Document A Q Response.pdf

Q: Who currently holds the contract for this business (who is the incumbent)?

A: Ability and Availity are currently providing services until a long‐term contract is awarded.

Q: Even with integration into RPMS, will CSU employees need a tool to log into to review, edit and resubmit claims?

A: Integration will provide the ability to export claims from RPMS into the Clearinghouse to payers and provide the ability to download data in reports and excel. The Clearinghouse will be able to post electronic payments and produce EOBs in Clearinghouse. Electronic payment records are able to download and post to RPMS AR. Staff would have capability to review, edit, and resubmit claims within Clearinghouse to export to payer.

Q: Will the offeror’s system be required to post into RPMS, or will offeror’s data files be received by RPMS so that RPMS can run the auto‐posting jobs?

A: The Clearinghouse will be able to post electronic payments and produce EOBs in the Clearinghouse. Electronic payment records will be able to download and post to RPMS AR.

Q: Can the agency describe to what extent the offeror will be required to integrate with RPMS?

What transactions are required to be integrated? What automation or actions will the offeror be required to provide?

A: Exporting to payer and electronic payments to upload and post.

Q: Can RPMS generate outbound HIPAA EDI files, such as 837, 835, 271?

A: RPMS can export 837, and 835. 271 is Clearinghouse related will need to verify with IHS IT security regulations. Clearinghouse should have realtime 270, 271 for eligibility verification on exporting.

Q: Can the agency clarify, will electronic pharmacy claims be received, and need to be converted to 837i electronic claims or dropped to HCFA1500 paper claims?

A: Veterans Affairs (VA) Claims.

Q: Will pharmacy claims be sent to a PBM or other pharmacy agent?

A: Veteran Pharmacy Claims need to be sent to payer.

Q: Does prime bidder have to be Tribal owned, or can it be a minority owned small business company owned by an individual Native American? (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).

A: Tribal Government ownership is not required. Businesses owned by Individual tribal members are acceptable in accordance with the Buy Indian Act.

Q: There seems to be a conflict in the requirement for a Native American Small Business vs an Indian Economic Enterprise. The criteria for these designations are different.

A: The solicitation specifies Small Business Indian Firms that meet the NAICS Code Small Business size standards. The IEE representation form verifies ownership is in accordance with the Buy Indian Act.