Q201--CCN Next Gen Medical Network - East

The Department of Veterans Affairs is conducting market research for the Community Care Network (CCN) Next Generation Medical Network - East, seeking a contractor to serve as a Third-Party Administrator responsible for establishing, maintaining, and managing a comprehensive network of qualified healthcare providers across eastern states including Alabama, Connecticut, Florida, and New York. The procurement aims to deliver medical services including primary care, specialty care, complementary and integrative health services, durable medical equipment, pharmacy services, and community nursing home care to eligible veterans in accordance with the VA MISSION Act of 2018. Key requirements include developing a medical network that meets specific adequacy standards for drive times and appointment availability, implementing robust credentialing and quality assurance processes, providing customer service capabilities, processing claims, and ensuring program integrity through advanced technology systems. The contractor will be evaluated based on performance metrics including customer service objectives with call blockage rates not exceeding 5%, claims processing timeliness with 98% adjudicated within 30 days, and network access standards. The current Request for Information response deadline is September 12, 2025, at 3:00 PM EST, with the VA planning to post a Request for Proposal in early Q1 of FY26.

This procurement does not utilize any set-aside designations and is classified under NAICS code 524114 (Direct Health and Medical Insurance Carriers) and Product Service Code Q201 (Medical-Managed Healthcare). No incumbent contractors or current service providers are specifically identified in the solicitation documents. The contract structure includes an Indefinite Delivery Indefinite Quantity (IDIQ) Firm-Fixed Price arrangement with multiple Contract Line Item Numbers covering healthcare services at up to 100% Medicare rates, payment rate waivers, seasonal vaccinations, and various fee schedules for non-standard medical services. Optional services include appointment scheduling, care coordination follow-up, software development, and disaster response medication support. The contractor must achieve go-live implementation within 18 months of contract award, with the VA seeking industry feedback on whether 6, 12, or 18-month implementation timelines are feasible. The contract includes provisions for potential extensions up to 120 months and requires strict compliance with federal regulations including HIPAA, FISMA, and NIST standards for data security and privacy protection.