ATTACHMENT A - Statement of Work.pdf

Shiprock Service Unit Clearinghouse Claims Management Vendor

Scope of Work

A. SCOPE OF WORK:

Clearinghouse Claims Management Vendor to provide a revenue cycle process which contains at a minimum:

automated components for Claims Submission & Management, Remittance & Payment Management, and Patient Billing & Payment Management. Clearinghouse vendor is to provide an innovative automated solution which improves the revenue cycle process and maximizes Medicare reimbursement, from front-end eligibility verification to reimbursement posting. The scope of the clearinghouse vendor is to provide accurate and regulatory billing reviews and reporting notices to assure accuracy, minimize denials, and improve the quality of billing data submitted to third-party payers. The clearinghouse vendor preference must incorporate a web-based, be HIPAA-compliant, and provide billing management solutions to include a single claims management interface for virtually all government and commercial payers.

B. OBJECTIVES:

The business objective of the clearinghouse vendor is to contain a revenue cycle management solution which will support and maintain the continuity of critical and timely services with Shiprock Service Unit; this in turn will support the I.H.S. mission of improving quality, safe and accessible healthcare services to the Alaskan Natives and Native Americans we serve in Indian Health Services.

The interconnection will be to assist the Shiprock Service Unit Business Office in performing patient eligibility verification, inquire of claims status, and provide address verification on a real-time basis. All transactions get routed through a communication server’s proprietary direct server engine and over a secure, encrypted connection to the vendor’s processing center that functions as the clearinghouse for claims management, billing, and eligibility inquiry transactions between Shiprock Service Unit and the clearinghouse. The Shiprock Service Unit Business Office, seeking to improve the accuracy and efficiency of its registration and billing operations, will utilize the clearinghouse vendor’s eligibility system to provide real time verification of eligibility, claim status, address, and other vital information.

C. PLACE OF PERFORMANCE AND PERIOD OF PERFORMANCE:

Delivery Location:

Northern Navajo Medical Center PO Box 160 Shiprock, New Mexico 87420

Four Corners Regional Health Center Highway 160 & Navajo Route 35 Teec Nos Pos, Arizona 86514

DZ Health Center 6 Road 7586 Bloomfield, NM 87413

Hours of Operation:

24/7 for Northern Navajo Medical Center Monday to Friday 8:00am to 4:30pm for FCRHC and DZ Health Center

Period of Performance:

Service will be provided for 12 continuous months with four Option Years

D. MAINTENANCE / SUPPORT PROCESS BY CONTRACTOR:

Contractor will provide the Shiprock Service Unit Business Office(s) on the maintenance and on-going support associated with vendor-related projects that may include:

1. Software Upgrades

2. Web-based connectivity service

3. Real-time EDI transactions including patient eligibility verification, claims status, address verification, denial/payment management, auto posting and others that have interface with the existing patient registration system so that inquiry and response data are electronically transferred between the RPMS registration/third party billing system and the clearinghouse solution program and its contracted carriers.

4. If required, programming fees will be a part of this maintenance and support services. Such programming services should include the transition process of the applicable Medicare intermediary services and any other third-party requirements, such as ICD and CPT mandates.

5. All maintenance and support services will be for the following Shiprock Service Unit locations:

i. Northern Navajo Medical Center

a) Ambulatory Care Center (Day Surgery Unit)

b) Toadlena Clinic

c) Sanostee Clinic

ii. Four Corners Regional Health Center

iii. Dzilth-Na-O-Dith-Hle Health Center

E. SECURITY, SAFETY, AND PRIVACY:

The Vendor/Contractor shall take appropriate security measures to ensure systems and other Government property is stored and installed in accordance with security guidelines and applicable regulations.

The Vendor/Contractor shall comply with all Federal, State and Local Safety regulations.

The Vendor/Contractor will adhere to Privacy and Patient Confidentiality laws that are consistent with the Privacy Act and JCAHO regulations.

SSU/Vendor/Contractor shall comply with all Federal, State and Local Safety regulations.

SSU will ensure security measures are in place to protect acquired equipment from disruption.

F. SSU SHALL PERFORM:

1. SSU shall provide third-party claims for the Contractor to process through the claims services.

2. SSU will provide and comply with required electronic transactions as required by the claim master suites, payment management, denial & Medicare management and switching services. Rejected claims will be corrected and resubmitted by SSU in a timely manner.

3. SSU is responsible for any costs incurred in connection with modifications or enhancements to the I.H.S.

software system that are necessary for implementing the interface with the claim master suites and switching services as required.

4. SSU will initiate and process all required procurements that will obligate funds for the claim master suites, denial management and point of sale switching services. SSU will also make timely payments on the invoices

5. SSU will implement a performance matrix to track and monitor period of performance.

6. SSU will initiate and coordinate with the customer service center with clearinghouse vendor on any issues or concerns that arise with the portal access, transmission of electronic claim files, setting up transaction codes, etc.

G. GOVERNMENT FURNISHED PROPERTY:

1. The Vendor/Contractor shall safeguard all Government property provided for use.

2. The Vendor/Contractor shall notify the Government any time the Contractor moves Government furnished equipment.

3. The Vendor/Contractor shall ensure that the Government facilities, equipment and materials are secured at the close of each work period.

4. The Vendor/Contractor shall take appropriate measures to safeguard their Government Issued Security badges and common access cards.

5. The Government shall provide access to applicable areas to complete the work requested.

6. The Government will provide appropriate space, power, and network connections to complete the work requested.

7. The Government will provide onsite support to work directly with the Vendor/Contractor as needed.

H. Section 508 and Accessibility

• 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 2.1 Level AA standards as outlined below.

• 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.

All Information and Communication Technology (ICT) deliverables under this contract (e.g., websites, applications, electronic documents, and multimedia) must comply with the Revised Section 508 Standards (36 CFR Part 1194) and the Web Content Accessibility Guidelines (WCAG) 2.1 Level AA standards. The Contractor shall ensure accessibility of all ICT deliverables and provide conformance documentation in the form of a Voluntary Product Accessibility Template (VPAT®) / Accessibility Conformance Report (ACR), or by completing the HHS Section 508 Accessibility Checklists. The current VPAT 2.5 template includes fields for reporting conformance to WCAG 2.1 and shall be used to document accessibility. The Contractor shall remediate any identified accessibility issues at no additional cost. The Contracting Officer will include the applicable Health and Human Services Acquisition Regulation (HHSAR) clauses 352.239-73 and 352.239-74 in the solicitation and resulting contract.

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!vedKLLB5_q-JnK_FWuxIHjnfvu3bigv6MkrYklx75ENWFof8NoauH6JFLD1wOKGX-P6kI-KyTMAxuVtJTY90E0t0pOA0ev6N0g$ 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!vedKLLB5_q-JnK_FWuxIHjnfvu3bigv6MkrYklx75ENWFof8NoauH6JFLD1wOKGX-P6kI-KyTMAxuVtJTY90E0t0pOA0ev6N0g$ https://urldefense.us/v3/__https:/www.itic.org/policy/accessibility/vpat__;!!Og_tST9LxTiQE1I!vedKLLB5_q-JnK_FWuxIHjnfvu3bigv6MkrYklx75ENWFof8NoauH6JFLD1wOKGX-P6kI-KyTMAxuVtJTY90E0t0pOAoG-BB7w$ https://www.w3.org/TR/WCAG21/ https://www.itic.org/policy/accessibility/vpat https://www.hhs.gov/web/section-508/accessibility-checklists/index.html https://www.acquisition.gov/hhsar/part-352-solicitation-provisions-and-contract-clauses#Section_352_239_73_T48_4018362938 https://www.acquisition.gov/hhsar/part-352-solicitation-provisions-and-contract-clauses#Section_352_239_73_T48_4018362938