

24 SOW 12 28

The contractor shall: TBD.

Please define requirements for Office of Communications

The task has been marked "Reserved" for the time being. Once the information is available, an amendment will be issued to add the task requirements.

25 SOW 14 48

A System of Records Notice (SORN) will be developed for this contract.

Is the contractor required to develop the System of Records Notice (SORN)? If so, when is that due?

The contractor is not required to develop the

SORN.

Backgroun d

Contract number 75R60221C0000 1 was originally awarded to the SSI Group, LLC on December 14, 2020 to meet the needs of the Government.

Please clarify the status of the current contract award winner (SSI Group). What is their current role & Functions performed?

Does the SSI Group have an enforce ATO?

Current contract is active until December 13, 2021. The contractor is responsible for meeting the requirements outlined in their contract. The question regarding "an enforce ATO" is unclear.

There is a provisional ATO in place.

Assumptio ns

Required fields for electronic data interchange (EDI) and Paper claims (claims will be rejected/returne d without these fields populated)

– shall be used for patient

Will the selected vendor be expected to receive & process paper claims? If so, can you provide estimated annual volume? If not, will an alternative claim form be developed and/or provided? Can you provide an estimated annual volume of paper claims?

No. All claims submissions and claims reimbursements must be submitted and remitted electronically.

verification demographics.

Assumptio ns

The Contractor shall have the following technical assumptions when developing the Claims Processing Services for the

COVID-19

Coverage Assistance Fund

Please confirm providers will submit claims using the HCFA 1500. If not, will an alternative claim form be developed and/or provided?

All claims submissions and claims reimbursements must be submitted and remitted electronically.

Claims will be submitted electronically using either The Electronic Data Interchange 837 Professional transaction or the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Version D.0 (or the most current standard), NCPDP Batch Standard Version 1.2 (or the most current standard).

Assumptio ns

The Contractor shall encourage providers to include in the claims submission:

Race, Ethnicity

Please provide ideas on how patient race & ethnicity will be collected.

The Contractor is expected to possess technical expertise and knowledge of industry standards and best practices in order to propose appropriate method of collection.

Assumptio ns

Contractor shall ensure that there is coordination of benefits before payment.

Please describe the depth at which you expect coordination of benefits (COB) to be performed.

The Contractor is expected to possess technical expertise and knowledge of industry standards and best practices in order to propose appropriate validation processes to include:

• For each claim, perform prepayment verification of patients’ insurance coverage status at time of service. This should include comparing submitted information about a patient’s coverage with information in Clearinghouses.

• For individual(s) (patient(s)) where eligibility is determined to be covered under the Vaccine Administration Assistance Fund Program, issue temporary member ID numbers for the use of claims submissions and processing.

• For individual(s) (patient(s) where eligibility is determined to be insured, send claims to qualified plans.

• Establish and manage a process for reconsideration of eligibility for providers who have received a denial of eligibility based on insurance coverage found for submitted individual(s) (patient(s)).

See PWS at Task 5.2.

Assumptio ns

Contract shall ensure that there is coordination of benefits before payment.

What COB rules will be applied? (i.e.

Birthday Rule)

The contractor is expected to possess technical expertise and knowledge of industry standards

COB rules for HRSA's consideration.

Assumptio ns

Contractor shall be able to commence reimbursement within 30 days of contract award.

Please provide anticipated claim volume in months 1, 2, & 3.

Month 1: 1 Million Month 2: 1 Million Month 3: 1 Million

33 SOW, 4.2 11

Draft and send mass email communications:

15 emails to 700,000 recipients

Please confirm that HRSA will provide emails for the "700,000 recipients"

HRSA will provide email addresses for the 700,000 email recipients. The contractor is also expected to disseminate program info through their established networks.

34 SOW, 4.2 11

15 emails to 700,000 recipients

Please define "recipients" (assumed to be providers)

Healthcare providers and other stakeholders such as associations representing health care providers.

Edits have been made to the PWS.

35 SOW, 4.2 11

Draft content and conduct educational webinars for providers (capacity over 10,000 attendees) via a contractor-provided platform:

Confirm number of providers that will be targeted for the webinars

Approximately 700,000 providers will be invited to participate in webinars.

36 SOW, 4.2 11

Draft content and conduct educational webinars for providers (capacity over 10,000 attendees) via a

a. Solicitation appears to limit it to 40,000 (4 x 10,000), is that the total number of providers expected to participate

Contractor must provide a platform with the capacity to host webinars with more than 10,000 attendees. Approximately 700,000 providers will be invited to attend such webinars.

contractor-provided platform: Four

(4) Webinars

37 SOW, 5.1 14

Per HRSA guidance and direction, develop, and maintain a portal based on program requirements to allow healthcare providers to confirm and/or submit data required for ACH transactions, and submit provider and patient rosters for validation to program guidelines.

Please expand on how you envision providers submitting patient rosters

The requirement for patient rosters has been removed. The task in the PWS was revised to clarify requirements for rosters.

38 SOW, 5.1 14

Per HRSA guidance and direction, develop, and maintain a portal based on program requirements to allow healthcare providers to

Please provide the HRSA definition of "underinsured"

For the purpose of this program, HRSA defines underinsured as an individual who has a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. Edits have been made to the PWS.

confirm and/or submit data required for ACH transactions, and submit provider and patient rosters for validation to program guidelines.

39 SOW, 5.1 14

Configure the portal so that it can be closed, once funding thresholds are met.

Expand on statement regarding "funding thresholds"

Payment of claims is subject to available funding.

HRSA will notify the contractor when funds are approaching depletion.

40 SOW, 5.1 14

Configure the portal so that it can be closed, once funding thresholds are met.

a. Will all valid claims be paid (eventually) Payment of claims is subject to available funding.

41 SOW, 5.1 14

Configure the portal so that it can be closed, once funding thresholds are met.

b. Are valid claims only paid "until funding is exhausted"

Yes. Payment of claims is subject to available funding.

42 SOW, 5.1 14

Configure the portal so that it can be closed, once funding thresholds are met.

c. If b, what happens to unfunded claims Once funding thresholds are met, no additional claims will be paid.

43 SOW, 5.2 15

For each claim, perform prepayment verification of patients’ insurance coverage status at time of service. This should include comparing submitted information about a patient’s coverage with information in Clearinghouses.

What is the extent of "comparison" performed regarding a patients eligibility and what is housed in the Clearinghouse?

A. Primary Insurance. B Secondary insurance.

The contractor is expected to possess technical expertise and knowledge of industry standards and best practices in order to propose appropriate validation processes.

44 SOW, 6 15

Set up an electronic system for health care providers to submit COVID-19 837 and NCPDP claims for individuals with a health and/or prescription benefit plan that does not include

COVID-19

vaccine administration as a covered

Describe the role you envision a prescription benefit plan playing. Should it be viewed equal to a primary insurance plan?

Yes, the contractor should develop mechanisms by which pharmacy providers can bill for vaccine administration claims.

benefit or covers

COVID-19

vaccine administration, but with cost sharing.

45 SOW, 6 15

Set up an electronic system for health care providers to submit COVID-19 837 and NCPDP claims for individuals with a health and/or prescription benefit plan that does not include

COVID-19

vaccine administration as a covered benefit or covers

COVID-19

vaccine administration, but with cost sharing.

Please define "cost sharing." Cost-sharing, for this purpose, means the share of costs not covered by insurance that a patient would pay out of pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but does not include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. See, e.g., Cost Sharing. Edits have been made to the PWS.

46 SOW, 6 15

Implement a system of edits at the EDI gateway or where applicable

Please detail the expected edits required to be performed at the EDI gateway regarding eligibility & reimbursement

The contractor is expected to possess technical expertise and knowledge of industry standards edits to HRSA for approval.

to identify claims not meeting program eligibility or reimbursement guidelines resulting in rejection of non-compliant claims.

47 SOW, 7 16

Implement fraud detection processes equivalent to commercial standards for reviewing and adjudicating claims. Detect and notify the COR within one

(1) hour from when fraudulent activity is detected and/or when an entity that is under investigation by any other Federal Government agency that submits a claim.

Payments shall

Please define "commercial standards" as it relates to fraud detection.

The contractor is expected to possess technical expertise and knowledge of industry standards and best practices in order to propose fraud detection processes to HRSA for approval.

not be issued to an entity in the event that fraudulent activity is detected and/or the entity is under investigation by any other Federal Government unless approval is given by the

COR.

48 SOW, 7 16

Send provider (including billing agents or clearing houses, acting on behalf of the provider) claims to a collection point that houses preprocessing functionality before entry into the adjudication systems.

Please describe the function and desired goal of the "preprocessing function"

The contractor shall develop a mechanism to complete all provider validations and claim eligibility checks prior to claims processing to prevent ineligible claims from being processed.

49 SOW, 7 16

Accept claims that meet eligibility requirements during established dates of service submitted by eligible provider(s) and only contains patients that have been determined eligible, defined as having insurance which does not cover vaccine administration, or covers vaccine administration but with patient cost sharing.

Please describe the process for determining if a specific insurance plan does not cover vaccine administration

Examination of the Claim Adjustment Reason Code provided in the remittance received from the payer.

Databases and processes leveraged to validate insurance coverage are to be identified and managed by the contractor.

50 SOW, 7 17

Establish and maintain written process that shall be shared with the COR that outlines the Contractor’s claims verification process to

Please provide the "eligibility requirements as indicated in HHS policies and regulations." Can you provide exact policy and/or regulations?

Please refer the program terms and conditions:

https://www.hrsa.gov/sites/default/files/hrsa/pro vider-relief/terms-and-conditions-coverage-assistance-fund.pdf ensure that claims are accurate and meet all eligibility requirements as indicated in HHS policies and regulations.

51 SOW, B 3

Required fields for electronic data interchange (EDI) and Paper claims (claims will be rejected/returne d without these fields populated)

– shall be used for patient verification demographics:

Will paper claims be allowed from medical providers?

No.

52 SOW, B 3

Required fields for electronic data interchange (EDI) and Paper claims (claims will be rejected/returne d without these fields populated)

– shall be used for patient

Is there a time requirement for the rendering provider requesting reimbursement to submit a claim from date of service?

Claims must be submitted within 365 calendar days from the date of service. Edits have been made to the PWS.

verification demographics

53 SOW, II 4

Leverage clearinghouses that Contractor may have existing relationships with to accept EDI and NCPDP claims, rather than requiring each individual provider to enroll in EDI or CEDI directly with Contractor.

Although separate contracting with a clearing house cannot be required, is it allowed?

Yes.

54 SOW, 3.4 7

Chair semi-weekly conference calls with the COR, providing an agenda by 5:00 PM Eastern Time (ET) the day prior, and update the agenda with action items and any corrections within 24 hours of the meeting.

Are the semi-weekly calls with the COR required for the entire duration of the contract of a period of time post award?

The semi-weekly calls with the COR are required for the duration of the contract.

55 SOW, 3.5.2 8

Provide a weekly report to the COR due on each Wednesday by 6 PM ET. The Weekly Status Report shall be cumulative and contain key data, such as customer service summary statistics, and reimbursement and return details. Each report shall contain data dictionary defining, in plain language, all data elements in the report.

What format are reports to be provided in?

Excel/CSV/PDF? Are data requirements provided for each report?

Weekly reports will be submitted in both Excel and .TXT formats. Edits made to Deliverables Table.

56 SOW, 3.7 10

Send any and all requests for changes, such as modifications to the COR and/or

CO.

Is there an expectation that requests for teleconferences/meetings from Government officials other than the CO or

COR?

All communication of this nature is supposed to route through the COR, While all programmatic communications shall be through the COR, there may be times in which program staff also communicate directly with the contactor.

57 SOW, 3.9 10

Implement Contractor performance and quality metrics in the Quality Assurance Surveillance Plan (QASP). The COR will evaluate the Contractor using these metrics on a weekly basis.

HHS/HRSA will require frequent updates on total claims reimbursements to ensure that the COVID-19 Vaccine Administration Assistance Fund stays within statutory funding limits.

What are the metrics outlined in the QASP? All proposals shall include a draft QASP. PWS has been revised to reflect this. See also L.4.2 Technical Approach which requires offeror's to include a draft QASP with their proposal as well as proposed metrics.

58 SOW, 5.2 15

For individual(s) (patient(s)) where eligibility is determined to be covered under the Vaccine Administration

Will a digital ID card be an option provided it is issued in a secure format?

Temporary Member ID refers to a Temporary Member ID number generated by the contractor for provider use during claim submission and processing.

Assistance Fund Program, issue temporary member IDs for the use of claims submissions and processing.

59 SOW, 5.2 15

For each claim, perform prepayment verification of patients’ insurance coverage status at time of service. This should include comparing submitted information about a patient’s coverage with information in Clearinghouses.

Is the expectation to send claims to a found qualified plan via 837 format? Is there an expectation to notify the rendering provider of the billing to a found qualified plan?

No, the Contractor is not required to send claims to a found qualified plan. Yes, the contractor is required to notify the rendering provider of the billing to a found qualified plan.

60 SOW, 7.2

16/1

Verify the Providers status using the following lists:

o Office of Inspector General's List of Excluded Individuals/Entiti es (LEIE), Will the verifications lists be pushed to contractor or placed into a secure folder for contractor to pull?

The verification lists will be placed into a secure folder for the contractor to pull.

updated monthly;

o Medicare Revocation List, updated weekly;

o Medicaid Termination List, updated monthly;

o CMS Compliance Hold List, updated monthly;

o Notify the COR and appropriate HRSA Team in writing immediately, in the event that a provider that is on either of the above lists has been reimbursed.

61 SOW, 7.3

17/1

Conduct monthly post pay review on a random sample of claims for the purposes of identifying and detecting patterns of abuse, and flag

Is there a volume expectation for the random sample of post pay reviews?

The contractor is required to conduct monthly post pay review of a random sample of 1% of the cumulative claims paid by the program. See updated PWS at Task 7.3.

any and all potential fraud and notify the COR within one

(1) hour from when fraudulent activity is detected.

62 SOW, 8.5.4 23

Send a reimbursement request to the COR for approval and funds certification prior to the initiation of a transfer to the Contractor’s Bank Account.

What is the timeframe from reimbursement request made to the funds deposited in the Contractor's bank account?

Approximately three (3) to four (4) business days.

63 SOW

Please clarify whether or not receipt of paper claims, and paper-to-EDI conversion, is included in this solicitation. Page 3 includes a reference to paper claims but on page 4 there is only a mention of electronic claims in 837 or NCPDP.

Page 3:

Required fields for electronic data interchange (EDI) and Paper claims (claims will be rejected/returned without these fields populated) – shall be used for patient verification demographics:

Page 4:

Claims will be submitted electronically using either The Electronic Data Interchange 837 Professional transaction or the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Version D.0 (or the most current standard), NCPDP Batch Standard Version

1.2 (or the most current standard).

The program does not accept paper claims.

Updated language in PWS.

64 Section B 2 B.2 Consideration and Payment

Can the Government verify that the volume estimates (in Section B-Supplies OR SERVICES AND PRICES/COTS) are correct?

Yes, estimates are correct.

65 Section B 2

B.2 Consideration and Payment

Can the Government clarify/define the process and volumes of “testing claims” referenced in Section B?

The government relies on the technical expertise of the proposing vendor to determine the approach for processing claims. Volumes are already identified in section B.2.

Can the Government reconfirm that electronic pharmacy claims (NCPDP) is a confirmed requirement? Are these claims also expected to be secondary claims, and will the requirement be to adjudicate/process these claims in real-time (as in the retail model) or in batch jobs?

Yes, this is correct. These are expected to be secondary claims with the program covering payments gaps where the pharmacy benefit plan did not cover the cost of vaccine administration or did, but requires patient cost sharing such as a co-payment.

The contractor is expected to possess technical expertise and knowledge of industry standards processes to HRSA for approval.