A00001_RFI_Clean.pdf

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REQUEST FOR INFORMATION (RFI)

IMMIGRATION AND CUSTOMS ENFORCEMENT (ICE)

ICE HEALTH SERVICE CORPS (IHSC)

MEDICAL CLAIMS PROCESSING SYSTEM

BACKGROUND/PROGRAM DESCRIPTION

The Department of Homeland Security (DHS) is conducting market research to identify potential vendors capable of providing a comprehensive medical claims processing system.

The system must support claims adjudication, reimbursement, program integrity, and related functions. Vendors are invited to respond to the specific questions outlined in the Response Requirements section below.

PURPOSE OF REQUEST FOR INFORMATION

THIS IS A REQUEST FOR INFORMATION (RFI) ONLY. This RFI is being issued to assist DHS in identifying potential vendors capable of providing a comprehensive medical claims processing system as well as understanding available solutions and industry capabilities to meet the below requested services:

• Medical and dental claims adjudication and provider reimbursement o Medicare rates for medical and 90% usual and customary reimbursement related to dental o Average medical claims count per year – 300,000 o Auto approval for emergency department claims o Prior authorization of referrals required

• Pharmacy Services o Stock medications purchase for facility clinics from wholesaler o Vaccine acquisition from vendor o Pharmacy Benefits Manger (PBM)

Prescription purchase through retail and mail order pharmacies Prescription approval and denial

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Prior authorization processes

• Bulk/High Volume/High Price invoicing for services and supplies o Medical supplies o Durable medical equipment acquisition o Ground/Air ambulance and non-emergent medical transport service

RESPONSE REQUIREMENTS

The submission must include response to the following:

1. Describe your claims processing technology that can adjudicate medical and dental claims submitted from community providers (emerging technologies).

2. Describe the system’s functionality, compliance with federal standards, average adjudication time frame per claim, timely filing practice, appeals process, and denial rates.

3. Describe the level of automation versus manual review in your medical claims adjudication process.

4. Does your solution support the acceptance of paper claims in addition to electronic submissions? If so, please describe the process and any associated limitations.

5. Are you able to reimburse providers directly for services rendered? If so, describe the process and any associated controls to ensure accuracy and timeliness.

6. Describe the enrollment process for provider enrollment to receive payment.

7. Describe prescription adjudication and the claims process from retail and mail-order pharmacies.

8. How do you house database for eligibility for prescription claims?

9. Do you have a clearinghouse for claims and medical records submissions?

10. Does your system allow claims to be pended for additional information rather than issuing immediate denials?

11. Can your system adjust for overpayments and/or manage bills of collection? Describe the process for identifying and resolving overpayments.

12. Does your medical claims processor have analytic capabilities to ensure program integrity (identify duplicates as well as reduce fraud, waste and abuse)?

13. Do you have the ability to purchase medical supplies and Durable Medical Equipment

(DME)? If so, please describe the process.

14. Do you have the ability to pay for invoiced services such as DME or non-emergent medical ground/air transportation services?

15. Is your system scalable to handle large volumes of claims and users?

16. Can your system integrate with other government systems, such as electronic health record (EHR or EMR)?

17. What interoperability standards (e.g. HL7, FEDRAMP) does your system support?

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18. Do you have the current ability to manage a full-scale provider network to include credentialing, enrollment, and maintenance?

19. Do you currently utilize a provider portal and if so, what services are incorporated for the provider?

20. What types of reporting or dashboard capabilities do you currently use for real-time data sharing?

21. Do you have any type of referral/authorization portal? If so, describe your processes and what national guidelines (e.g. InterQual, MCG, etc.) are used in your processes.

22. Describe your customer and business support services (call center, mail room, enrollment, etc.).

23. What is your range of coverage (national, regional)?

24. What volume range is within your capability related to claims processing?

QUESTIONS

Questions shall be directed to the Contracting Officer, Ms. Genna Braden, via email at Genna.Braden@ice.dhs.gov, and must be received no later than August 13, 2025, by 12:00 pm Central Standard Time (CST). Verbal questions or requests will NOT be accepted.

Questions and requests for additional information may be answered/addressed by publicly posting the government’s responses. Accordingly, questions and requests for additional information shall NOT contain proprietary or classified information. The government may not provide response to every question or request received. Additionally, questions and requests received after the submission deadline may be answered at the discretion of the government.

RESPONSE INSTRUCTIONS

Responses shall be in either Word or PDF format and submitted via e-mail to the Contracting Officer at Genna.Braden@ice.dhs.gov. Submissions must be received no later than no later than August 28, 2025 by 12:00 pm CST. Late submissions may be considered at the discretion of the government.

Additionally, submissions must:

• Address all items outlined in the Response Requirements section.

• Include a Cover Letter which contains the following information:

o Date submitted.

o Company name, mailing address, and website address.

o Company's System for Award Management (SAM) registration status. All respondents must register on the SAM located at http://www.sam.gov/.

o Company Unique Entity Identifier (UEI) number.

o Company’s SAM size and socio-economic status information for NAICS codes relating to this requirement.

o Contracting Point of Contact(s) (Name, title, email, and phone number) mailto:Genna.Braden@ice.dhs.gov mailto:Genna.Braden@ice.dhs.gov http://www.sam.gov/

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• Be a maximum of fifteen (15) pages inclusive of the cover letter.

• Not include proprietary information. Submissions containing sensitive or proprietary information are highly discouraged unless excluding such information would inhibit the vendor’s ability to provide a complete submission. Any submitted proprietary information must be clearly marked. Only unclassified submissions will be accepted.

REQUEST FOR INFORMATION CONDITIONS AND NOTICES

The RFI is solely for market research, planning and information purposes. It shall not be construed as a commitment by the government to issue a subsequent solicitation (Broad Agency Announcement, Request for Proposal, etc.). Furthermore, the government is not at this time seeking quotes and will not accept unsolicited quotes. Respondents are advised that the government will not reimburse for any information or administrative costs incurred in response to this RFI; all costs associated with responding to this RFI will be solely at the interested parties’ expense. Not responding to this RFI does not preclude participation in any future solicitation, if any is issued.

The agency does not intend to award a contract because of this RFI, but rather gather capabilities and market information pertinent for acquisition planning. The responses to this RFI will be captured as market research and may contribute to the development of an acquisition strategy. Information provided may be used to assess tradeoffs and alternatives available for potential requirement and may lead to the development of a solicitation.

The information provided in this RFI is subject to change and is not binding on the government. All submissions become government property and will not be returned. The government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Unless advised or indicated on the responses to this RFI, all information furnished will be considered non-proprietary.

The government reserves the right to hold one-on-one meetings as a result of responses received from this RFI as part of its market research. In addition, there may be a need to seek further clarification from those respondent(s) identified as capable. This clarification may be requested in the form of brief verbal communication by telephone; written communication;

electronic communication; or a request for a presentation of the response. The government reserves the right to seek additional information from those vendors identified with unique solutions that are determined to be beneficial to the government.