R499--Modern Claims Processing (MCP) Program Support Sources Sought Notice

1.SOURCES SOUGHT NOTICE (SSN) ONLY. The U.S. Government is conducting market research only to determine the availability of qualified Contractors capable of providing Modern Claims Processing Program Support services. Interested Contractors are invited to provide a capability statement with responses to the Veterans Benefits Administration (VBA) questions via e-mail to Contract Specialist Ross Byrne at ross.byrne@va.gov by April 10, 2024 1:00 pm (PT). The email subject line must contain the following: Response to Sources Sought Notice 36C10D24Q0129, VBA Modern Claims Processing Program Support services . Sources Sought Notice responses shall not exceed 8 pages total. Responses shall be prepared on standard 8.5 x 11-inch paper (charts may be landscaped but must be on 8.5 x 11-inch paper) and shall be in Times New Roman, font size (12), with 1 margins. All pages of the response shall be appropriately numbered and identified with the Sources Sought Notice number.

Responses will be used to determine the appropriate strategy for a potential acquisition. Please clearly identify any information your company considers sensitive or proprietary. This notice is issued solely for information and planning purposes - it does not constitute a Request for Quotation (RFQ), or a promise to issue an RFQ in the future. This notice does not commit the U.S. Government to contract for any supply or service. Further, the U.S. Government is not seeking quotes, or proposals at this time and will not accept unsolicited quotes in response to this Sources Sought Notice. The U.S. Government will not pay for any information or administrative costs incurred in response to this notice. Submittals will not be returned to the responder. Not responding to this notice does not preclude participation in any future RFQ, if any is issued.

2.BACKGROUND: The Veterans Benefits Administration (VBA) Office of Automated Benefits Delivery has a current need for a Contractor to provide Modern Claims Processing Program Support services. The Modern Claims Processing (MCP) Program support is intended to provide transformative services to Veterans Benefits Administration s (VBA) claims processing. The program is leveraging computable benefits data from VBA and medical data from the Veterans Health Administration (VHA) to conduct analysis and identify administrative tasks and workflows for automation. The goal is to assist claims processors in making fast, accurate, consistent, and equitable claim decisions for Veterans and beneficiaries.

Through automation the efficiency of compiling and indexing evidence data are improving the effectiveness of compiling relevant evidence into more intuitive information for claim processors to review and adjudicate. Hence, claim processors are making faster, well-informed decisions while maintaining full adjudicative discretion in accordance with statutes and regulations.

3.NAICS: 541611, Administrative Management and General Management Consulting Services

4.Information Sought

Contractor Information

Contractor Responses to Questions

4.1 Contractor Information

Contractor Name:

Address:

Contractor point of contact:

Phone number:

email address:

SAM IUE:

Please indicate business size:

Small Disadvantage Business (SDB)____

8(a)____

Historically Underutilized Business Zone (HUBZone)____

Service-Disabled Veteran-Owned Small Business (SDVOSB)____

Veteran-Owned Small Business (VOSB)_____

Economically Disadvantaged Women-Owned Small Business (EDWOSB)_____

Women-Owned Small Business concerns (WOSB)_____

Small Business_____

Large Business_____

Please state if you possess a Federal Supply Schedule (FSS) under 541611________

4.2 Contractor Capability Statement response to VBA Program Office Questions.

Please submit your Capability Statement response to the questions below that demonstrates your company has the capability, experience and resources to provide the required Modern Claims Processing Program Support Services as stated in the attached draft Performance Work Statement below.

Provide an overview of your firm s capabilities to fulfill the requirements of the PWS, to include organizational and staff capability and experience.

Provide a brief narrative summary of your technical approach to mapping XSD schema representations of disability benefits questionnaires (DBQs) to VA Schedule for Rating Disabilities (VASRD) evaluation criteria.

Provide a sample mapping of a DBQ to VARD evaluation criteria.

Provide a brief narrative summary of your technical approach to developing SQL queries that chain adjacent hospital admissions within VA s Corporate Data Warehouse (CDW) in order to accurately determine total duration of hospitalization as it pertains to entitlement to Veterans Benefits Administration benefits under Title 38 of the Code of Federal Regulations (CFR) 4.29, 4.30, 3.552, etc.

Provide an example of your experience with the following:

a.           Electronic Health Record Medical Data to VASRD

b.           Health Data Repository (HDR)

c.            VA Informatics and Computing Infrastructure

d.           Current Procedural Terminology (CPT) Coding

e.           International Classification of Diseases (ICD) Coding

f.            38 CFR Part 3, VA Adjudication

g.           38 CFR Part 4, VA Schedule for Rating Disabilities

h.           M21-1, VA Adjudication Procedures Manual

i.             Fast Healthcare Interoperability Resources Specifications