Medical Adjudication Services Correction

Added: June 4, 2007 Modified: June 29, 2007Track Changes The Federal Bureau of Prisons (BOP) is seeking quotes from sources having the ability to provide medical claims adjudication services for BOP institutions. Adjudication services will process claims for health care service providers and contractors paid under Medicare-based rate structures. The BOP currently provides healthcare to more than 190,000 inmates in more than 100 prisons (institutions) geographically dispersed throughout the contiguous United States, Hawaii, and Puerto Rico. In fiscal year 2006, approximately 45,215 medical payments were completed. The services described shall be in accordance with the ?Federal Bureau of Prisons Medical Claims Adjudication Services? statement of work. For the purpose of contract award, a claim for contracted healthcare services reimbursed using the Medicare model is defined as either: a current paper version of the UB92 or CMS-1500; or alternatively, electronic claims that conform to Medicare and HIPAA electronic billing standards from a contracted hospital, physician's office, or other healthcare provider. A claim for all other contracted healthcare services (not using Medicare reimbursement model) is defined per the terms of the individual contracts. The system used by the contractor to adjudicate claims shall be an automated system and have the capability, to generate Explanation of Benefits. The contractor shall integrate a preauthorization process into their claims adjudication system. Electronic Data Interchange invoicing of claims between the healthcare provider and the contractor will be required. The contractor shall not make payments for medical services rendered to BOP inmates on behalf of the BOP. The contractor will be required to provide customer support services (7:30AM Atlantic time to 4:00PM Hawaii-Aleutian Time) for BOP institutions, as well as, healthcare providers. The proposed system must meet computer and security system technical requirements. Contractor and subcontractor personnel shall have security investigations commensurate with the highest level of information processed by the system. The contractor shall also train BOP staff in the use of the adjudication system. Healthcare providers currently providing health care services to the BOP under contract, purchase order, or other service agreement, whether directly and/or indirectly, are precluded from participating in this solicitation/contract. This is a firm-fixed price Requirements type contract and will be awarded to a single provider. The solicitation will be available on or about June 11, 2007 and will be distributed solely through the Federal Business Opportunities website, http://www.fbo.gov. Hard copies of the solicitation document will not be available. The site provides downloading instructions. All future information about this acquisition, including solicitation amendments, will be distributed solely through this site. Interested parties are responsible for monitoring this site to ensure that they have the most current information about this acquisition. The estimated closing date is on or about June 28, 2007. Faith-Based and Community-Based organizations can submit quotations equally with other organizations for contracts for which they are eligible. All responsible sources may submit a quote which will be considered by this agency.

Added: June 4, 2007 The Federal Bureau of Prisons (BOP) is seeking quotes from sources having the ability to provide medical claims adjudication services for BOP institutions. Adjudication services will process claims for health care service providers and contractors paid under Medicare-based rate structures. The BOP currently provides healthcare to more than 190,000 inmates in more than 100 prisons (institutions) geographically dispersed throughout the contiguous United States, Hawaii, and Puerto Rico. In fiscal year 2006, approximately 45,215 medical payments were completed. The services described shall be in accordance with the ?Federal Bureau of Prisons Medical Claims Adjudication Services? statement of work. For the purpose of contract award, a claim for contracted healthcare services reimbursed using the Medicare model is defined as either: a current paper version of the UB92 or CMS-1500; or alternatively, electronic claims that conform to Medicare and HIPAA electronic billing standards from a contracted hospital, physician's office, or other healthcare provider. A claim for all other contracted healthcare services (not using Medicare reimbursement model) is defined per the terms of the individual contracts. The system used by the contractor to adjudicate claims shall be an automated system and have the capability, to generate Explanation of Benefits. The contractor shall integrate a preauthorization process into their claims adjudication system. Electronic Data Interchange invoicing of claims between the healthcare provider and the contractor will be required. The contractor shall not make payments for medical services rendered to BOP inmates on behalf of the BOP. The contractor will be required to provide customer support services (7:30AM Atlantic time to 4:00PM Hawaii-Aleutian Time) for BOP institutions, as well as, healthcare providers. The proposed system must meet computer and security system technical requirements. Contractor and subcontractor personnel shall have security investigations commensurate with the highest level of information processed by the system. The contractor shall also train BOP staff in the use of the adjudication system. Healthcare providers currently providing health care services to the BOP under contract, purchase order, or other service agreement, whether directly and/or indirectly, are precluded from participating in this solicitation/contract. This is a firm-fixed price Requirements type contract and will be awarded to a single provider. The solicitation will be available on or about June 11, 2007 and will be distributed solely through the Federal Business Opportunities website, http://www.fbo.gov. Hard copies of the solicitation document will not be available. The site provides downloading instructions. All future information about this acquisition, including solicitation amendments, will be distributed solely through this site. Interested parties are responsible for monitoring this site to ensure that they have the most current information about this acquisition. The estimated closing date is on or about June 28, 2007. Faith-Based and Community-Based organizations can submit quotations equally with other organizations for contracts for which they are eligible. All responsible sources may submit a quote which will be considered by this agency.