Amend_5_Responses_to_Questions.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

05/17/2016

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

BCOCODE

Federal Bureau of Prisons Central Office

320 FIRST STREET NW

WASHINGTON, DC 20534

Donna Grube

(O) 202-616-6150 dgrube@bop.gov

6. ISSUED BY CODE7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NO.

RFPP0700NAS1600833

CODE FACILITY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, country, state and ZIP Code) (X)

X 9B. DATED (SEE ITEM 11)

02/19/2016

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X XThe above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning __1__copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment your desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return _______ copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

This solicitation is amended to incorporate responses to vendor questions. The closing date is extended until June 3, 2016, 1:00pm. The Offeror shall include a signed copy of this amendment with their offer.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

Donna Grube

(Signature of person authorized to sign)

15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED

By (Signature of Contracting Officer)

16B. UNITED STATES OF AMERICA 16C. DATE SIGNED

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

RFPP0700NAS1600833/0005 Page 1 of 3 x 1

Table of Contents

Section Description Page Number

1 Solicitation/Contract Form 2 Commodity or Services Schedule 3 Contract Clauses 4 List of Attachments 5 Solicitation Provisions

RFPP0700NAS1600833/0005 Page 2 of 3

Section 2 - Commodity or Services Schedule

The Federal Bureau of Prisons is seeking proposals for Medical Claims Adjudication in accordance with the solicitation and Statement of Work.

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Section 3 - Contract Clauses

No Clauses

This Section Is Intentionally Left Blank

Section 4 - List of Attachments

No Clauses

No Attachments

Section 5 - Solicitation Provisions

No Clauses

RFPP0700NAS1600833/0005 Page 3 of 3

Federal Bureau Of Prisons Medical Claims Adjudication

Questions from RFPP0700NAS1600833

Can the BOP provide an estimate of future claim volumes?

- It is anticipated approximately 500,000 claims will be generated for 119 institutions; this is variable and cannot be guaranteed. It should be noted some institutions will have small claim volume and others very large volume; this is dependent upon the type and size of the institution. Please note, all institutions may not utilize services during the term of this contract.

Attachment 2, all sections; Attachment 3, Submission Instructions. Please clarify for all volumes the font size, font type, and spacing (single or double) for paragraphs, headings, tables, graphics and captions, headers and footers?

- Courier New, 12 font size, single spacing; all other items will be within standard business writing practices.

Attachment 2 "In Attachment 2, the BOP specifies the maximum number of pages for most sections. Please clarify the maximum number of pages for the following sections:

• Healthcare Provider Invoicing of Medical Services

- It is expected this section will be accomplished in one

(1) paragraph.

• Special Security and Clearance Requirements

- It is expected this section will be accomplished in one

(1) paragraph.

• Billing of Adjudication Services

- It is expected this section will be accomplished in one

(1) paragraph.

• Period of Performance

- It is expected this section will be accomplished in one

(1) paragraph.

• Exclusions

- It is expected this section will be accomplished in one

(1) paragraph.

Attachment 2, page 3 of 28, Minimum System Features.

Please clarify what the BOP means by "episode of care." Also, could the BOP clarify the requirement for a .pdf of the EOB and claim "within the claim system itself?" Is it the BOP's intent

Questions from RFPP0700NAS1600833 to display a .pdf of the EOB and claim image within the system or is it the requirement to produce a print file containing the .pdf documents?

- An episode of care is an interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care and can also identify the sequence of care (e.g., emergency, inpatient, and outpatient).

It is the BOP’s intention that the system should display a .pdf of the EOB, claim, and authorization within a central system; these will be connected to each inmate with the option to print individually or as a group.

Attachment 2, page 3 of 28, Minimum System Features.

The BOP states, "The Bureau expects to locate a .pdf of the EOB, claim and authorization within one central location/system.

Vendor shall provide notification of new/updated information to each institution as it is generated." Please clarify what the BOP intends in terms of "provide notification of new/updated information to each institution as it is generated."

- In the event an EOB, claim and/or authorization is generated/received (corrected claim, EOB changed due to processing error, etc.), the BOP shall be notified specifically that an updated and/or new EOB/claim/authorization is available.

Attachment 2, page 7 of 28, Experience.

The BOP states, "The contractor must have specific experience in medical claims adjudication services required and requested in the SOW. The contractor shall have a minimum of five years of proven, past experiences in this field to perform the services in accordance with the SOW." Please clarify whether or not contractors can use a subcontractor's past experience to meet this requirement.

- The contractor will have five years of experience.

Subcontractor past experiencef will not be evaluated.

Attachment 2, page 10 of 28, Implementation and Training, Section C. The BOP states, "The technical proposal shall include an example of a manual." Please clarify if the manual example counts against the 3-pages length requirement for this section?

Questions from RFPP0700NAS1600833

Would the BOP allow the sample to be included as an Appendix? If so, please clarify the page length of the example.

- The manual example does not count against the three page length requirement. The BOP will allow the example to be included as an appendix. There is no length requirement for the manual.

Attachment 2, page 20 of 28, Period of Performance.

The BOP states, "Option Period Three: 27 months through 48 months." Please clarify if Option Period Three is for 37 - 48 months.

- Option Period Three is for 37-48 months.

Attachment 3, page 2 of 5, Past Performance.

The BOP states, "Past Performance will be evaluated based on the following factors demonstrated during the offeror's performance of services similar to this requirement. The currency and relevance of the information, source of the information, context of the data and general trends in the contractor's performance shall be considered." Please clarify if the BOP's evaluation will include a subcontractor's past performance.

- Subcontractor past performance will not be evaluated.

Attachment 2, page 9 of 28, Authorizations, Paragraph D.

The BOP states, "Based on authorization information, the contractor shall provide, within three (4) business days of receiving an authorization, a good faith estimate (GFES) of the expected costs of the service." Please clarify if the contractor must provide a good faith estimate within three (3) or four (4) days of receiving an authorization.

- The Good Faith Estimate shall be provided to the appropriate institution within four (4) business days of receiving an authorization for services.

Minimum System Features “The system used by the contractor to adjudicate claims shall be an automated system and have the capability, at a minimum, to generate Explanation of Benefits (EOBs) which indicate the correct payment amount for each claim based upon the contracted rates, identify large case management opportunities, and integrate utilization

Questions from RFPP0700NAS1600833 review decision documentation, automatically “pend” claims for medical records review (for certain DRGs), and evaluate potential invoice (claim) error patterns across all healthcare providers (e.g., CMS PEPPER system).”

1. What is being defined as a large case by the BOP? Will there be a per claim dollar amount threshold established, or a cap on an episode of care that will determine how a large case is defined?

- At this time claims (facility and/or ancillary charges) for a single episode of care in excess of $35,000 is considered a large case. However, this is subject to change and it is expected the contractor will be able to modify/update its tracking/identification mechanism to reflect the needs of the agency as it evolves.

2. What type of UR decision documentation will be utilized?

Since the BOP performs all UR functions, are there standard BOP forms that can be provided as examples.

- Currently, we do not have any Utilization Review decision to include in the contractor’s system.

3. Is there an existing list of DRGs that the BOP wants pended?

Will it be specific DRGS or only specific DRGs that meet certain dollar amount or length of stay thresholds?

- There is no existing list of DRGs at this time; however, it is the BOPs expectation that the vendor will identify specific DRGs as well as DRGs that meet either dollar amount of length of stay thresholds as determined by the agency. These will change, and it is also expected the vendor will be able to modify/change the tracking based on the needs of government.

“EOBs shall include detailed information for each line item per claim with an appropriate explanation as to the logic supporting the payment recommendation. The contractor will also address how corrections and/or corrected claims will be addressed within the system with the vendor providing screenshots.”

1. What is the BOPs definition of an Episode of Care?

Typically, and episode of care, when completed, will be comprised of a few to several claims and EOBs. Is the expectation that the contractor will assign an internal

Questions from RFPP0700NAS1600833

Episode of Care tracking number in order to maintain the integrity of each Episode of care? If so, does the BOP have any requirements as to format or application of an Episode of Care tracking function?

- See page 2 for the response to this question.

- An EOC tracking number is not expected.

2. Claims detail by line item on the EOB is not an industry standard practice for hospital bills. Inpatient hospital bills can have several line items based on revenue codes but only a few line items with actual ICD/CPT/HCPS coding.

EOBs for inpatient hospital bills role up to a single line item for the DRG, CMG, RUG, etc. Outpatient EOBs role up into either several APCs or into a single claim payment.

What is the expectation of the BOP with regard to EOB for both inpatient and outpatient claims?

- A preauthorization process shall also be incorporated into the system. The Bureau expects to locate a .pdf of the EOB, claim and authorization within one central location/system. Vendor shall provide notification of new/updated information to each institution as it is generated. At a minimum, EOBs shall contain, inmate name, register number, account number, claim number, Medicare allowed amount, DOS, HCPCS/CPT/ICD-9 code to include modifiers, units, claim amount, markup percentage and final payment recommendation amount and clear explanation(s) of processing logic along with date the claim was received by contractor and date processed.

Explanations will be easily understood by Bureau staff that does not specialize in Medicare claims processing.

The contractor will also demonstrate how adjustments will be reflected on an EOB.

1. It is presumed that the reference to ICD9 was meant to be

ICD10.

- The BOP expects the EOBs to accurately reflect the correct code based on the claim submitted. This may be ICD-9 or ICD-10, depending on the date of the service.

2. Wouldn’t the markup percentage apply only to those claims that are priced under the comprehensive healthcare contract model of Benchmark Medicare +/- a percentage? Case-By-Case pricing may be a percentage discount off billed charges, per diem rates, or even a flat/capitated rate and therefore a markup percentage would not apply. EOBs coded to show a markup percentage would not be able to provide the calculation methodology for non-Medicare pricing. Will it be acceptable for EOBs to show the billed amount from the provider and the resulting payment amount based on the contract specific pricing without the actual percentage application?

- Yes, it is acceptable for the EOB to reflect the billed amount from the provider and payment recommendation calculated utilizing the CBC pricing methodology agreed upon by the institution. However, the methodology and calculations must be clearly identified on the EOB.

Inmate Movement “Inmate location and demographic data will be submitted to the contractor via SENTRY feeds transmitted nightly by IPPA. It is expected the contractor will have the technical infrastructure to accept this information systematically. This system will be updated by the contractor daily to accurately reflect inmate location in real time.”

1. Access and/or data feeds from SENTRY have historically been off-limits to the comprehensive contractors. Will the BOP provide technical specifications, requirement documents, file format information, and data transfer information for the use of SENTRY information?

- The BOP will collaborate with the contractor to identify technical specifications and requirements. Documentation will be established based upon the collaboration efforts between both parties and DOJ requirements for such interfaces.

Invoicing of Medical Services (Claims) Electronic data interchange (EDI) of claims between the healthcare providers and the contractor will be required. Claims are to be itemized and provide the detail necessary to facilitate the adjudication of the claims. The contractor shall provide the Bureau with a copy (can be electronic) of the original claim and an explanation of benefits (EOB) in lay terms

Questions from RFPP0700NAS1600833 for the Bureau to process payments. Additionally, the claim submission summary (or similar report) with notification of acceptance/rejection sent to the health care provider shall also be copied to the appropriate institution.

1. Please define “healthcare provider” and “contractor” in this context. These terms seem to be contrasting each other in this section. Is healthcare provider the healthcare professional servicing the inmate health needs (i.e. physician) or is healthcare provider the comprehensive contract holder? Further, is contractor the comprehensive healthcare contract holder or the audit contract recipient bidding on this RFP? Historically, the community healthcare providers (physicians/hospitals) submit their claims directly to the comprehensive contract holders who then price the claims according to their individual BOP contract; then send EDI files to the claims audit contractor for a secondary repricing, who then sends the findings to the individual BOP institutions. Is it the intent of the BOP to initiate direct contact and communication between the community healthcare providers (specific provider networks of the comprehensive contract holders) and the third party audit contract holder in this scenario?

- The healthcare provider is the comprehensive health contract holder who is responsible for providing the institution the medical services required.

- The contractor is the individual or company who will provide medical claims adjudication services according to the statement of work.

- Questions above do not apply to the medical claims adjudication services required in the statement of work.

2. How will the audit contract vendor submit original claims if the community healthcare providers are submitting their claims, mostly electronically, directly to the comprehensive healthcare contract vendors for pricing adjustments based on the specifics of each comprehensive healthcare contract?

- The question above does not apply to the Medical Claims

Adjudication statement of work.

3. Will the BOP provide a workflow of the anticipated information flow under this contract?

- The workflow of information will be between the contractor who is awarded the medical claim adjudication contract, the institution comprehensive healthcare provider, and the institution.

Interoperability “B. Support secure file transfers of medical claims, EOBs and GFE documents between the contractor and the Department of Justice’s MB system. However, the specific system utilized is subject to change secondary to DOJ system upgrades/changes/requirements. Support secure automated file transfers of inmate information from the Bureau’s mainframe system.”

1. What is the DOJ’s MB system? Are there technical specifications available?

- MB system is Medical Billing. Specifications for this solution will be provided after award. The proposed solution from the vendor should address its capabilities to exchange information via automated file transfers.

2. Subject to change secondary to DOJ system upgrades/changes/requirements is very open ended and virtually impossible to predict or even estimate costs in order to build pricing. Will the vendor on this contract have an opportunity to negotiate rates for significant changes required as a result of significant changes by DOJ to their systems?

- Contract line items will not be renegotiated.

3. Are there technical specifications available for review on the Bureau’s mainframe system to assist with interoperability planning and cost estimating?

- BOP will collaborate with the contractor to identify technical specifications and requirements. Documentation will be established based upon the collaboration efforts between both parties and DOJ requirements for such interfaces.

Questions from RFPP0700NAS1600833

“C. Allow Bureau Central Office Information Systems staff to manage and maintain, if necessary, the system from the Washington, DC, offices.”

1. In what context would the Central Office need to manage and maintain the system? Can you define manage and maintain?

There will inevitably be proprietary coding involved in the overall delivery of this system. What protections will be in place for the vendor? What measures of accountability or remedy will be in place should the Central Office cause issues with the system by “managing and maintaining”?

- The context is related to hardware that may be used to implement a solution. BOP wishes to have the hardware installed at its Central Office location. Managed and maintain, from BOP’s perspective, is to have the hardware physically accessible by BOP IT staff. BOP has no expectation of having access to software and any other proprietary information. However, software system upgrades, hardware upgrades, and patches would be a coordinated effort between BOP and the vendor. An agreement will be established between the parties that identify responsibilities for managing and maintaining the proposed solution.

“D. Function and provide adequate response times across wide-area network connections of three T-1 circuits to as fast as a DS-3 that are part of the Department of Justice’s JUTNET network. Each institution has a 10/100 megabit/second Ethernet network. The Central Office runs a 10/100/1000 megabit/second Ethernet network in its computer room.”

1. Are there technical specifications available for review on the JUTNET network?

- BOP will collaborate with the contractor to identify technical specifications and requirements. Documentation will be established based upon the collaboration efforts between both parties and DOJ requirements for such

“H. Must be able to interoperate with other Bureau information systems such as the email system GroupWise (all emails containing PII shall be encrypted and the contractor all be able to send and receive encrypted email), network file server system from Novell, and our electronic medical and pharmacy systems.”

1. Are there technical specifications available for review on the GroupWise email, Novell file server, and electronic medical and pharmacy systems?

- BOP will collaborate with the contractor to identify technical specifications and requirements. Documentation will be established based upon the collaboration efforts

2. The presumption is that PII stands for Protected Inmate

Information.

- The presumption is not correct; PII stands for Personally Identifiable Information.

“The Contractor must be able to support any and all hardware and software installation that is necessary for the Bureau to connect to and use the new system.”

1. “Any and all hardware and software installation” is very open ended and virtually impossible to predict or even estimate costs in order to build pricing. Will the vendor on this contract have an opportunity to negotiate rates for significant changes required as a result of hardware and software installations by the Bureau that may not be compatible with the overall system?

- Contract Line Items will not be renegotiated.

Provider Data Submission “The contractor will accurately maintain and update provider data submitted from the comprehensive medical contractors as defined in the CMS contracts (Attachment B). This includes, but is not limited to single practitioners, group practitioners, institutional providers, and Doing Business As (DBA) providers as required for HIPAA compliant claim submission as well as ensuring the appropriate Medicare/contract rates are applied during the adjudication process. The proposal shall include the contractor’s plan to receive, update and maintain this information, i.e., web-based, spreadsheet, etc.”

1. The presumption is that by “CMS contracts” the BOP is referring to the comprehensive healthcare contracts.

- CMS contracts refer to the Comprehensive Medical Services contracts.

Security Requirements “B. Allow any stored data to be encrypted both in the database and while it is being transmitted on the local and wide-area networks.”

1. Are the defined encryption standards to be used?

- The National Institute of Standards and Technology (NIST) FIPS 140-2 is the government standard.

“E. Allow all security functions to be performed by facility, regional office, and Central Office staff for their respective levels of responsibility.”

1. Can you define security functions? In what context would security functions need to be performed by the facility, regional office and the Central Office? Having multiple individuals in multiple locations with access to security will compromise the integrity of the security in place.

What protections will be in place for the vendor? What measures of accountability or remedy will be in place should non-vendor access to security cause issues with the system, PHI breech, or intellectual property leaks?

Security functions in this context are synonymous with application roles and responsibilities. The intent is for a solution that will allow hierarchical flexibility that mimics the BOP org structure. For example, a local institution would only have access and privileges for its data. If applicable, regions would only have access and privileges for data of institutions that are within the region. If applicable, Central Office headquarters would have access and privileges for data across all regions and institutions.

Data “The contractor shall describe how the Bureau will have access to the data collected during the adjudication process, and include any costs of providing this service. However, as a condition of a contract, the contractor agrees the Bureau owns all data generated by the medical claims adjudication process and the Bureau will have access to the data. The contractor shall ensure all data files and formats will be sequential flat

Questions from RFPP0700NAS1600833 files containing ASCII character data to ensure compatibility with other Bureau data systems. The contractor shall also provide technical documentation regarding all data files and formats, as well as provide updated documentation as changes occur.”

1. Pricing is requested as a line item, per claim transaction fee and a one-time transition out fee. How will the costs associated with providing the service of Bureau access to data collected be proposed?

- All costs shall be incorporated into the appropriate line items.

2. All data is to be transferred to the BOP in the adjudicated claims files (claims data, EOBs, Authorizations). What other data is the Bureau referring to in this requirement?

- All data refers to claims files.

Authorizations “The contractor shall describe how they will integrate an authorization process into their claims adjudication system to include a .pdf of the form. The contractor shall include specific details on how authorization would be delivered, entered into their system, and tracked. With the exception of the standard outpatient surgical package (i.e., preoperative anesthesia assessment, procedure, and postoperative follow-up), blanket or continuing authorization will not be given. Each episode of care for contracted specialty physician, outpatient, and inpatient hospital services shall be authorized by the institutions. All Medicare-based services provided on-site at a Bureau facility are to be authorized. “

1. It is typical of the comprehensive contracts to also include an authorization process for approving healthcare services for inmates. By the vendor of this contract also providing an authorization form/process; is this not creating additional and possibly redundant work by the BOP institution staff? Would the BOP entertain any alternative methods in an attempt to leverage existing authorization communications/processes from the existing comprehensive contracts?

- These questions are not applicable to the Medical Claims

Adjudication Services’ SOW.

“D. Based on authorization information, the contractor shall provide, within three (4) business days of receiving an authorization, a good faith estimate (GFES) of the expected costs of the service.”

1. As a matter of clarification; is this no longer a requirement of the comprehensive healthcare contracts?

Otherwise, this would be duplicate work which would likely create two separate estimates for the same episode of care.

GFEs will be submitted electronically to the DOJ MB system in .pdf format. However, the specific system utilized is subject to change secondary to DOJ system upgrades/requirements.

- A GFE is a requirement of the Medical Claims Adjudication

Services’ SOW. The vendor must be able to meet this requirement, and describe how they will meet this requirement in the proposal.

1. Subject to change secondary to DOJ system upgrades/requirements: What protections will be in place for the vendor? What measures of accountability or remedy will be in place should changes/upgrades to DOJ requirements adversely affect the vendor’s ability to perform based on the original contract?

- The IT environment is very dynamic. The contractor is expected to have the ability and resources necessary to adapt and perform satisfactorarily at all times. The applicable Federal Acquisitions Regulations will apply.

Implementation and Training “A. The Bureau expects initial training on-site at each individual institution. Institutions currently participating in claims adjudication are to receive training first. The technical proposal will outline a training plan and schedule for the remaining institutions. The schedule will be coordinated with the COR and the Bureau will have final approval.”

1. In order to determine implementation and initial training costs for the initial BOP institutions currently, can you provide a listing of those institutions? Because there is not separate pricing for these two services, the number and locations of those initial institutions will have a large factor on the implementation and training costs.

Furthermore, most institutions have multiple sites that will require training (i.e. FCC Coleman and FCC Butner both have four facilities each).

-FCC Allenwood -USP Atwater -FCI Beckley -FPC Bryan -FCC Butner -FCI Dublin -FCI Estill -FCI Fort Worth -FDC Honolulu -USP Lewisburg -MDC Los Angeles -FCI Memphis -OTV Otisville -FCC Petersburg -FCC Phoenix -FCI Tallahassee -FCC Terre Haute

At sites with multiple institutions, i.e., Butner and Coleman, training will be consolidated.

“C. Contractor will provide institution-specific reference manuals to each site on the medical claim adjudication process.

All manuals shall be current, and notification shall be made by the contractor to the appropriate Bureau staff regarding any updates and/or revisions. Technical manuals will be available in an electronic format that is searchable. Manuals will also be sent periodically at the request of an institution. The technical proposal shall include an example of a manual.”

1. Will electronic reference manuals be acceptable? Hard copy manuals become damages, pages get lost, and maintaining any updates requires administrative effort by BOP staff.

Electronic versions are always available, can be printed for specific sections or in whole, and are easily updated without any involvement of BOP staff.

- Electronic reference manuals are acceptable. However, when the contractor provides onsite training the hard copy manuals are expected. Also, a hard copy manual is expected with the contractor’s technical proposal.

“D. The technical proposal shall include a step-by-step plan for implementation at the institutions currently participating in claims adjudication as well as a plan for the remaining institutions.”

1. Will you provide a list of those institutions currently participating in the existing claims audit contact? Is there a list established for adding additional institutions and can that list be provided for planning purposes?

- See page 14 for the list of institutions currently receiving the services. The contractor is to outline a training plan and schedule for the remaining institutions. The schedule will be coordinated with the COR and the BOP will have final approval.

“Within 30 working days after award of contract: Contractor shall accept and input provider data submitted by comprehensive medical services contractors and complete EDI submission testing.”

1. This will require cooperation by the various comprehensive healthcare contract vendors. Will there be allowances for delays should those vendors not provide cooperation in the transmission of information?

- The 30 working days is a reasonable time to transmit the necessary files to the new contractor. We have not experience any delays with the comprehensive healthcare contractor. All vendors will cooperate in the transmission of information. If there are any issues during transmission, we can discuss.

“Within 60 working days after award of contract: Contractor will complete on-site training at the institutions currently participating in claims adjudication. After completion of training, institutions will send authorization information and contractor will start generating GFEs.”

1. Committing to meeting this 60-day window will be dependent upon advance planning of the number and locations of the currently participating BOP institutions. Will the BOP provide this list?

- See page 14 for the list of institutions currently receiving the services.

“90 days from award of contract: The contractor shall be fully operational and in compliance with all contract requirements.”

1. 90 days to be fully operational at all participating BOP facilities is very optimistic considering the necessary communication, data transfers, and cooperation necessary from the various BOP institutions; as well as the existing comprehensive healthcare contract vendors at those institutions. Will there be any allowance for delays beyond that of the new contractor?

- The 90 days from award is a reasonable time for the contractor to be fully operational. The 22 institutions have been receiving services for the past 4-5 years so they know the process. If there are any issues during this period, we can discuss.

Transition-Out to New Contractor “The current contractor will transition the contract to the new contractor via a mutually agreed upon format. The claims history developed for the outgoing contract will need to be electronically passed to the new contractor.”

1. Claims history should be transitioned in standard HIPPA format. This will avoid any incompatible formats between the old and new vendors. Will the requirements be re-stated to include standard HIPAA transaction formats?

- The current contractor will transition the contract to the new contractor via a mutually agreed upon format.

Reports “Other reports will be required by the Bureau on an ad hoc basis. All requested ad hoc reports will be sent to the requesting party within three (3) business days.”

1. By ad hoc is the BOP referring to the standard reports mentioned in the SOW, only on an other than quarterly basis? Or does ad hoc refer to some other report not yet defined. Without defined reporting parameters, it is impossible to guarantee deliver within 3 working days.

- Ad hoc basis means used for a special purpose or an immediate need. The request for a report may be both;

information required on a stand report or a report not yet defined. When ad hoc reports are requested from the contractor, additional information will be provided.

Payment Schedules “Inmate location and demographic data will be submitted to the contractor via SENTRY feeds transmitted nightly by IPPA. It is expected the contractor will have the technical infrastructure to accept this information systematically. This will be updated by the contractor daily to accurately reflect inmate location.”

1. Access and/or data feeds from SENTRY have historically been off-limits to the comprehensive contractors. Will the BOP provide technical specifications, requirement documents, file format information, and data transfer information for the use of SENTRY information?

- BOP will collaborate with the contractor to identify technical specifications and requirements. Documentation will be established based upon the collaboration efforts

“Case by Case (CBC) is defined as a provider rendering medical services outside of the normal contract payment structure at a rate agreed upon by the Bureau. Bureau comprehensive medical contractors should be utilizing their contracted networks;

therefore, the instances of CBC pricing should be minimal.

However, the Bureau cannot guarantee a limited number of CBC claims as this is secondary to the needs of the institution and is subject to change. CBC rates should be submitted to the contractor by the institution prior to submission of such claims; however, the contractor is expected to contact the institution in an effort to obtain these CBC rates before manually or systematically denying these claims.”

1. Will there be service level agreements or other requirements in place to ensure that should the vendor request CBC information from a BOP institution, that the institution will provide the information within a timeframe which allows the vendor to avoid delays in processing the overall claims file containing the needed CBC pricing?

- As stated in the statement of work, the instances of CBC pricing should be minimal. The contractor should work with the institution to obtain the required information.

Each institution has separate and unique contract(s) with healthcare providers in their area. Therefore, the “network of healthcare providers” will be those healthcare providers with current BOP contracts and agreements. These contracts and agreements will each have formally negotiated and specifically, documented contract payment rates.

Prompt Pay Considerations “Immediately upon receipt of an invoice (claim) from a healthcare provider, the contractor shall date stamp the claim as received. The contractor shall not hold claims prior to date stamping for any reason as this is time sensitive secondary to the Prompt Pay Act. If the contractor receives an improper claim from the healthcare provider, or additional information is required to process the claim, the contractor shall notify the healthcare provider and/or institution within seven (7) days after receipt of the improper claim. Upon receipt of a proper claim, the contractor shall provide the Bureau institution making payment, a written EOB, within four (4) working days.”

1. Please define healthcare provider and contractor as they pertain to this section. It is confusing as it seems to pertain to community healthcare providers submitting claims to the comprehensive healthcare vendors; which takes place prior to the audit vendor becoming involved. Community healthcare providers do not submit claims directly to the audit vendor but to the comprehensive healthcare vendors with whom they have contracts.

- See page 7 for the response to this question.

Information Requirements for Claims and EOBs “Comprehensive medical contractors are required to submit claims with the following information/formats. The claims system, including claims and EOBs, will mirror this requirement.

B. The invoice number transmitted in electronically submitted medical claims shall be referenced in the Patient Account Number field in the 2300 loop, CLM01 segment. In a UB-04 hard copy medical claims, the invoice number shall be included in the Patient Account Number field, block 3a. In a professional

Questions from RFPP0700NAS1600833 hardcopy medical claim submission, the invoice number shall be included in the Patient Account Number Field, block 26.”

1. This requirement is understood to mean that the comprehensive healthcare vendors are required to place their invoice number in the above stated locations on the claims forms. However, these locations are used by the healthcare providers to record their internal account tracking needs. If these fields are used to display the invoice numbers rather than report back to the providers, on their EOBs, the patient account numbers, the provider will not know which accounts to post the payment to upon receipt. Please provide some clarification to this requirement.

- CMS contractors are required to include their invoice number in blocks 3a and 26 as appropriate. As the CMS contracts are not with individual providers, the internal accounting/tracking requirements are between the physician/hospital and the contractor are no concern of the BOP. Claims are currently submitted in this format.

Customer Service “The vendor shall also describe support services available to comprehensive contractor regarding HIPAA critical issues and EDI rejections.”

1. Historically, comprehensive contractors were prohibited from direct communication with the claims audit vendor, without BOP contract personnel present or on a call. Is this no longer a requirement?

- This assertion is incorrect. The vendor has, in fact, historically been permitted to discuss issues directly relating to the transmission/receipt of claims via EDI, i.e., HIPAA critical changes, provider data submissions.

This expectation is related to the technical component of claims submission only.

Pricing “Line item pricing is established as a per claim fee with a single total fee for a transition out fee.”

1. Is it accurate to state that any transition in, ramp up, or other start up/implementation costs must be built into either the per claim transaction fee; or the transition out fee to be billed at the end of the resulting contract?

- The above statement is correct; however, the transition out fee is to be included as a separate line item on the price schedule with your proposal.

Is it a requirement that the vendor/offeror’s software and/or hardware be NIST Risk Management Framework certified as a condition of the award? If not, is the government willing to sponsor the contractor to obtain this certification after award?

- This is not a condition of award. The government will collaborate with the vendor to perform a risk assessment based upon the solution that is developed after award.

Is the Bureau of Prisons anticipating material volume growth from the current state? Are these volume projections available to be provided to the bidders?

- Once implemented at the institutions with comprehensive medical contracts, it is estimated that the claim volume will be approximately 500,000 annually. However, this volume cannot be guaranteed.

How is the past performance being evaluated? Is it through the past performance questionnaire or through the Experience section? If the past performance is being evaluated through the Experience section, would the government consider increasing the page limit to 5? This will ensure the government is in the best position to evaluate the vendor’s past performance.

- Past performance will be evaluated independently of experience.

It appears that Section L and Section M are missing from the formal solicitation package. Will the government provider Sections L and M? Will the government allow oral presentations by bidders? Oral presentations will save the government time and money by ensuring bidders have the opportunity to clearly communicate their solution.

Questions from RFPP0700NAS1600833

- This solicitation does not require Sections L and M. The government does not currently plan to allow oral presentations.

The schedule of supplies and services provides the estimated number of claims the contractor will process each option year.

Could the government provide an estimate of the number of prisons they plan to transition in over the life of this contract that coincides with 80,000 claims per option year?

- The government’s intention is to implement at all institutions with comprehensive medical contracts when awarded; this may be up to 119 facilities. If implemented at all institutions, the annual claim estimate is approximately 500,000.

How many institutions do not hold CMS contracts?

- As of this date, 35 institutions do not have comprehensive medical contracts.

SOW states, “the contractor shall provide within three (4) business days of receiving an authorization, a GFE of expected costs of the service.” Please confirm within how many days the GFE should be provided.

- The correct number is four business days.

Is the training manual to be included within the three page limitation? If so, would the government consider expanding this page limit to 10 pages?

- No, the training manual is not included in the three page limit, and may be submitted as an appendix.

Will the government accept and evaluate past performance references for the subcontractor or are references only evaluate for the prime contractor?

- Subcontractor references will not be evaluated.

Questions from RFPP0700NAS1600833

How many institutions of the 119 are currently participating, and in which states?

-There are currently 17 institutions submitting claims for adjudication; they are located in the following states:

-North Carolina -Pennsylvania -California -West Virginia -Texas -South Carolina -Tennessee -Virginia -Indiana -Hawaii -Arizona

Could you please provide additional detail with regard to volume in addition to the estimated 80,000 claims/year? i.e., Number of claims by state, by facility type, etc.?

- We do not have the specifics for each institution. It varies by location.

With regard to integration of UR decision documentation, would UR be required on every claim, from every physician and/or facility, or just the claims from specialty physicians/facilities outside of FBOP?

- There will be a mixture of UR decisions; all institutions will require UR for services outside the BOP with some requiring Medicare-based in-house services.

Page 9, Letter D: We are requesting confirmation of how many business days of receiving an AUTH to send GFEs- 3 or 4?

GFEs are Good Faith Estimates, correct?

- GFE is a Good Faith Estimate; the correct number of business days to return a GFE to the appropriate institution is four (4).

Questions from RFPP0700NAS1600833

Is it possible to get an estimate of how many contracts exist currently?

- There are currently 84 institutions with Comprehensive Medical Services contracts.

Is there an annual review and assessment or can changes occur at any time?

- There is no annual review or assessment of the Medical Claims Adjudication Services. However, any changes that may occur must be provided to the Contracting Officer Representative (COR) and the Contracting Officer, prior to the change.

Will claims be submitted only by the Comprehensive Medical Contractor (CMC) for each BOP institution or will individual providers who are part of each CMC’s network submit claims directly?

- Claims will only be submitted by the Comprehensive Medical Services contractor; individual healthcare providers will not submit claims.

Can the Government please confirm that the “Federal Operating Rate Medicare rates for the applicable area for inpatient facility services” are a pre-determined average rate by Medicare DRG and that a CMC then bids a discount or premium for each DRG rate?

- The Federal Operating Rate for each DRG is established by Medicare each fiscal year. For inpatient facility services, an offeror submitting a proposal for comprehensive medical services can propose a discount from or premium to the Federal Operating Rate.

Can the Government please confirm if the contractor will need to calculate facility specific factors in determining inpatient reimbursement based on Medicare such as Disproportionate Share (DSH) payments, Graduate Medical Education (GME) payments, Quality-Based Payment Adjustments, and Outlier payments or if there is a set fee schedule per DRG in each CMC’s contract?

- The contractor will need to calculate facility specific factors.

Questions from RFPP0700NAS1600833

In addition to the CMC contractors, can the Government please estimate the total number of “healthcare providers with current Bureau contracts and agreements” that will also participate in claims adjudication?

- Only institutions with CMS contracts will participate in claims adjudication; there are approximately 20 different CMS contractors at this time throughout the BOP.

Under “Minimum System Features”, the Government references that the system must “identify large case management opportunities”, “integrate utilization review decision documentation” and “automatically ‘pend’ claims for medical records review (for certain DRGs)”. Can the Government please confirm that case management, utilization review and/or medical records review services are considered out-of-scope as they are not referenced elsewhere in the SOW?

- The Bureau is requiring a system is an automated system and have the capability, at a minimum, to generate Explanation of Benefits (EOBs) which indicate the correct payment amount for each claim based upon the contracted rates, identify large case management opportunities, integrate utilization review decision documentation, automatically “pend” claims for medical records review (for certain DRGs), and evaluate potential invoice (claim) error patterns across all healthcare providers (e.g., CMS PEPPER system). The contractor should indicate in their proposal if the above features are available in their system. This requirement is not considered out of scope.

What guidelines are used to pend claims for medical records review? “For certain DRGs” is indicated, but will the DRGs vary by CMC contractor or institution?

- Determination of pended DRGs will be made at both the national and local level, and will vary by contractor and/or institution.

The government will advise the contractor of the applicable DRGs on an ongoing basis.

Can the Government please confirm that claims from “all other contracted healthcare services (not using Medicare reimbursement model)” are also considered in scope for claims adjudication?

- Claims utilizing other reimbursement methods other than Medicare, i.e., case-by-case, fee schedule, etc., are considered in scope for claims adjudication.

Can the…