RFQ-CSU-23-001-JJP.pdf

RFQ-CSU-23-001-JJP

The Billings Area – Crow Service Unit, Indian Health Service (IHS) is requesting quotes in response to RFQ-CSU-23-001-JJP for Medical Insurance Claims Eligibility Verification and Clearinghouse Services, Crow/Northern Cheyenne Hospital (CSU), and outlying Clinics. The CSU/IHS intends to award a Firm Fixed Price Purchase Order for Clearinghouse and Eligibility Verification Services as provided in the scope of work.

The procurement was conducted pursuant to the authority of Federal Acquisition Regulation (FAR) Subpart 12.6 - Streamlined Procedures for Evaluation and Solicitation for Commercial Items, FAR Part 13.5, Simplified Procedures for Certain Commercial Items; as supplemented with additional information included in this notice, and FAR 37.101- Non-personal Services Contracts. The associated North American Industrial Classification System (NAICS) code for this procurement is: 518210 and the small business size standard is $35.0 million. This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Regulation (FAR) Circular FAC 2022-07.

This solicitation is set-aside for Small Business Indian Firms (SBIF) pursuant to the Buy Indian Act 25 U.S.C. 47. If IHS does not receive at least two offers that are reasonably priced offers from SBIF’s, IHS will then evaluate quotes and consider award to other small business concerns under the following 5-tier cascading set-aside (in order of first consideration to last consideration):

• 1st Tier—Small Business Indian Firms

• 2nd Tier – Service Disabled Veteran Owned Small Businesses

• 3rd Tier – Certified HubZone Small Businesses

• 4th Tier – Small Disadvantage Businesses

• 5th Tier—All other Small Business Concerns.

Demonstration sessions to include overview of model/solutions shall be included during this solicitation. Times have been set aside during October 24th to November 4th. Due to Covid restrictions, all demonstrations shall be remote. Time length is set for no longer than 30 minutes. Please schedule an appointment with Johnna Pryor at Johnna.pryor@ihs.gov to set up the demonstration. This service shall be at no cost to the government and does not deem an automatic award if provided.

1. DESCRIPTION OF SERVICES/SUPPLIES:

The CSU is seeking a well-established Medical Claims Clearinghouse service provider whose proposed solution is the most advantageous in meeting the CSU’s needs. The CSU process up to 72,000 claims per year, approximately 6,000 per monthly billing cycle. The medical claims clearinghouse will work directly with CSU to securely and electronically transmit medical claims to insurance companies and to electronically verify patient eligibility in real time.

The proposed solution will have the ability to be integrated into the existing health information system (RPMS) billing software and automatically in processing exported claims to third party payers; Medicare, Veterans Affairs, and Private Insurance electronic claims. The CSU is also seeking a solution that is able to setup third party payer accounts with minimal transition from the existing clearinghouse. The proposed solution should be able to review and filter claims against established edits to identify any errors. As well as provide a means to correct the claim before the claim is submitted to the insurance company. The service shall enable CSU/payer data exchanges approved by the Indian Health Service Office of Information Technology.

A. The service shall support 270,271, 277, and 999 EDI transactions and other industry standard healthcare EDI Transactions.

B. The service shall support multiple users, access and access shall be workstation independent.

C. The service shall not entail development of HIPAA transaction set translation or claims mapping processes, non-IHS generated data or messages, or data reformatting.

D. The service shall conform to the information agreements to be established via a Business Partner Interconnectivity Security Agreement between the CSU and the vendor. The service shall also conform to a business associate agreement already established between CSU and the Vendor.

E. Workflow/Dashboard to prioritize their work or assign eligibility transactions to other users/departments.

F. Send batches of eligibility requests.

G. Transaction repository.

H. Medicare Eligibility.

I. See and fix problem Medicare claims immediately and proactively

J. Automated weekly eligibility checks on all Active Patients

K. Medicare/HMO/MA eligibility status alerts

L. Daily Medicare Claims Activity Reporting

M. Medicare AR dashboard with analytical support.

2. STATEMENT OF WORK:

This Statement of Work defines the effort required for the Medical Claims Clearinghouse Service at the Crow Service Unit.

A. OBJECTIVES:

The CSU seeks to utilize a Medical Claims Clearinghouse Service that can process medical claims and enhance existing procedures and processes. The CSU is interested in service types that will help improve the efficiency of insurance claim processing. The selected Vendor must demonstrate a stable, compliant, and comprehensive solution that will interface with existing technologies and processes with minimal service disruption. The selected Vendor must demonstrate broad knowledge and experience in providing information services to federal health facilities similar to CSU.

B. REQUIREMENTS:

i. Platform Interface: Proposed solution should include an intuitive interface capable of immediate deployment and operation by the CSU personnel. Proposed solution will interface with our existing health information system (RPMS) and automatically post response data into existing data fields and system records.

ii. The proposed solution must have an estimated timeline of when services will be fully functional for use.

iii. The proposed solution(s) must have the following service types:

1. CLEARINGHOUSE

a. Shall have the ability to import through RPMS export 6,000 claims per monthly billing cycle

b. summary of the number of claims exported by day successful to reconcile with

RPMS exports.

c. shall have electronic claims submission and Electronic Remittances Advice

(ERA) – Automatically updates Payments & Adjustments. Capability for CSU to download electronic EDI files and interface for posting to RPMS. 837 ERA Claims are currently in use. Industry Standard ERA’s must be available.

d. Claim Status Reports – Dashboard reports on claims; ie., top 10 payers, amounts, number of claims within time frames. The vendor must have an accurate status of our claims upon request.

e. Denial Prevention and Rejection Analysis – A process and report that identifies claims rejecting in the export process. Ability to correct those claims prior to export. Technical assistance is provided same day and no later than 24 hours.

Reductions in rejections and explanation of error codes.

g. Direct Data Entry – Edit and correct claims on line.

h. Printed Claims & EOB’s– Automatically drop claims (Pharmacy Claims to 837I, Dental Claims to ADA-837D, Professional to 837P) to paper and submit to Vendor when requested by Service Unit. Ability to print EOB’s for all claims processed.

i. Secondary Claims Processing – Electronic Submission.

j. Real-Time Support – Technical System support and personal training by an experienced consultant upon selection for staff.

k. Set-up Of Third Party Payers – Sets up of accounts for export and import of

ERA’s in Clearinghouse. The transition of migration with no down time in claim processing after selection of Clearinghouse

l. Transaction Summary – All the Clearinghouse activities must be available upon request.

2. ELIGIBILITY VERIFICATION

a. Eligibility – Real time eligibility checks.

b. Third Party – Identifies and scrubs claims by Third Party edits/criteria.

3. PROFESSIONAL SERVICES

a. Training – Online training to all system users and administrators.

b. Onboarding – Payers and Providers

c. Maintenance and Support:

I. Technical Support: The proposed solution should offer robust customer support that will be responsive to the needs of the CSU and provide timely resolution to clearinghouse system outages. The CSU is interested in a Vendor offering a high degree of accountability and ownership of technical support processes that will assist in meeting critical deadlines for claim submission and fulfillment.

II. The contractor shall provide routine support to implement corrections to service occurring as a result of errors, flaws or other failures within their service.

III. The contractor shall notify a designated CSU point of contact or the Technical Representative of any scheduled maintenance that shall result in downtime.

IV. Notification at least (2) days prior to the maintenance period.

V. The contractor shall notify a designated CSU point of contact of any issues at the CSU that result in a disruption of data exchange capabilities. This notification shall occur as soon as the disruption is identified.

VI. The contractor shall provide customer service support for reporting, documenting, tracking and resolving of service problems, which shall be available via telephone and email to CSU technical staff.

iv. Compliance: The proposed solution(s) shall comply with all aspects of Joint Commission (JCAHO); Health Insurance Portability and Accountability Act of 1996 (HIPAA). All facets of the proposed services should adhere to the laws that regulate the processing and storage of protected health information with sufficient security features to maintain the integrity, privacy and security of patient and billing data.

v. User Access: Up to Twenty five (25) CSU staff will have simultaneous access to the provided solution.

3. PLACE OF PERFORMANCE:

Each location requires its own NPI Number.

a. Crow Service Unit b. Pryor Health Clinic c. Lodge Grass Clinic

1 Hospital Way Pryor Gap Road 418 Harding Ave Crow Agency, MT 59022 Pryor, MT 59066 Lodge Grass, MT 59050

4. DELIVERABLES:

The will provide point-of-service eligibility data from third party insurance databases. These inquiries and responses will provide accurate and up-to-date eligibility information available to the end user. The vendor shall also provide Medicare AR dashboard and reports for AR management.

5. PRICE SCHEDULE:

Rates are based on the annual estimated amount of 72,000 claims. The approximate monthly amount of 6,000 claims are established for proposal purposes to match the monthly billing cycle for all three (3) sites.

Contract Line Item Number (CLIN)

BASE YEAR

CLIN Description Monthly Rate

001 Clearinghouse Services

002 Clearinghouse Overage (Exceeding 6,000/per month)

003 Eligibility Verification Services

004 Eligibility Verification Overage (Exceeding 6,000/per month)

005 Professional Services

006 Additional Fees (Optional)

OPTION YEAR ONE (OY1)

101 Clearinghouse Services 102 Clearinghouse Overage (Exceeding 6,000/per month) 103 Eligibility Verification Services 104 Eligibility Verification Overage (Exceeding 6,000/per month) 105 Professional Services 106 Additional Fees (Optional)

OPTION YEAR TWO (OY2)

201 Clearinghouse Services 202 Clearinghouse Overage (Exceeding 6,000/per month) 203 Eligibility Verification Services 204 Eligibility Verification Overage (Exceeding 6,000/per month)

205 Professional Services 206 Additional Fees (Optional)

OPTION YEAR THREE (OY3)

301 Clearinghouse Services 302 Clearinghouse Overage (Exceeding 6,000/per month) 303 Eligibility Verification Services 304 Eligibility Verification Overage (Exceeding 6,000/per month) 305 Professional Services 306 Additional Fees (Optional)

OPTION YEAR FOUR (OY4)

401 Clearinghouse Services

402 Clearinghouse Overage (Exceeding 6,000/per month)

403 Eligibility Verification Services

404 Eligibility Verification Overage (Exceeding 6,000/per month) 405 Professional Services 406 Additional Fees (Optional)

6. PERIOD OF PERFORMANCE:

Performance of this contract is intended to start February 1, 2023, through January 31, 2024 with four (4) 12-month option years. If the Government exercises the options pursuant to Federal Acquisition Regulation (FAR) 52.217-9, Option to Extend the Term of the Contract (MAR 2000), the period of performance shall be extended in accordance with the following schedule:

Base Year 02/01/2023 to 01/31/2024 Option Year 1 02/01/2024 to 01/31/2025 Option Year 2 02/01/2025 to 01/31/2026 Option Year 3 02/01/2026 to 01/31/2027 Option Year 4 02/01/2027 to 01/31/2028

7. BASIS FOR AWARD:

Award shall be made to the offeror whose quotation offers the best value to the government, considering technical, past performance, and price. The quotation must contain a technical description of the items being offered in sufficient detail to evaluate compliance with the requirements in the solicitation. Technical and Past Performance, when combined, are considered approximately equal to Cost/Price.

The following factors shall be used to evaluate offers:

1. PAST PERFORMANCE: Offerors must demonstrate their record of successful performance in past contracts and/or jobs. Each offeror will be evaluated on the following sub-factors:

Sub-Factor 1: Relevancy of the offeror’s past performance to the requirement of this

RFQ.

Sub-Factor 2: The quality of the offeror’s past performance.

Offerors must include past performance of contracts/jobs that are related to this project and include up to (3) three references. Please submit the most recent contract/jobs, within that past 3 years. NOTE: The Government reserves the right to contact any reference provided by the offeror in evaluating the offeror’s past performance. Furthermore, the Government reserves the right to use any information that comes to the attention of the Government in evaluating the offeror.

2. TECHNICAL: Offeror must submit a technical proposal, not to exceed 7 pages, that addresses the following:

Subfactor 1: Quality Assurance

a. The contractor’s understanding of the Statement of Work, specific tasks, and planned execution of the project.

b. Requirement to FAR 52.219-14: Perform at least 50% of the total performance effort with own labor force.

3. COST/PRICE: Price is not assigned an adjectival rating or scored. It will be evaluated to determine whether it is reasonable and if the quotation reflects an understanding of the requirement. This factor will be evaluated utilizing price analysis techniques identified in FAR Part 15.404-1. Analysis will include review of price reasonableness and balanced pricing. Offerors are cautioned that "materially unbalanced" prices and/or unreasonably high or low prices may cause your quotation to be deemed unacceptable and rejected.

CONTRACTING OFFICER AUTHORITY:

Authority to negotiate changes in the terms, conditions or amounts cited in this contract is reserved for the Contracting Officer.

TECHNICAL ADVISOR:

The technical advisor will be Mary Nomee (Mary.Nomee@ihs.gov). Monitoring of contract compliance and appropriate recordkeeping will be demonstrated using reports, billing details, or any other appropriate records. Mary Nomee will be responsible for verifying contract compliance to the COR.

CONTRACTING OFFICER REPRESENTATIVE (COR):

The COR shall be responsible for:

(1) Monitoring the Contractors technical progress, including surveillance and assessment of performance and recommending technical changes;

(2) Interpreting the Statement of Work;

(3) Technical evaluation as required;

(4) Technical inspections and acceptance; and

(5) Assisting the Contractor in the resolution of technical problems encountered during performance of this contract.

INVOICE SUBMISSION AND PAYMENT:

Invoices shall be submitted on a Monthly basis through IPP, a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury’s Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis. The use of IPP shall take precedence over previously established invoicing procedures in accordance with HHSAR 352.232-71, Electronic Submission and Processing of Payment Requests”. The IPP website address is: https://www.ipp.gov. If you require assistance registering or require IPP account access, please contact the IPP Helpdesk at (866) 973-3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov. Please send a courtesy copy of the invoice by email to lori.oldbear@ihs.gov Failure to include the required information may delay payment. Payment shall be made by the Billings Area Financial Management Branch, P.O. Box 36600, Billings, Montana 59107. Payments are made in arrears.

SECTION C - CONTRACT CLAUSES

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these addresses:

https://www.acquisition.gov/

FAR

No. Clause No. Title Date

1. 52.204-9 Personal Identity Verification of Contractor Personnel JAN 2011

2. 52.204-13 System for Award Management Maintenance OCT 2018

3. 52.204-18 Commercial and Government Entity Code Maintenance AUG 2020

4. 52.204-19 Incorporation by Reference of Representations DEC 2014 and Certifications

5. 52.209-10 Prohibition on Contracting with Inverted Domestic NOV 2015

Corporations

6. 52.211-16 Variation in Quantity APR 1984

7. 52.212-1 Instructions to Offerors – Commercial Products and NOV 2021

Commercial Services.

8. 52.212-4 Contract Terms and Conditions-Commercial Items NOV 2021

9. 52.212-5 Contract Terms and Conditions Required to Implement NOV 2021

Statutes or Executive Orders – Commercial Items**

10. 52.219-1 Small Business Program Representations NOV 2020

11. 52.219-6 Notice of Total Small Business Set-Aside NOV 2020

12. 52.219-14 Limitations on Subcontracting SEP 2021

13. 52.219-28 Post-Award Small Business Program Representation NOV 2020

14. 52.222-53 Exemption from Application of the Service Contract MAY 2014

Labor Standards to Contracts for Certain

Service-Requirements

15. 52.223-5 Pollution Prevention and Right-to-Know Information MAY 2011

16. 52.223-6 Drug-Free Workplace MAY 2001

17. 52.223-10 Waste Reduction Program MAY 2011

18. 52.224-1 Privacy Act Notification APR 1984

19. 52.224-2 Privacy Act APR 1984

20. 52.224-3 Privacy Act Training JAN 2017

21. 52.227-14 Rights in Data-General MAY 2014

22. 52.227-17 Rights in Data – Special Works DEC 2007

23. 52.227-15 Representation of Limited Rights Data and Restricted DEC 2007

Computer Software

24. 52.227-19 Commercial Computer Software License DEC 2007

25. 52.229-3 Federal, State, and Local Taxes FEB 2013

26. 52.232-18 Availability of Funds APR 1984

27. 52.232-33 Payment by Electronic Funds Transfer – System OCT 2018 for Award Management

28. 52.233-3 Protest After Award AUG 1996

29. 52.233-4 Applicable Law for Breach of Contract Claim OCT 2004

30. 52.237-3 Continuity of Services JAN 1991

31. 52.242-15 Stop Work Order AUG 1989

32. 52.239-1 Privacy or Security Safeguards AUG 1996

33. 52.242-17 Government Delay of Work APR 1984

34. 52.243-1 Changes—Fixed Price Alternate I (Apr 1984) AUG 1987

35. 52.245-1 Government Property JAN 2017

36. 52.245-9 Use and Charges APR 2012

37. 52.246-4 Inspection of Services – Fixed Price AUG 1996

38. 52.249-1 Termination of Convenience of the Government(Fixed APR 1984

Price)(Short Form)

39. 52.249-8 Default (Fixed-Price Supply and Service) APR 1984

**The following FAR clauses cited in 52.212-5 are applicable to the acquisition: 52.203-6 with Alternate I, 52.204-10, 52.204-14, 52.209-6, 52.219-6, 52.219-8, 52.219-28, 52.222-3, 52.222- 19, 52.222-21, 52.222-26, 52.222-35, 52.222-36, 52.222-37, 52.222-40, 52.222-50, 52.222-54, 52.223- 18, 52.225-1, 52.225-3, and 52.225-13. The provisions and clauses may also be accessed electronically at https://www.acquisition.gov/ and http://ecfr.gpoaccess.gov/.

FAR CLAUSES IN FULL TEXT

C1. 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 1 day of contract expiring.

(End of Clause)

C2. 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 30 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 30 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed Five (5) years.

(End of Clause)

DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION

REGULATION (HHSAR) (48 CFR CHAPTER 3) CLAUSES

HHSAR

Clause No. Title Date

352.222-70 Contractor Cooperation in Equal Employment DEC 2015

Opportunity Investigations

352.223-70 Safety and Health DEC 2015

352.232-71 Electronic Submission of Invoice Payments FEB 2022

352.237-70 Pro-Children Act DEC 2015

352.237-75 Key Personnel DEC 2015

SECTION D – SOLICITATION PROVISIONS

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

The following provisions apply to this acquisition

52.212-1 - Instructions to Offerors-Commercial Items” -- June 2020 52.212-3 - Offerors Representation and Certificiation-Commercial Item” – June 2020

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v)) of this provision.

52.204-7 System for Award Management Oct 2018 52.204-16 Commercial and Government Entity Code Reporting Jul 2016 52.204-17 Ownership or Control of Offeror Jul 2016 52.222-52 Exemption from Application of the Service Contract Labor May 2014

Standards Contracts for Certain Services – Certification

OFFER SUBMISSION INSTRUCTIONS:

Contractors intending to conduct business with the Federal Government must register with the System for Award Management (SAM). SAM is now the primary Government repository, which retains information on Government contractors. You may register via the Internet at www.sam.gov.

This is a combined synopsis/solicitation for Medical Claims Eligibility Verification and Clearinghouse Services. The government intends to award a Firm Fixed-Price Contract as a result of this combined synopsis/solicitation that will include the terms and conditions set forth herein. To facilitate the award process, all quotes must include a statement regarding the terms and conditions herein as follows:

"The terms and conditions in the solicitation are acceptable to be included in the award document without modification, deletion, or addition."

OR

"The terms and conditions in the solicitation are acceptable to be included in the award document with the exception, deletion, or addition of the following:"

Offeror shall list exception(s) and rationale for the exception(s).

PROPOSAL/OFFER

All responsible offerors may submit an offer within the specified timeframe, which shall be considered by the Agency.

Questions are due October 21th 2022; please submit questions to the Purchasing Agent, Johnna Pryor at Johnna.pryor@ihs.gov

All responsible offerors may submit a proposal, which shall be considered by the Agency. Offers shall be submitted via email to johnna.pryor@ihs.gov no later than 2:00pm MST, November 7, 2022. The solicitation number RFQ-CSU-23-001-JJP must be in the subject line.

Submit signed and dated offers to the office specified in this solicitation at or before the exact time specified in this solicitation. As a minimum, offers must show:

52.212-3 52.212-3(1)The solicitation number; (2)The time specified in the solicitation for receipt of offers; (3)The name, address, and telephone number of the offeror; (4)A technical description of the items being offered in sufficient detail to evaluate compliance with the requirements in the solicitation. This may include product literature, or other documents, if necessary; (5)Terms of any express warranty; (6)Price and any discount terms; (7)“Remit to” address, if different than mailing address; (8)A completed copy of the representations and certifications at FAR (see FAR (b) for those representations and certifications that the offeror shall complete electronically);

(9)Acknowledgment of Solicitation Amendments; (10)Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers and other relevant information);

ACCEPTANCE PERIOD

Your offer must stipulate that it is predicated upon all the terms and conditions of this RFQ. In addition, it must contain a statement to the effect that it is firm for a period of at least 90 days from the date of receipt by the Government.