Medical Claims Adjudication

The solicitation has been amended to extend the close date to Friday, October 10, 2014 at 12:00 p.m. EST.  Questions that were submitted by interested vendors by the close date of September 10, 2014 will be posted within the next week.

The cut-off to submit questions and/or clarifications will be Wednesday, September 10, 2014 at 4:00 p.m.  Please submit questions and/or clarifications in writing to the attention and e-mail address of the contracting officer listed in the solicitation.  Also note that the close of the solicitation has been extended to Friday, September 26, 2014 at 12:00 p.m. Eastern.

The Federal Bureau of Prisons (BOP) is seeking proposals from sources having the ability to provide medical claims adjudication services for BOP institutions.  Adjudication services  will ensure compliance with the Medicare Claims processing guidelines/manual in conjunction with the National Correct Coding Initiative edits for fee schedule healthcare providers.  The BOP currently provides healthcare to more than 220,000 inmates in more than 119 prisons (institutions) geographically dispersed throughout the contiguous United States, Hawaii and Puerto Rico.  The services described shall be in accordance with the BOP's 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 UB04 or CMS-1500 or alternatively, electronic claims that confirm to Medicare and Health Insurance Portability and Accountability Act (HIPPA) 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.  Current adjudication data must be integrated into the new medical claims adjudication system.  The contractor shall integrate a preauthorization process into their claims adjudication system.  Electronic Data Interchange invoices 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 during normal business hours (7:30 AM Eastern time to 4:00 PM Hawaii-Aleutian Standard 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 July 18, 2014 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 August 1, 2014. Faith-Based and Community-Based organizations can submit quotations equally with other organizations for contracts for which they are eligible.

The Federal Bureau of Prisons (BOP) is seeking proposals from sources having the ability to provide medical claims adjudication services for BOP institutions.  Adjudication services  will ensure compliance with the Medicare Claims processing guidelines/manual in conjunction with the National Correct Coding Initiative edits for fee schedule healthcare providers.  The BOP currently provides healthcare to more than 220,000 inmates in more than 119 prisons (institutions) geographically dispersed throughout the contiguous United States, Hawaii and Puerto Rico.  The services described shall be in accordance with the BOP's 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 UB04 or CMS-1500 or alternatively, electronic claims that confirm to Medicare and Health Insurance Portability and Accountability Act (HIPPA) 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.  Current adjudication data must be integrated into the new medical claims adjudication system.  The contractor shall integrate a preauthorization process into their claims adjudication system.  Electronic Data Interchange invoices 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 during normal business hours (7:30 AM Eastern time to 4:00 PM Hawaii-Aleutian Standard 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 2, 2014 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 20, 2014. Faith-Based and Community-Based organizations can submit quotations equally with other organizations for contracts for which they are eligible.