SSN Details _FEHB_.pdf

United States Office of Personnel Management

Office of Procurement Operations

Instruction to Vendors

Request for Information (RFI) for

Federal Employees Health Benefits Medical Review Services

Date: February 5, 2023

THIS IS A RFI ONLY - OPM IS NOT SOLICITING QUOTES AT THIS TIME

DISCLAIMER:

THE GOVERNMENT DOES NOT INTEND TO AWARD A CONTRACT ON THE BASIS OF THIS RFI

OR TO OTHERWISE PAY FOR THE INFORMATION SOLICITED.

This RFI does not constitute a solicitation for quotes or the authority to enter into negotiations to award a contract. This RFI is for planning purposes only and shall not be considered as a Request For Proposal/Quote or as an obligation on the part of the Government to acquire any products or services. No entitlement to payment of direct or indirect costs or charges by the Government will arise as a result of contractor submission of responses to this RFI or the Government’s use of such information. Responses to this RFI will not be returned.

Whatever information is provided in response to this RFI may be used to assess tradeoffs and alternatives available for determining how to proceed in the acquisition. Any proprietary information that is submitted may be used in establishing requirements, but specific contractor-submitted information will be safeguarded as proprietary.

For Schedules Only: Based on the responses submitted to this RFI, the Government reserves the right to issue all future requests for quotes directly to identified sources via email in accordance with FAR 8.405-3(b)(1)(ii)(B)(2) and/or FAR 8.405-2(c)(3)(iii)(B).

BACKGROUND:

The Office of Personnel Management’s (OPM) Federal Employees Healthcare Insurance (FEHI) program administers the Federal Employees Health Benefits (FEHB) and the Postal Service Health Benefits (PSHB), for Federal employees, retirees, fire protection personnel, employees of Federally recognized Indian tribes, tribal organizations, and urban Indian organizations (tribal employer), and their eligible family members. FEHI is responsible for resolving disputed health insurance claims between members and their health insurance carrier. Two types of health insurance plans participate in the FEHB and the PSHB Programs: Fee-for-Service (FFS) and Health Maintenance Organizations (HMO) plans. The FEHB administers many healthcare insurance groups. Such as, all FFS contracts to include but not limited to Blue Cross and Blue Shield Service Benefit contract; as well as experience rated HMO plan contracts; and community rated HMO plan contracts.

A draft Performance Work Statement (PWS) is attached which provides more details.

Company Information:

Please complete the information below to the best of your ability.

Where the Government asks for URLs, please only provide URLs, non URLs will be deleted.

Company Name:

Applicable Contract Number (GSA, GWAC, etc.):

POC Email:

POC Phone#:

Company Website URL:

UEI #:

CAGE Code:

Please state the NAICS code you believe is most appropriate for this requirement.

Please indicate the size of your business.

Size Description Key:

s - small business o - other than small business s - small o - other than small

Please select all socio-economic categories that apply to your business.

Please note, your company must be recognized as 1 or more of these designations under your GSA

Contract for you to select it. Data is validated prior to reports being issued.

Socio-economic description Key:

w - Woman Owned business.

wo - Women Owned Small business (WOSB) ew - Economically Disadvantaged Women Owned Small business v - Veteran Owned Small business dv - Service Disabled Veteran Owned Small business d - SBA Certified Small Disadvantaged business

8a - SBA Certified 8(a) Firm h - SBA Certified HUBZone Firm

We seek Industry to review and comment on whether they have the expertise that can provide the solution related to the requirements identified in the SOO and provide comments to the following:

TECHNICAL QUESTIONS:

1. Can your company provide detailed research and medical opinions from a multidisciplinary group of healthcare specialist? Please list the type and number of medical specialists available.

2. Do you review medical claims for another company? If so, what type of employer groups are serviced by the company? Please include the names of the companies and any other details in your explanation.

3. What is your definition of medical necessity? Which definition is used when medical reviews are completed, your definition or the Healthcare Plan’s definition? Please provide details in your explanation.

4. What is the maximum number of disputed claims your company can review in seven days?

Please provide details.

5. If using a GSA, GWAC, etc., is this work required within the scope of your contract? Briefly explain.

6. Is the requirement clear? If not, in what ways do you recommend improving it?

7. Does any specification listed for this requirement appear restrictive? If yes, please briefly explain.

8. Do you have the capability to perform?

9. Would you need a sub-contractor to perform?

10.If the Government issues a RFP for this requirement in the next 60 days, would you submit a proposal?

11.Does your company have prior experience with the product/service for this requirement? if yes, please briefly explain the magnitude of your prior experiences.

12.Does your company have corporate work experience similar in nature, scope, complexity, difficulty and within very constricted timelines of the work described in the attached PWS?

13.Can you provide a ballpark estimate for the work detailed in the PWS?

Range Min-Max.

14.If you are unable to do so because of insufficient information, please indicate what additional information would allow you to make such an estimate.

15.Is there any additional expertise OPM should look at to evaluate potential vendor proposals to meet this requirement?

RESPONSE DUE & POC:

Responses to this RFI should be e-mailed to: erica.randall@opm.gov as either a pdf or MS Word attachment. OPM requests a response by February 26, 2023. OPM may establish a dialog with vendors who respond if needed to gain a better understanding of their service offerings.

AFTER YOU SUBMIT YOUR RESPONSE:

A confirmation email will be sent to the provided POC email with confirmation that your response has been received with a copy of your completed responses.

SERVICE(S): EXPERIENCE, LABOR CATEGORIES & ESTIMATES:

1. Using the example below, please include a breakout of all Labor Categories and Services to be provided with your Company’s Response; add rows as necessary.

# Labor

Category ID.

Labor Description Key Requirement Labor is Addressing?

Optional.

1.

2.

3.

4.