D303--Healthcare Clearinghouse (HCCH) to Support Health Care Electronic Data Interchange (EDI) & paper-based Health claims and associated medical documentation (VA-19-00068629)

PRESOLICITATION NOTICE: The Department of Veterans Affairs (VA) Strategic Acquisition Center (SAC-VA) in Fredericksburg, Virginia intends to issue a solicitation for the procurement of contractor to support for the VA Veterans Health Administration (VHA), Office of Community Care (OCC) with Electronic Data Interchange (EDI) transactions and paper-based Health claims and associated medical documentation.

VHA/OCC uses a HCCH to provide connectivity for incoming and outgoing EDI transactions to support the payment for services provided by community providers to Veterans and Veteran Families. The Payer EDI program provides interfaces to both external and internal systems to facilitate the reimbursement processes. As a payer OCC accepts both paper and electronic submissions for health claims and for supporting documentation (i.e. attachments). Current programs are as follows:

Veteran:

Non-VA Medical Care Program (NNPO-legacy name VA Fee Basis)

Non-VA Medical Care Dialysis National Contracts (DNC)

Patient-Centered Community Care (PCCC)

Indian Health Service and Tribal Health Program (IHS/THP)

Community Care Network (CCN)

CHOICE

VA Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION)

Veteran Families:

Camp Lejeune Family Member Program (CLFMP)

Civilian Health and Medical Program VA (CHAMPVA)

Spina Bifida Health Care Program (SB)

Children of Women Vietnam Veterans (CWVV)

As a Payer, VHA/OCC has initiated multiple projects to increase the volume and overall percentage of electronic transactions versus paper or other manual transactions to comply with legislation and to facilitate administrative simplification. VHA/OCC also employs a HCCH to transmit incoming and outgoing EDI transactions to the over one million medical and dental providers throughout the United States, Puerto Rico, and US Territories. The EDI transactions consist of batch and real-time transfers of Health Information Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12N 5010 transactions. VHA/OCC also supports several hosted real-time EDI transactions.

VHA OCC will maintain EDI transaction capability throughout the term of this contract giving community health care providers access to HIPAA-compliant data and processes and contract support for the receipt of paper claims and their conversion to EDI transactions. Finally, the overall effectiveness and quality of these activities will be monitored using standard, regular reports.

VHA OCC currently exchanges EDI transactions between health care entities. OCC is seeking a Health Care Clearinghouse (HCCH) contractor, referenced as the Contractor , to support all its current EDI transactions across the United States and territories and to assist in continuing its mission to implement EDI transactions and utilization of a single national location that will receive paper-based submissions and convert these submissions to electronic formats and transmit these submissions via EDI to the VA. The Contractor will support three major EDI activities over the course of this contract: Implementation, Operations and Maintenance, and Reporting. Implementation shall cover all activities required to establish initial operational capabilities for Payer EDI. The initial implementation should limit the need for programmatic changes on VHA OCC Information Technology (IT) systems and shall not be priced separately. Implementation shall include full trading partner transaction capabilities with provider communities in all 50 United States, Puerto Rico and Territories. Additional Implementations shall be proposed as optional tasks at various levels of effort (LOE) (i.e. small, medium, or large). Operations and Maintenance shall cover all activities required to sustain Payer EDI transactions over this contract s period of performance. Finally, reports shall be required to monitor quality and volumetric data over the course of the contract. The Contractor shall provide all services related to receiving paper claims and/or paper medical documentation from community health care providers and Veteran Family Member Program (VFMP) providers via postal mail, in a single location, converting these documents to the appropriate HIPAA-compliant EDI transactions and sending as EDI transactions

The Government intends to issue a Request for Proposal (RFP) to establish single award Firm Fixed Price Requirements Contract, the anticipated period of performance is 48-months.

The Government intends to post an RFP to Federal Business Opportunities on or about May 4, 2020. The solicitation will remain open for 30-days for proposals to be submitted for evaluation. Specific details will be included in the RFP.

This requirement is restricted for full and open competition. SDVOSB contractors must be verified and viewable in VetBiz www.vip.vetbiz.gov prior to submission of proposal and prior to award of contract. Status as a qualified SDVOSB concern is under the authority of 38 CFR Part 74 in accordance with the VA Acquisition Regulation (VAAR) Part 819. Eligibility determination is performed by the Center for Veterans Enterprise (CVE).

To be eligible for award the vendor must be considered registered all under 518210 NAICS code in System for Award Management (SAM): https://www.sam.gov/portal/public/SAM/

No telephone or email request for information will be taken at this time.