7A21--Prepayment Claims Software Editor

The Department of Veterans Affairs Technology Acquisition Center is seeking a prepayment claims editor software solution to enhance healthcare claims processing and prevent erroneous payments. The solicitation targets a medical claims editing tool capable of identifying program integrity issues before payment, with specific requirements including auditing professional and facility claims, validating frequency limits, medical necessity, and applying coding crosswalks. The software must be able to integrate VA policy, industry standards, and CMS regulations to ensure accurate claims processing. Potential vendors are expected to provide detailed responses demonstrating their solution's capabilities, implementation timelines, and cost structures by June 19, 2025, at 2:00 pm Eastern Time. The RFI is coded under NAICS 513210 (Software Publishers) and Product Service Code 7A21, indicating a focus on business application software.

The opportunity is not designated for any specific set-aside, which means it is open to a broad range of contractors. The solicitation suggests flexibility in software delivery models, including commercial off-the-shelf systems, software as a service (SaaS), or custom-developed solutions tailored to VA requirements. While specific budget ranges are not disclosed in the pre-solicitation notice, the complexity of the claims editing software implies a potentially significant investment. The VA Technology Acquisition Center is seeking a comprehensive solution that can effectively process and validate medical claims across professional and facility domains. The timeline for implementation and potential contract duration are not explicitly stated, but the June 2025 posting suggests an imminent procurement process.