RFI_Medical Claims Management.pdf

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REQUEST FOR INFORMATION (RFI)

IMMIGRATION AND CUSTOMS ENFORCEMENT (ICE)

ICE HEALTH SERVICE CORPS (IHSC)

MEDICAL CLAIMS PROCESSING SERVICE

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. Currently, the government is considering North American Industry Classification System (NAICS) number 518210 - Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services. A final NAICS determination will be made after the Market Research is analyzed.

• 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

RESPONSE REQUIREMENTS

The submission must include response to the following:

1. What are your typical and realistic timeline for transitioning complex and comprehensive claims adjudication and provider reimbursement services (i.e. the system will be fully operational and all staff onboarded)?

2. What are the key milestones and deliverables considered in your typical transition plan

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3. Please provide examples and key lessons learned from previous transitions of similar size, complexity, and scope.

4. What best practices do you recommend ensuring a successful transition of services?

5. Describe your claims processing technology that can adjudicate medical and dental claims submitted from community providers (emerging technologies) including the system’s functionality, compliance with federal standards, average adjudication time frame per claim, timely filing practice, appeals process, and denial rates.

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

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

8. Describe prior experience establishing a claims reimbursement banking process for facilitating payments to medical providers on the government’s behalf. Are you able to reimburse providers directly for services rendered? If so, describe the process and any associated controls to ensure accuracy and timeliness. Can your system adjust for overpayments and/or manage bills of collection? Describe the process for identifying and resolving overpayments.

9. Would you require contract financing for payment of the adjudicated and approved claims (advanced payments, delivery payments, etc.)? Or could you absorb the cost, and the government would simply reimburse you for the paid claims?

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

11. Do you have a contract with a specific clearing house for clean claim clearance or rejects prior to submission and processing in your claims adjudication system? If so, describe the process/workflow? Does your system allow claims to be pended for additional information rather than issuing immediate denials?

12. Does your medical claims processor have analytic capabilities to ensure program integrity (identify duplicates as well as reduce fraud, waste and abuse)? What types of fraud, waste, and abuse capabilities does your system used for medical claims management have for real-time detection of medical claims?

13. Do you have the ability to purchase medical supplies and Durable Medical Equipment (DME)? If so, please describe the process. Do you have the ability to pay for invoiced services such as DME or non-emergent medical ground/air transportation services?

14. Is your system scalable to handle large volumes of claims and users? What is your range of coverage (national, regional)? What volume range is within your capability related to claims processing?

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

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

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

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

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

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20. 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.

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

22. Describe prior experiences with government or similar contracts supporting a claims management service. Please include:

a. Government Agency

b. Government Point of Contact (POC)

c. Applicable Contract/Order Numbers

d. Annual Contract Value

e. Total Contract Value

f. Brief Description of Tasks Performed

g. Approximate Number of Full Time Employees (FTEs)

h. Periods of Performance

23. Do you have experience working within the federal government cloud environment (e.g., GovCloud)? If so, describe prior experience and security implementation.

24. Describe your experience in supporting the federal government with obtaining an Authority to Operate (ATO). Describe your experience in supporting the federal government with obtaining a Privacy Threshold Analysis (PTA).

25. Explain your capabilities and experiences with respect to data transmission and exporting data in various formats required for IHSC decision-making/operations (SFTP/Secure File Transfer Protocol, Pipeline Connectors, CSV, Excel, data formats, etc.). Data contents of interest to the federal government include, but are not limited to: paid claims, denied claims, healthcare provider information, and reference tables (e.g., ICD Codes, CPT Codes, Medicare/Medicaid Data Tables, etc.).

26. Explain your experience with developing/delivering both technical and business documentation to include, but not limited to: data dictionaries that explains fields and tables;

data mapping documentation; SQL queries for report generation; workflow diagrams; system diagrams; business rules/logic/algorithms; etc.

27. Describe any innovative business and/or technical enhancements that you have successfully implemented to either save resources (cost, time, etc.) or improved overall functionality (automation, accuracy, credibility, etc.).

28. Describe your capability to transfer in authorization referrals and custody data from an external system (e.g., federal government system) into your solution and process them in accordance with federal government business rules.

Describe any Artificial Intelligence (AI) and Machine Language (ML) tools that you have used to detect duplications, fraud, waste, abuse, and missing data values. What kind of error reporting and alert mechanisms are available within your solution? What kind of system availability and disaster recovery capabilities are provided by your solution?

29. What contract types are typically utilized (i.e. Firm Fixed Price, Labor Hour, Reimbursable, Hybrid etc.)? What Contract Line Item Number (CLIN)/pricing structures are commonly utilized? Please provide an example.

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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 June 24, 2026, 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 Microsoft Word or Adobe pdf format and submitted via e-mail to the Contracting Officer at Genna.Braden@ice.dhs.gov. Submission must be received no later than July 15, 2026, by 5:00 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 the NAICS code(s) considered for this requirement.

o Contracting Point of Contact(s) (Name, title, email, and phone number) o Technical Point of Contact(s) (Name, title, email, and phone number) who has the authority and knowledge to clarify responses with government representatives.

• Be a maximum of twenty (20) pages inclusive of the cover letter (Font size 11, Times New

Roman).

• Not including 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.

mailto:Genna.Braden@ice.dhs.gov mailto:Genna.Braden@ice.dhs.gov http://www.sam.gov/

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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 requirements 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.