Scope of Work revision 1.pdf

Scope of Work

Revenue Cycle Management

General:

This Scope Of Work (SOW) describes the requirements for a Network Service Vendor software agreement which provides Subscriber and Dependent coverage for eligibility, submission of Institutional and Professional 837 EDI files (claims) for Medicare, Medicaid and Private Insurance payers, as well as scrubbing, editing and status inquiries of medical claims.

Background:

IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American

Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million

American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states. Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest

Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

Scope:

The Contractor shall provide Revenue Cycle Management software as a service for eligibility verification and medical claims processing at Chinle Comprehensive Health Care Facility.

Location:

Duties and responsibilities will be used by the Chinle Comprehensive Health Care Facility, Chinle, Arizona. Contractor shall provide monthly subscription services.

Place of Performance:

Service applications are to be performed by the Chinle Comprehensive Health Care Facility, Chinle, Arizona.

Period of Performance:

July 01, 2021, to December 31, 2021. Will be flexible and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

Major Duties and Responsibility Requirements:

Patient Access ‐ Ability to verify multiple commercial and government payers. Results in faster/more reimbursement for the facility.

‐ Identify additional billable insurance coverage for patients.

Billing ‐ Electronic claims submission for Medicare, Medicaid, Veteran Administration and Private Insurance.

‐ Provides claims status and 999 reports for electronic claims submitted to Medicare and other payer.

‐ Dashboard of insurance rejections by date, payer, user and other metrics.

‐ Ability to run reports for errors, denials, and rejections.

‐ Capability to identify and correct claim errors, obtain denial reasons and resubmit claims to payers.

‐ EDI claims tracking capability.

FISS/DDE

‐ Securely connect to Medicare Direct Data Entry (DDE).

‐ Support for multiple log‐ins and user IDs.

‐ Complete visibility to Medicare claim submissions and adjudication.

‐ Online claim corrections and ability to obtain denial reasons.

Definitions:

Acceptance: Constitutes acknowledgement that the network services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the

Contractor from responsibility for compliance with contract requirements.

Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

Contractor: The individual awarded a legal binding contract to provide supplies and services.

Contracting Officer's Representative (COR) or Project Officer (PO): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day‐to‐day program management of the ordering activity's task orders. Ordering activities may have different designators for this employee (e.g. GTR – Government Technical Representative, COTR‐Contracting Officer's Technical

Representative, or PO ‐ Project Officer).

Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

Ordering Activity Contracting Officer: A Government employee of IHS authorized and warranted to issue requests for services and to make modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of maintenance services.

Requirements:

The Contractor shall provide full network server services in the delivery of IT server services to CCHCF, an IHS provider. Specific tasks include the following:

Requirements: The Contractor shall maintain full network services for the delivery of IT services to

CCHCF.

The Contractor shall provide training to CCHCF users of Contractor’s services.

The Contractor shall limit the amount of downtime with continuous operations.

Submission of Invoices: The contractor will submit invoices in accordance with FAR 52.212‐ 4(g) on a monthly basis beginning January 01, 2021 to December 31, 2021, to the Chinle Comprehensive Health

Care, Facility, Attention: Business Office, P.O. Drawer PH, Chinle, Arizona 86503. Telephone: 928‐674‐

7166; Fax: 928‐674‐7705.

Contractor Qualification Requirements:

Experience. The Contractor shall possess basic knowledge, skills and abilities to maintain and provide network services on a monthly basis.

The Contractor shall be in full compliant with Health Insurance Portability and Accountability Act of 1996

(HIPAA).

The Contractor shall define license and all relative documents.

Government Furnished Information, Property and Services:

Inspection: All services rendered will be inspected, reviewed, and monitored by Patrick Yazzie, BOM.

Contracting Officer Representative (COR): Michael Lampert

Department Point of Contact: Patrick Yazzie