Scope of Work Draft.pdf

Scope of Work For PMA/Maintenance Services

CY2026

General:

This scope of work (SOW) describes the requirements for a full maintenance agreement for the network server which provides subscriber and dependent coverage for claims status, submission of 837 claims for Medicare and Private insurance payers and inquiry/correction of pending claims.

Background:

IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

Scope:

The Contractor shall provide Full Preventive Maintenance services for existing Internet Server for 837 claims processing at Chinle Comprehensive Health Care Facility.

Location:

Duties and responsibilities will encompass full maintenance service for the network server located at the Chinle Comprehensive Health Care Facility, Chinle, Arizona. Contractor shall provide monthly service.

Place of Performance:

Services are to be performed at the Chinle Comprehensive Health Care Facility, Chinle, Arizona.

Period of Performance:

Will be effective for 6-months from the date of award. Will be flexible and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

Major Duties and Responsibility Requirements:

- Patient Access

- Ability to verify multiple commercial and government payers. Results into faster/more reimbursement for the facility.

- Identify additional billable insurance coverage for patients.

Billing

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

- Provides 277 and 999 reports for electronic claims submitted to Medicare.

- Dashboard of Private Insurance rejection session.

- Ability to run reports for denials.

- Capability to correct claims, obtain denial reasons and resubmit claims to payers

FISS/DDE

- Securely connect to Medicare Direct Data Entry (DDE)

- Support for multiple submitted IDs

- Complete visibility to Medicare claim submissions

- On-line claim corrections and ability to obtain denial reasons

- Medicare Eligibility verifications

- Built in EDI tracking capability

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

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

Area: A defined geographical region for Indian Health Service administrative purposes.

Each Area Office may administer several Service Units.

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

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

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

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

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

Requirements:

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

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

The contractor shall provide training to CCHCF users.

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

Submission of Invoices: The contractor will submit invoices in accordance with FAR 52.212- 4(g) on a monthly basis beginning March 01, 2026 to August 31, 2026, to the Chinle Comprehensive Health Care, Facility, Attention: Business Office, P.O. Drawer PH, Chinle, Arizona 86503. Telephone: 928-674-7030;

Fax: 928-674-7705.

Contractor Qualification Requirements:

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

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

The contractor shall define license and all relative documents.

Government Furnished Information, Property and Services:

Inspection: all services rendered will be inspected, reviewed, and monitored by TBD, BOM.

Contracting Officer Representative (COR): TBD

Department Point of Contact: TBD

52.249-12 Termination: The Government may terminate this contract at any time upon at least 15 days' written notice by the Contracting Officer to the Contractor. The Contractor, with the written consent of the Contracting Officer, may terminate this contract upon at least 15 days' written notice to the Contracting Officer.

The contractor will comply with the following listed regulations:

- Privacy Act, 5 U.S.C. 552a - Office of Privacy and Civil Liberties | Privacy Act of 1974

- Health Insurance Portability and Accountability Act (HIPAA) - eCFR :: 45 CFR Part 164 -- Security and Privacy

- CFR 42 Part 2 - eCFR :: 42 CFR Part 2 -- Confidentiality of Substance Use Disorder Patient Records

Indemnification and Governing Law

Indemnification, Liability, Statute of Limitations: Any provisions in the Terms of Service (TOS) related to indemnification and filing deadlines are hereby waived, and shall not apply except to the extent expressly authorized by law. Liability for any breach of the TOS as modified by this amendment, or any claim arising from the TOS as modified by this amendment, shall be determined under the Federal Tort Claims Act, or other governing federal authority. Federal statute of limitations provisions shall apply to any breach or claim.

Governing law: Any arbitration, mediation or similar dispute resolution provision in the TOS is hereby deleted. The TOS and this amendment shall be governed by and interpreted and enforced in accordance with the laws of the United States of America without reference to conflict of laws. To the extent permitted by federal law, the laws of the State of XXXXX will apply in the absence of applicable federal law.