JSU Clearinghouse Services SOW.pdf
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- Jicarilla Service Unit Clearinghouse Services
- Solicitation number
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About this file
This Statement of Work outlines requirements for clearinghouse services at the Jicarilla Service Unit of Indian Health Services. The contractor must provide electronic healthcare transaction services facilitating claims and payments between providers and payers, with specific emphasis on claims processing, eligibility verification, regulatory compliance (HIPAA and CORE), and pharmacy services including direct connection to IHS Pharmacy Point of Sale billing system.
The work will be performed at the Jicarilla Service Unit Business Office and HIM Department in Dulce, NM. The contractor is responsible for implementing all required software and must provide access to a network of over 1 million physicians and 2,400 payers. The contract is multi-year with operations Monday-Friday 8am-4:30pm, excluding federal holidays. The contractor must comply with all Federal, State, Local, Tribal and IHS regulations while ensuring minimal disruption to government personnel, property and the public.
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STATEMENT OF WORK
Change Healthcare Clearinghouse
Purpose:
The contractor shall provide clearinghouse services that facilitates electronic healthcare transactions, including claims and payments, between providers and payers.
Description of Service/Supplies:
The contractor shall be in accordance with all Federal, State, Local, Tribal and IHS regulations and shall be made with minimal divergence from the schedule established and with minimum disturbance and maximum protection of government personnel, property and general public.
Background:
Requiring a clearinghouse that allows providers and pharmacies to communicate with payers and PBMs about claims and payments. This includes checking a patient’s eligibility, sending claims, and receiving information about payment.
Scope:
Claims: Healthcare facilities use Change Healthcare to submit and receive payment for claims.
Eligibility and benefits: Change Healthcare helps verify eligibility and benefits before care to determine health coverage.
Regulatory compliance: Change Healthcare helps with HIPPA and CORE compliance, as well as government benefit reporting.
Pharmacy Services: Change Healthcare is responsible for direct connection to Indian Health Services Pharmacy Point of Sale billing system.
Network Access: Change Healthcare provides access to over 1 million physicians and 2,400 payers.
Materials: Contractor is responsible for implementing all software.
Place of Delivery:
Jicarilla Service Unit Business Office and HIM Department 500 N Mundo Dr.
Dulce, NM 87528
Persons of Contact:
Kayla Sandoval- primary COR, Tammie Valdez-Alt, COR
Period of Performance: multiple year contract. Contractor shall follow the hours of operation to complete task. Jicarilla Service Unit is open Monday-Friday 8am- 430pm. Exclude federal holidays.
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