W91YTZ-17-R-0036_0001.docx

W91YTZ-17-R-0036

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 07-May-2017 10:00 AM to 08-May-2017 10:00 AM.

The following have been added by full text:

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

for

(W91YTZ-17-R-0036)

Please provide your candid responses. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Thank you.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Name of Contractor/Company being evaluated:

Name of Contractor/Company Name/Division providing the evaluation:

Address:

Program/Account Identification/Title:

Contract Number:

Contract Type:

Contract Amount:

Prime Contractor Name (if different from the contractor name cited above):

Period of Performance:

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Detailed description of purchases or services provided:

Was this work with a: Commercial_____ Fed Gov’t_____ Local/State Gov’t_____ entity.

Relevance of the referenced contract to the current requirement:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

PART II. EVALUATION (TO BE COMPLETED BY POINT OF CONTACT – RESPONDENT)

For each performance element identified below, references should evaluate performance of the firm or individual identified in Part 1 of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the contractor’s control). An individual within your organization that is knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

The following chart depicts the ratings that are to be used to evaluate the contractor’s performance:

Little doubt exists, based on the offeror's preponderance of good, if not excellent past and current records of contract performance, especially in large contracts similar to the size and complexity of the services under solicitation. Verification of past performance shows that offeror consistently meets work schedules, provides specified services, meets contract terms without failure, and has not been defaulted on any contract within the past three years.

Some doubt exists based on instances of record of poor performance, especially in contracts similar to the size and complexity of the services under solicitation. Verification of past performance shows that offeror meets work schedules and specified services most of the time, meets contract terms without failure or resolves issues immediately, and has not been defaulted on any contract within the past three years.

Significant doubt exists that the offeror will satisfactorily perform the services on solicitation, based on preponderance of unsatisfactory performance records under the various factor evaluations, or offeror’s record of unsuccessful past and current contracts performance in fulfilling requirements similar to the size and complexity of the services under solicitation. Verification of past performance shows that offerors have consistently not met work schedules and other obligations, have defaulted on at least one contract within the past three years, or have chronically failed to meet contract terms.

No relevant past performance information.

When responding to the questions listed, circle the letter that most accurately describes the contractor’s performance or situation. For any low, medium, high or neutral rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, circle N/A. If you circle a Yes/No answer that is marked with an asterisk (*), please provide a corresponding explanation in the remarks block. If more space is required, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legibly.

Your time and effort in providing this vitally important information are greatly appreciated.

PERFORMANCE ELEMENTS:

QUALITY OF SERVICE

TIMELINESS OF SERVICE

BUSINESS RELATIONS

CONTRACTUAL CONSIDERATIONS

Partially ________ Completely _________

*REMARKS

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

PART III. RETURN INFORMATION

Please return the completed Questionnaire via e-mail to Mr. Wesley J. Harris, wesley.j.harris15.civ@mail.mil on 8 May 2018.

QUESTION AND ANSWERS

1. Given the timeline for the government to respond to questions and for contractors to have adequate time to review questions to finalize proposals, will the government consider extending the due date?

Government Response: Solicitation has been extended until 8 May 2017 at 1000 Eastern Time.

2. Is the ABACUS software contractor allowed to bid on this opportunity? If yes, how does the government plan to prevent an unfair advantage in the pricing/bidding on this contract given the ABACUS vendor’s access to current costs, MTF receivables, etc.?

Government Response: Yes, the Government will require an Organizational Conflict of Interest Mitigation Plan be submitted to outline/address any unequal access to information.

3. What is the number of MTF staff by facility that will be assigned to this contract?

Government Response: 4(14)=56

4. How many intake points for OHI discovery are you expecting the contractor to cover by facility?

Government Response: All intake points of the Treatment Facility will be expected for OHI discovery

5. What is the number of seats allotted at each MTF for the contractor staff?

Government Response: 0

6. Will the contractor be allowed to use additional tools and enablers to support the TPC functions in addition to CHCS and ABACUS?

Government Response: The Contractor will be allowed to use various means of discovery to include but not limited to personal interviews, electronic discovery and mailings.

7. What does the government intend by requiring the contractor to perform billing audits to improve coding quality and what clinical data will be available to the contractor?

Government Response: N/A

8. "The RFP requires Electronic discovery (identification and verification ) of Other Health Insurance (eOHI) to include scope & dimension of such coverage (i.e., co-pays, deductibles, time limits, min/max order limitations, etc.) -- MTF and/or Contractor? How does the government anticipate how the contractor will coordinate eOHI discovery efforts with the existing ABACUS eOHI contract element?"

Government Response: The Contractor will process eOHI out of ABACUS and any systems that the contractor uses to collect eOHI.

9. What report and which data elements will the government provide to the contractor to do electronic OHI discovery?

Government Response: Contractor will be-able to request for CHCS beneficiaries Demographic data to search for eOHI

10. ABACUS has the capability to support electronic imaging and storage. Does the government expect the contractor to provide an additional system for storage outside of ABACUS?

Government Response: No. All images and data will be stored in ABACUS

11. What is the government's expectation of the contract on -back-billing functionality beyond ABACUS provides?

Government Response: To conduct claims follow-up to claims resolution. After claims has reached 270 days without payment will be sent to SJA for action

12. What additional reporting will be available to support this back-billing requirement?

Government Response: Aged Accounts Reporting

13. On pages 90-91 of the RFP, the government states, The contractor, in conjunction with the Government, shall establish and maintain a performance goal for the optimization of outpatient and inpatient revenue collection activities across the RHC-A region, ensuring the requirements of this PWS are provided as specified. The performance goal(s) will be stated in terms of the total annual TPCP outpatient and inpatient collections (in $) the contractor is expected to meet or exceed in the base year and in the option periods if exercised. The contractor’s performance (measures) expectations will be incorporated into the resulting contract? Is it the government's intent is for both the government and contractor to establish the performance goals for the optimization of outpatient and inpatient revenue collection activities after award?

Government Response: No. MEDCOM/RHC-A will provide performance goals to the MTF/Contractor.

14. What is the government's expected collections for each MTF?

Government Response: This a performance based contract.

15. The RFP has the following statement about quarterly meetings: ""The contractor and RHC-A, Chief Patient Administration Officer or Resource Management Officer, and the Contracting Officer Representative (COR) shall meet at least Quarterly to discuss past performance, current status, and review the QASP and future planning reference operations associated with TPC throughout the RHC-A?

Government Response: The meeting with be via Tele-Conference

16. Will this quarterly meeting be an in-person meeting? If so, should the contractor include the costs of travel in the CLINs?

Government Response: The meeting with be via Tele-Conference

17. Is the requirement for the contractor to train their own personnel or additional personnel at the MTF and how often training will be required?

Government Response: The Contractor must be knowledgeable of ABACUS to train MTF staff as well

18. The government references Appendix 6, but the appendix is not included with the solicitation. Will the government please provide Appendix 6?

Government Response: N/A

19. "The RFP states that the contractor shall not perform functions however that are inherently governmental in nature? What functions are considered inherently governmental in nature?

Government Response: The Contractor will perform all TPC Functions for the MTFs. No inherent governmental functions

20. Does ABACUS provide detailed adhoc Denial management reports and working queues that can be utilized and/or exported by the contractor?

Government Response: Yes

21. In the last year or so, the FMR has been updated to reflect unresolved debts must be turned over at 180 days delinquent. Please confirm this the following requirement should be at 180 days delinquent and not 270: If these actions fail to resolve the disputed claim within 180 days post initial billing, but no more than 270 days postdate of service unless there is clear evidence the claim will be paid, the Contractor, in conjunction with the MTF staff, will consider the claim delinquent and will then forward a report listing the claim as disputed for referral to MEDCOM OSJA. The Contractor and/or MTF personnel will reflect claim referral in the system of record per MEDCOM UBO published guidance?

Government Response: Yes

22. Will the MTF notate and upload in ABACUS pertinent patient medical records and document the action taken and completion date?

Government Response: Yes

23. Does the government expects the contractor to train their own personnel or additional personnel at the MTFs and how often training will be required? Also, what will be required of the contractor from a reporting specific to this requirement?

Government Response: Yes. The MTFs will request additional training when needed. The contractor will provide a training completion document of all training that was performed.

24. Will the government provide the A/R aging reports for each MTF so that contractors can determine workloads for pricing and staffing? What is the government's resolution expectation?

Government Response: Yes

25. The RFP has the following statement: The amount of the monthly payments to the contractor for all work performed under this contract will be in the form of a Performance-Based Percentage (PBP), which is the percentage (%) of the Third Party Collections (TPC) POSTED in the system of record of the MTF for the contract period for which the invoice upon this contract’s MTFs Task Order is filed; up to, the not to exceed (NTE) amount found in the Task Order and Contract schedule for the MTF’s sub-CLIN? If recoveries are greater than expected, will the Task Order be adjusted to accommodate the contractor's enhanced performance?

Government Response: The IDIQ is Firm fixed Priced.

26. Will EOBs and non-payment documentation not be made available for elements of the A/R?

Government Response: N/A

27. The government states: The Contractor shall complete its work on the last day of the contract. The Contractor will be paid only on that work that the contractor has posted on or before the ending date of the contract. In the event that this contract is followed by a new contract, the succeeding contractor will be paid on that work posted on or after the beginning date of the new contract? Will the government consider revising this requirement to include the following normal best practice, which will enhance best practices, create a smoother transition of services, and increase competition? “Any claims processed by the Contractor prior to the end of the Contract term shall be credited to the Contractor. Each claim processed up to a Contractor’s expiration date will have 60 days allowance for payment. Invoicing from the Contractor will continue for the duration of this 60 day period beyond the end of the contract term. Invoice amount will be the average monthly collections for the prior 12 months’ collections?”

Government Response: No

28. The government references Appendix 1, but the appendix is not included with the solicitation. Will the government please provide Appendix 1?

Government Response: N/A

29. The RFP states that Contractors shall utilize contractor provided computerized billing systems. Does the government require the contractor to provide a separate billing system beyond ABACUS?

Government Response: No.

30. Since the contractor will be required to access government systems, will the government provide equipment and supplies for the contractor's staff located at the MTF?

Government Response: No. Contract staff will not be placed at any MTF.

31. The RFP requires that ""Conformation of system lock down shall be agreed upon during the definition of the C&A boundary and be signed and documented as part of the Department of Defense Information Assurance Certification and Accreditation Process (DIACAP ). Please confirm that the government requires DIACAP and not NIST?

Government Response: No. We don't require DIACAP. The system is a Web Base System.

32. Will the government provide interim access for HUB and MTF contractor personnel until favorable clearance is received from the government?

Government Response: No

33. Will the government provide the historical data for FY 2016?

Government Response: No

34. Attachment 3 references TPOCS in the second paragraph: Contractor shall prepare and transmit (or mail) claims within three (3) business days after coding is completed; or once the hold-time in TPOCS is complete, whichever is the soonest? Will the contractor use TPOCS or ABACUS for this requirement?

Government Response: ABACUS

35. The requirements listed in Attachment 3 and 4 do not seem to be related to TPC services? Please confirm that these are the correct attachments that contractors should use for the TPCP?

Government Response: Yes

36. The RFP requires that, In addition, the contractor shall provide a breakdown of percentages for each MTF by percentage per transaction identified in this solicitation? Is this per transaction fee required in addition to the contingency fee pricing included in the CLINS?

Government Response: The contractor shall provide a breakdown of percentages for each MTF by percentage per transaction identified in this solicitation.

37. The totals for the page limitations for subfactors 1 and 2 do not total to match the required limits (25 pages). Please clarify the page limits by section?

Government Response: 25 pages

38. Will the government be providing the past performance questionnaire for contractors to submit to past performance references?

Government Response: Yes

39. What is the average third party bill size to be collected?

Government Response: $318,841.97

40. What is the average accounts receivable for each MTF?

Government Response: 3530

41. Just to confirm, are the amounts shown in attachment 2 the actual amounts collected (accounts receivable)?

Government Response: Yes

42. Can the Government share the number of third party bills per year processed at each MTF?

Government Response: 164,125

43. What is the average aging of third party receivables?

Government Response: 1,887,993.07

44. Due to the processing variance of each transaction type, can the government provide a breakdown of the types of billing transactions for each historical amount provided?

Government Response: No.

45. Will the Government provide the necessary system access levels to allow precertification personnel to perform OHI verification duties outlined in the PWS?

Government Response: Yes

46. What systems will OHI discovery personnel be given access to?

Government Response: CHCS

47. The current proposal due date is on a Sunday. Would the Government consider extending the proposal due date by at least one week?

Government Response: No. See question 1

48. Can the government please clarify the specific transactions they are referring to in "contractor shall provide a breakdown of percentages for each MTF by percentage per transaction? Is the government referring to the Averages in Attachment 2: Third Party Collection Historical Data? If not, what are the transactions?

Government Response: Yes

49. Can Government specify the breakdown of transaction type (i.e. outpatient, inpatient, ancillary, etc.) by MTF?

Government Response: All services

50. The definition for the Performance Based Percentage describes a percentage of the Third Party Outpatient Collection System of a MTF. Is the government also going to consider Inpatient collections?

Government Response: Yes

51. Will the government please clarify what number is to go in the "Unit Price" field? Are we to put our Firm Fixed Percentage in this field?

Government Response: Please see the instruction to vendors.

52. For the requirement of a contractor furnished remote location – Can the remote location be anywhere in the U.S. or must it be within the vicinity of the MTF?

Government Response: Anywhere in the US

53. Will all contractor personnel require a Common Access Card (CAC)?

Government Response: Yes

54. Are contractor pre-certification staff required to be on-site at the MTF? If so, is it full time and what will the government provide? (I.e. desk, room to interview)

Government Response: No. Documents will be scanned and sent to the Contractor for Pre-certification

55. Will contractor pre-certification staff obtain Other Health Insurance (OHI) information from government personnel or the patients directly?

Government Response: Yes

56. In our experience we know over 95% of claims have a large number of medical coding issues. These claims are typically sent back to coders for fixing, resulting in a delay of up to several weeks. How will the government take delays out of contractors control into account with performance?

Government Response: The contractor will not be penalize for coding issues that result from the MTF

57. How long will it take to receive copies of checks received by the MTF?

Government Response: Checks will be scanned and sent on a weekly basis

58. The government states to accurately process initial billings to insurance companies including coding review and audits. Will the contractor be required to provide coding services?

Government Response:No

59. What metric is the government using to assess “timely” billing functions, including claim turn-around times?

Government Response: The Government is using DoD Standard for timely billing. Inpatient claims to the third-party payer within ten(10) business days following completion of the medical record and coding. Outpatient claims shall be prepared and sent within seventeen (17) business days after the outpatient encounter information and coding for billing is obtained

60. Does the government have a Verification of Insurance Coverage training and education plan already in place for government personnel?

Government Response: Yes. Collection of the DD2569 Manually

61. What specific metric is the government using to assess track records of successful relationships with health insurance plan payers?

Government Response: No metric.

62. The Government allots 10 pages for sub-factor 1, and 5 pages for sub-factor 2. However, the total page count for the volume is 25 pages? What should we use the remaining 10 pages for?

Government Response: 25 total pages for techcial solution.

63. If the only elements being evaluated under the technical evaluation factor is sub-factors 1 and 2, what are the evaluation criteria for any additional information included in the 10 pages beyond the 15 allotted for those sub-factors 1 and 2?

Government Response: Please read instructions to vendors and technical evaluation factors.

64. Will the government provide the labor categories required to perform the work on this contract?

Government Response: No.

65. Other than the FSO, will the government identify which labor categories shall be key personnel or is this at the discretion of the contracting company?

Government Response: No.

66. What collection attempts are performed or will be performed internally prior to placement?

Government Response: The MTFs will continue to attempt to collect monies from the payer until the contract is in-place.

67. What is the total dollar value of accounts available for placement now by category, including any backlog?

Government Response: The Current Third Party Claims/Dollars including backlogged are: 124,046/$26,431,903.02

68. What is the average balance of accounts by category?

Government Response: 1.8M

69. What is the average age of accounts at placement (at time of award and/or on a going-forward basis), by category?

Government Response: The Average Accounts 8,860.

70. What is the monthly or quarterly number of accounts expected to be placed with the vendor(s) by category?

Government Response: The Quarterly number of claims: 82,062

71. What is the monthly or quarterly dollar value of accounts expected to be placed with the vendor(s) by category?

Government Response: The Quarterly number of Dollar billed/Collected:(B)$14,340,788.46/(C)6,417,801.39

72. If applicable, will accounts held by any incumbent(s) or any backlog be moved to any new vendor(s) as a one-time placement at contract start up?

Government Response: Not Applicable

73. Do you subscribe to any offset programs?

Government Response: No

The following have been modified:

52.212-1 ADDENDUM

ADDENDUM TO 52.212-1

a. ELECTRONIC OFFERS. Offers in response to this solicitation shall be submitted electronically to the Contract Specialist via email wesley.j.harris15.civ@mail.mil. Faxed or emailed quotations will not be accepted.

b. The Government will not be responsible for any failure of transmission or receipt of the offer, or any failure of the offeror to verify receipt of the emailed offer.

c. Offeror Questions and Clarifications: Offeror Questions and Clarifications: Any questions, comments or clarifications concerning any aspect of the solicitation shall be submitted in writing via e-mail to wesley.j.harris15.civ@mail.mil no later than 1 May 2017 AT 10:00 AM EDT. Questions or clarifications submitted should identify the topic, and must reference the applicable section(s) of the solicitation (e.g., Section, paragraph, and subparagraph) and RFP number. Follow-up/additional questions will not be accepted after this date.

d. The Government intends to award a firm fixed-price contract IDIQ.

e. Proposal Due Date: 10:00 a.m. Eastern Standard Time (EST) on 8 May, 2017.

f. Proposal Content Requirements: Offeror shall submit proposal as follows:

(1) The Offerors shall propose a firm fixed-percentage for each Contract Line Item Number (CLIN) on the SF 1449. In addition, the contractor shall provide a breakdown of percentages for each MTF by percentage per transaction identified in this solicitation. The offeror may propose a price for the Contract Manpower Reporting (CMR) requirement. If the Offeror elects not to separately price the CMR, $0 shall be entered.

g. Proposal Content and Format Instructions.

The Offeror’s submission shall include four separate parts: A Technical proposal and a Redacted Copy of Technical of proposal, a Price proposal and Past Performance information.

(1) TECHNICAL PROPOSAL CONTENT INSTRUCTIONS. The Offeror’s technical proposal shall clearly reflect the offeror’s approach to execute and comply with the performance requirements identified in the PWS, regardless of the Government’s estimated effort. Your technical proposal, including any supporting documentation, is to be clear and concise. The level of effort proposed must be consistent with the proposed solution outlined in your technical proposal. The proposal must fully document and substantiate a cross mapping of your percentage approach as it equates to the technical proposal.

(a) PAGE LIMITS: Technical proposals are limited to 25 single-sided pages. Pages should be numbered consecutively throughout the document and not by sections. For any sections of a proposal with a defined page limit, pages exceeding the specified limit will be removed and not forwarded for evaluation. The following sections are not subject to the 25 single-sided page limit listed above:

· Table of Contents

· Title page

· Quality Control Plan (shall not exceed 15 single-sided pages)

(b) FORMATTING: Proposal content shall be no smaller than Times New Roman size12 font with 1” margins. Exhibits, graphics, charts, captions, etc., shall be no smaller than size 10 font.

(2) PAST PERFORMANCE REFERENCES: The Offeror shall submit no more than three (3) references of recent/relevant contracts within the past three (3) years for its own performance. The Offeror shall also submit no more than one (1) reference for each Subcontractor proposed. The contracts may be past or current as long as the performance did not end more than three (3) years prior to the due date for the submission of the task order proposal, and the contracts may have been with Federal, State and/or City agencies and commercial customers.

(a) REFERENCE CONTENT: It is the Offeror’s responsibility to provide valid, current and verifiable references. References must include all items identified in the attached Past Performance Questionnaire:

(b) POCs: The above POCs must be either Government personnel (civil service or military) or employees of private sector clients (such as public or private sector medical facilities) with whom you have provided services. Information provided by or for POCs who work directly for your company, or indirectly (i.e. in a prime or subcontractor relationship), will NOT be considered relevant. Offerors shall ensure that contact information for designated references is accurate and up-to-date.

(c) INFORMATION FROM OTHER SOURCES: The Government may consider information obtained through other sources.

(3) PERCENTAGE PROPOSAL CONTENT. Offerors’ percentage proposal shall include proposal percentage assumptions and include required information, i.e. a percentage breakdown by each MTF.

(b) Line Item No. (SF 1449): The Offeror’s proposal shall include completed the percentage for each CLIN identified in the SF 1449 to include the option year. The Offeror shall ensure mathematical computations are correct. Errors in addition or multiplication may be considered a reason to remove your proposal from the competition.

(a) Offerors’ proposals shall remain valid for a minimum of 180 days from the date of submission.

(b) Note to offerors: The limitations of our procurement system does not allow the removal of unit price on the schedule B. Offerors are instructed to by pass the unit price incorporate their percentage based rate into the text of each CLIN.

h. Organizational Conflict of Interest. The government requires potential offerors to disclose actual or potential OCIs or PCIs, the proposed mitigation plan will be evaluated prior to award.

i. PROCESS FOR AWARD. Discussions may be conducted whenever the Contracting Officer deems it appropriate. This contract will be awarded strictly in accordance with the criteria and process established in 10 USC 2304 and 41 USC Chapter 33.

j. BASIS FOR AWARD. Award will be made to the lowest price technically acceptable offeror with an acceptable record of past performance. A neutral rating will be considered as an acceptable past performance.

(m) The non-FAR Part 12 discretionary FAR, DFARS, AFARS, and LOCAL provisions included herein are incorporated into this solicitation either by reference or in full text. If incorporated by reference, see provision 52.252-1 herein for locations where full text can be found.

ADDENDUM TO 52.212-2

Paragraph (a) is hereby supplemented with the following:

BASIS FOR AWARD. Award will be made to the lowest price technically acceptable offeror with an acceptable record of past performance; who is deemed by the Contracting Officer as being responsible; and, whose percentages per transaction are the lowest. A neutral rating (in past performance) will be considered as acceptable past performance.

The Government will evaluate each proposal strictly in accordance with its contents. A proposal that is unrealistic in terms of technical quality will be deemed reflective of an inherent lack of technical competence or indicative of failure to comprehend the complexity and risks of the contractual requirements. Such proposals may be determined unacceptable.

Award will be made using the lowest-price, technically-acceptable source selection process.

The government will initially list proposals from lowest to highest price.

The government will evaluate the Technical Acceptability of the 5 lowest priced proposals first. If one of those proposals is rated Technically Acceptable, the government will not evaluate any other proposals. If those proposals are determined technically unacceptable, the government will evaluate the next 5 lowest priced proposals and continue in that manner until a proposal is rated Technically Acceptable. If a proposal is rated Technically Unacceptable, the government will not evaluate any other factor.

ALL PROPOSALS MAY NOT BE EVALUATED

Award will be made using the lowest price technically acceptable (LPTA) source selection process. Award will be made to the responsible offeror on the basis of the lowest evaluated price of proposals meeting or exceeding the acceptability standards for non-cost factors. Award maybe made without discussions with offerors (except communications conducted for the purpose of minor clarification). Therefore, each initial offer should contain the offeror's best terms from a technical and price standpoint. However, the Government reserves the right to conduct discussions if it is later determined by the contracting officer to be necessary.

Evaluation Factors

PART I: TECHNICAL INFORMATION.

The contractor shall have the demonstrate exprience with Armed Forces Billing and Collection Utilization Solution (ABACUS), including working with billing functions, collection functions and understanding of the ALL requirements stated in the Performance Work Statement necessary to provide the requested service.

Evaluation Factors. The following sub-factors will be evaluated:

Sub-factor 1: Third Party Collection (TPC) Revenue Cycle Plan.

- Proposal shall include how the Offeror proposes to accomplish the TPC revenue cycle function. The proposal shall reflect a sound management approach and full understanding of TPC requirement to include all component functions.

- Shall demonstrate ability to accurately process initial billings to insurance companies including coding review and audits.

- Shall demonstrate experience in using the Armed Forces Billing and Collection Utilization Solution (ABACUS).

- Shall demonstrate ability to capture Other Health Insurance information from individual claimants.

- Shall demonstrate ability to perform timely billing function including claim turn-around times.

- Shall include a “Verification of Insurance Coverage” training and education plan for contract employees and MTF staff.

- Shall demonstrate a track record of successful relationships with health insurance plan payers in terms of first time billings acceptance, low rate of initial claims denials and successful problem resolution, reducing revenue cycle times and improving cash collection performance.

- Shall include a claims denial/appeals management plan.

- Offeror is encouraged to provide any innovative approaches stating benefits to the government for their technical approach.

SUB-FACTOR 2: Information Security Plan

- Proposal shall include a HIPPA compliant, comprehensive Information Management/ Information Technology (IM/IT) integration plan so that contractor systems and equipment will interface with the government network, and also addresses security of protected information, reaction plans to security breaches, mitigation procedures, and corrective action plans and procedures.

- Shall demonstrate that all contractor computer operating systems support antivirus.

- Shall demonstrate that validated remote access requirements are met through common criteria or Federal Information Processing Standards.

- Shall demonstrate that all sensitive data transmitted and accessed outside government networks meet Federal Information Processing Standards.

- Shall demonstrate that each user accessing contractor-government interface systems must have a unique identifier as part of the system credentials.

- Shall demonstrate that systems will process Electronic Protected Health Information or information that falls under the “For Official Use Only” category and supports role designation for user and administrator access and privilege inside the information and system modules.

- Shall demonstrate that mobile devices will not affect encrypted or stored data and it can support antivirus software and on-device authentication.

Technical Acceptability. The Offeror’s Technical Proposal will be evaluated for technical acceptability as compared to this RFP and will be evaluated on a Acceptable / Unacceptable basis. The following adjectival ratings will be used in evaluating each Offeror’s technical proposal:

Technical Acceptable/Unacceptable Ratings

requirements of the solicitation.

requirements of the solicitation.

Note: To receive consideration for award, a rating of acceptable must be achieved in all technical factors.

PART II: PAST PERFORMANCE. Offeror is required to submit information, on a single page, identifying federal, state and local government and private contracts performed within the past three years from the date the solicitation is issued, which are similar in scope, type of work, and complexity to the effort described in this solicitation. If none, Offeror should so state and provide information on references. All Offeror must submit a copy of the past performance questionnaire to each individual listed in the past performance proposal.

Information provided by the contractor shall state:

a) The type of service provided, (should be similar to services being requested)

b) Name, telephone, fax numbers and electronic mail address(es) of a point of contact for the administering contracting office, -award/contract number, the term of the contract, number, the total amount, and number and types of personnel furnished.

The information which will be used for evaluation will be obtained from those presented in the Offer’s past performance documentation, the Contractor Performance Assessment Reporting Systems (CPARS) http://www.cpars.csd.disa.mil/cparsmain.htm, and any other sources. The Government may reject a proposal if it is found that any information that has a negative impact on the offeror’s past performance record has been deleted, misrepresented, or withheld. Past performance surveys should be based upon performance of like services to those in this solicitation.

The Offeror’s performance will be rated in terms of performance risk. A performance risk rating (acceptable or unacceptable) will be assigned dependent upon the evaluator’s assessment of the level of confidence in the Offeror’s performance record (submitted as Appendix #6). Past performance will be evaluated based on assessments of the performance under current and prior contracts for the last three years from the date the solicitation is issued.

Past performance shall be evaluated in accordance with FAR 15.305 and DFARS 215.305. However, the comparative assessment in FAR 15.305(a) (2) (i) does not apply. Therefore, past performance will be rated on an “acceptable” or “unacceptable” basis using the ratings below.

Past Performance Evaluation Ratings

Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown. (See note below.)

Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

Note: In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance (see FAR 15.305 (a) (2) (iv)). Therefore, the offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability, “unknown” shall be considered “acceptable.”

PART III: PRICE

Price will be evaluated to support the selection of the lowest priced, technically acceptable offereor. The offerors with the lowest overall Price will be ranked accordingly.

The offeror's Price Quotations shall be evaluated by CLIN level inclusive of the percentage rate per transaction and the total contract price inclusive of option years. The government will apply the performance base percentage for each CLIN to the average of collection totals in Attachment 2 of the Performance Work Statement to determine the overall celing for each CLIN on the IDIQ.

(i)If adequate price competition is not obtained or if price reasonableness cannot be determined using price analysis of Government obtained information, additional information in accordance with FAR 15.4 may be required to support the proposed price.

(ii) Balance

In addition, offerors are cautioned against submitting an offer that contains unbalanced pricing. Unbalanced pricing exists when, despite an acceptable total evaluated price, the price of one or more contract line items including the Basic ordering period and out year ordering periods, is significantly overstated or understated as indicated by the application of analysis techniques.

The Government will analyze offers to determine whether there are unbalanced separately priced line items or subline items. Prices submitted will be compared and evaluated to assure that a logical progression exists as related to price and quantity changes within each offeror’s response to the pricing structure in the line items Offers that are determined to be unbalanced may be rejected if the lack of balance poses an unacceptable risk to the Government.

Note: Offerors are encouraged to substantively review section paragraph 1.7.1. of the performance work statement in response to this request for proposal.

(End of provision)

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT

Regional Health Command- Atlantic Third Party Collection Program

TABLE OF CONTENTS

22.0 Program Manager

27.0 Immunizations

1.0 INTRODUCTION.

1.0.1 Department of Defense (DOD) policy requires that all Military Treatment Facilities (MTFs) collect payment for medical services rendered to authorized DOD beneficiaries who have other health insurance (OHI) coverage. Under the Third Party Collection Program (TPCP), the Contractor shall augment current MTF staff in such actions which ensure that; MTFs receive Third Party Collection payments for services provided to non-Active Duty DOD beneficiaries who have OHI coverage, and who receive medical treatments from Medical Treatment Facilities (MTFs) named herein, from those patients’ OHIs for those the costs of health care provided in any Government facility of the uniformed services from those third party payer/insurance company(s) who are obligated to pay the United States Government. The contractor shall, in conjunction with MTF staff, perform such steps from OHI discovery through collection to posting from third party payers in this Third Party Collection Program (TPCP). The Government will retain overall responsibility for the Third Party Collection program. Functions performed by government employees will continue to be performed with the in-house staff. Contractor augmentation at each MTF will be specified in the applicable task order.

2.0 SCOPE OF WORK.

2.0.1 Contractor shall, in conjunction with and under the direction of the MTF staff, provide a regional solution that transitions the current individual MTF outpatient and inpatient billing operations into a decentralized regional concept of business/billing revenue cycle activities for the Region Health Command – Atlantic (RHC-A). Industry best business practices shall be incorporated to ensure MTF Third Party Collection (TPC) operations are efficient, effective, and result in maximized collections within Uniform Business Office (UBO) compliance guidelines. Contractor, in conjunction with MTF staff, shall improve the methodology and management of billing processes, improve data quality of coding through billing audits of claims, and optimize implementation of electronic itemized-billing practices as directed by DOD and DA. The Contractor provides all personnel, supervision, training, and services necessary to perform their augmentation of the Government’s automated billing, collection for outpatient, inpatient and ancillary services (pharmacy, laboratory, radiology, EKGs, EEGs, anesthesia, ambulance services, etc.) to include emergency room visits and ambulatory procedure visits and other health insurance management for TPCP within RHC-A. The Government provides all personnel, supervision, training, and services necessary to perform their portion of the Government’s automated billing, collection for outpatient, inpatient and ancillary services (pharmacy, laboratory, radiology, EKGs, EEGs, anesthesia, ambulance services, etc.) to include emergency room visits and ambulatory procedure visits and other health insurance management for TPCP within RHC-A . This is achieved through optimized processes or systems for:

2.1 Electronic discovery (identification and verification) of Other Health Insurance (eOHI) to include scope & dimension of such coverage (i.e., co-pays, deductibles, time limits, min/max order limitations, etc.) -- MTF and/or Contractor.

2.2 Manual discovery (identification and verification) of Other Health Insurance (eOHI) to include scope & dimension of such coverage (i.e., co-pays, deductibles, time limits, min/max order limitations, etc.) -- MTF and/or Contractor.

2.3 Pre-certification & verification of OHI coverage(s) to include scope & dimension of such coverage (i.e., co-pays, deductibles, time limits, min/max order limitations, etc.) – MTF and/or Contractor.

2.4 As coordinated with MTF billing staff claims preparation, submission (to OHIs), processing & follow-up with OHIs, from initial claim file through to claim(s) resolution and monetary transfers -- MTF and Contractor.

2.5 Electronic document imaging, records management, including remote storage and retrieval of records -- MTF and Contractor.

2.6 Aged accounts receivable tracking, processing, and follow-up to resolution -- MTF and Contractor.

2.8 Back-billing of claims (for newly discovered beneficiaries possessing OHI) through claims follow-up through to claims resolution -- MTF and Contractor.

2.9 Denials management and refund request review and resolution -- MTF and Contractor.

3.0 PERFORMANCE MEASURES.

3.0.1 The contractor, in conjunction with the Government, shall establish and maintain a performance goal for the optimization of outpatient and inpatient revenue collection activities across the RHC-A region, ensuring the requirements of this PWS are provided as specified. The performance goal(s) will be stated in terms of the total annual TPCP outpatient and inpatient collections (in $) the contractor is expected to meet or exceed in the base year and in the option periods if exercised. The contractor’s performance (measures) expectations will be incorporated into the resulting contract. The contractor and RHC-A, Chief Patient Administration Officer or Resource Management Officer, and the Contracting Officer Representative (COR) shall meet at least Quarterly to discuss past performance, current status, and review the QASP and future planning reference operations associated with TPC throughout the RHC-A.

4.0 OTHER HEALTH INSURANCE (OHI) IDENTIFICATION AND VERIFICATION.

4.0.1 The contractor shall, in conjunction with the Government, establish and maintain a performance goal for the identification and verification of OHI for non-Active Duty DOD beneficiaries who receive medical treatments from MTFs within the RHC-A region, ensuring the requirements of this PWS are…