Historical Medical Claims Data Analysis

Sources Sought Notice / Request for Information (RFI)

Historical Medical Claims Data Analysis Services

1. Purpose

This Sources Sought Notice/Request for Information (RFI) is issued solely for market research purposes in accordance with Revolutionary FAR Overhaul (RFO) Part 10 and RFO Subpart 8.4. This notice is not a solicitation and does not constitute a commitment by the Government to award a contract.

The Government seeks information from contractors to determine the availability of qualified sources, evaluate the capabilities of small business concerns, identify commercially available solutions, obtain budgetary pricing information, and assist in determining the appropriate acquisition strategy, including whether a socioeconomic set-aside is appropriate.

The Government will not reimburse respondents for any costs incurred in responding.

2. Background

The Federal Bureau of Prisons (BOP) is conducting market research for professional analytical support services to evaluate approximately 2,000,000 historical medical claims.

The effort is analytical in nature and will support evaluation of Medicare reimbursement methodologies and future acquisition planning. The contractor will not perform claims adjudication, claims processing, utilization management, provider network management, or payment administration.

The analysis will be used to examine the data for fraud, waste, and abuse; as well as to identify trends within the claims data such as over-use or over-billing including duplicate charges.  No current real-time data will be provided as this analysis is solely intended for historical evaluation.  Additionally, no personally identifiable information (PII) will be provided in the dataset. 

3. Draft Requirement

The contractor shall furnish all personnel, management, commercial software, analytical tools, and other resources necessary to analyze approximately 2,000,000 historical medical claims.

The analysis deliverables shall include:

• Duplicate claims
• Inappropriate procedure code based on included diagnostic code
• Outliers (overuse) of specific procedure codes by specific providers and/or sites
• Comparison of billed rates to Medicare rates, reported as a percentage of Medicare rates
• Ranking of providers by amount billed
• Ranking of patients by amount billed
• Ranking of sites (facilities) by amount billed
• Ranking of procedure codes by amount billed
• Ranking of providers by procedure code
   

The data provided by the Government will include:

• Claim ID
• Patient gender
• BOP internal patient ID number
• Authorization number
• Payor/institution information (name, city, state)
• Diagnostic codes
• Service Dates
• Procedure (CPT) codes
• Procedure description
• Charge amount
• Billing provider information (NPI, ID number, name)
• Providing facility information (name, NPI)

4. Commercial Artificial Intelligence (AI)

The Government is interested in commercially available AI-enabled capabilities that could improve the efficiency, quality, and timeliness of the required analyses. The Government is not seeking development of a custom AI model.

Respondents should describe proposed commercial AI tools, the analytical functions they support, human validation processes, protection of PHI/PII and other sensitive information, and whether the capabilities are available under the respondent's GSA MAS contract (if applicable).

Please note that this needs to be a closed source AI model.

5. Performance Timeline

The contractor shall complete the required analyses and provide all required reports and recommendations within sixty (60) calendar days after the Government provides the historical claims data.

Respondents should identify any assumptions affecting their ability to meet this schedule.

6. Security

The contractor may have access to Protected Health Information (PHI), Personally Identifiable Information (PII), and other sensitive Government information. Respondents should assume compliance with all applicable Federal privacy and cybersecurity requirements.

7. Applicable Classifications

NAICS (under consideration): 541611
PSC (under consideration): R405

Respondents may recommend alternative classifications with supporting rationale.

8. Information Requested from Industry

Please provide:

• Company name
• UEI
• Cage Code
• Business size and socioeconomic status
• GSA MAS contract number (if applicable)
• Applicable SIN(s) (if applicable)
• Confirmation that the required services are within the scope of your awarded SIN(s) (if applicable)
• Primary Point of Contact

Relevant experience involving large healthcare claims datasets, Medicare reimbursement methodologies, healthcare reimbursement analysis, healthcare financial analysis, or statistical analysis of healthcare claims. Include customer, period of performance, scope, dollar value, and approximate number of claims analyzed.

Describe your technical approach, analytical methodology, software platforms, quality assurance processes, and any commercially available AI capabilities proposed.

If your organization qualifies as a small business, describe your ability to perform the entire requirement as the prime contractor and identify any anticipated subcontractors.

9. Budgetary Firm-Fixed-Price Estimate

For market research purposes only, respondents are requested to provide one Budgetary Firm-Fixed-Price estimate for completing the analysis of approximately 2,000,000 historical medical claims.

The estimate should include all labor, management, software, commercial AI tools (if proposed), licensing, reporting, quality assurance, and all other costs required to complete the effort.

Do not provide labor category rates or labor-hour estimates.

Identify:
• One Budgetary Firm-Fixed-Price
• Pricing assumptions
• Factors that could materially affect cost

10. Questions for Industry

1. Can your organization perform the entire scope of the draft requirement?
2. Is the requirement representative of commercially available services?
3. Is the 60-calendar-day performance timeline reasonable?
4. If your organization is a small business, describe why it is capable of performing this requirement as the prime contractor.
5. Identify the GSA MAS contract and SIN(s) under which these services would be offered and confirm they are within scope (if applicable).
6. Identify any recommendations that would improve the Government's requirement or acquisition approach.

11. Response Instructions

Responses should not exceed 15 pages, excluding supporting documentation. Submit responses electronically in searchable PDF format to kmfisher@bop.gov

12. Disclaimer

This notice is issued solely for market research purposes and does not constitute a solicitation.

The Government may use responses to determine the appropriate acquisition strategy, including commerciality, competition, pricing approach, and whether the requirement should be reserved or set aside for one or more small business programs.

The Government is not obligated to issue a solicitation, award a contract, or reimburse any costs incurred in responding.