Secure Exchange Data Software - 3rd Party Insurance Claims M/M/VA/Commercial Payers - Santa Fe Indian Health Center

SOURCES SOUGHT

BACKGROUND:

The Albuquerque Area Indian Health Service (AAIHS), Santa Fe Indian Health Center (SFIHC) Business Office Department, has a requirement for Secure Exchange Data Software - Perform Third-Party Insurance Claims Processing for Medicare, Medicaid, VA and Commercial Payers. Santa Fe, New Mexico.

OBJECTIVE:

Santa Fe Indian Health Center requires a secure exchange data software solution to provide connectivity to various Revenue Cycle Management services, insurance verification/discovery, perform third-party insurance claims processing for Medicare, Medicaid, VA and Commercial Payers, claims attachments and denial prevention analytics with RCM Intelligence. SFIHC is looking for business and revenue continuity, to keep Software as a Service (no contractor software within the SFIHC environment), confidentiality, authentication, integrity, and non-repudiation as required.

Secure exchange managed services are needed for the medical, behavioral, and dental claims process to keep in compliance with Indian Health Service mandates.

RESPONSIBILITIES: 

• To provide secure exchange software platform to perform third-party insurance claims processing for Medicare, Medicaid, VA and Commercial Payers.
• To allow SFSU to submit, edit and receive claims for Medicare, Medicaid and other commercial insurance companies.
• To allow use of Electronic claims for submission. And claims to be submitted multiple times per day.
• A system must be in place to identify claims that will not be accepted by Payers. Errors will be identified, so users can correct those claims through pre-established instructions to correct claim.
• Support end-to-end communication testing, implementation and daily operations of the data transfers from the contractor to Santa Fe Indian Health Clinic.
• Provide staff training via internet meetings upon implementation and as needed. Provide helpful videos and support pages throughout each system will be included.
• Provide routine technical support to implement corrections to service occurring as a result of errors, flaws, or other failures within its service.
• Notify a designated Santa Fe point of contact (Contracting Officer’s Representative (COR)or designated department POC) of any scheduled maintenance that shall result in downtime at least two (2) days prior to the maintenance period.
• Notify a designated SFSU point of contact of any issues as that result in a disruption of data exchange capabilities. This notification shall occur as soon as possible after the disruption has been identified.
• Provide customer support for reporting, documenting, tracking and resolving of service problems, which shall be available via telephone and email to the Santa Fe Service Unit technical staff during the period 7:30 am to 7:30 pm Central Standard Time on weekdays.
• Provide knowledgeable support personnel to assist with any issues regarding the processing of the medical claims.
• Provide toll free telephone/technical support during normal business hours, 7:30 am to7:30 pm Central, Monday through Friday.
• Compliant with HIPAA regulations. 

Claim Attachments to Payers – Ability to upload and send additional documentation for those payers that require claim attachments.

REQUIRED PROVIDER SOLUTIONS FOR SFIHC:

·         RCM Intelligence

·         Claims Management Pro (All-Payer Revenue Cycle Management)

·         Dental Claims Management

·         Enhanced Insurance Discovery with Demographic Verification

·         Eligibility Workflow

HOURS OF OPERATION & PLACE OF DELIVERY:

All deliverables shall be delivered to the client no later than the date specified in the SOW unless otherwise agreed upon. Hours of installation will be M-F from 8:00 AM to 4:30 PM.

The Vendor shall provide shipping date information to the Contracting Officer’s Representative (COR) or POC listed.  The equipment shall be shipped to the following location:

Santa Fe Indian Health Center

Attn: Business Office Department

1700 Cerrillos Road

Santa Fe, NM  87505

CONTRACTING OFFICER’S RESPRSENTATIVE (COR)/POINT OF CONTACT (POC):

The Contractor shall verify all equipment information and coordinate delivery with the COR as follows:

Travis Snyder, travis.snyder@ihs.gov, (505) 946-9209.

Helena Burbank, helena.burbank@ihs.gov, (505)

STATEMENT OF OBJECTIVES:     

• Locate eligible and qualified Small Business Indian Firms to support IHS procurement needs under NAICS code: 522320 – Financial Transactions Processing, Reserve, and Clearinghouse Activities.
• Utilize the information received with future acquisition planning efforts and potential Buy Indian set aside. 

HOW TO RESPOND:

This is a sources sought notice under the authority of the Buy Indian Act. The Indian Health Service (IHS) is attempting to locate qualified and eligible Small Business Indian Firms, “Native American Indian Owned and Operated businesses,” that can provide services/supplies to the Indian Health Service.  This is a request for information only, this is not a solicitation.  Responses to this notice are not considered offers and cannot be accepted by the Government to form a binding contract.  Any information submitted by respondents to this notice is strictly voluntary with no obligation or incurred cost by the government.

Provide with response –

1. E-mail response.  Shall be in a printer friendly format, Word or PDF, 8x11 page size, 5-page limit.
2. Certification as a Small Business Indian Firm. The government is ONLY interested in Small Business Indian Firms. (See attached Representative Form).
3. The government requests that interested parties respond to this notice if applicable and identify your business status to the identified NAICS code. 
4. Prospective vendors shall be properly registered in SAM.gov; this includes proper registration as a Small Business Indian Firm and if eligible, registered as applicable small business certifications (e.g. HubZone, 8(a), Service Disabled Veteran Owned, Veteran Owned, Women-Owned, Small Disadvantaged), in order for IHS to issue an award and claim procurement actions with eligible Small Business Indian Firms.
5. Provide detailed capabilities statement, website, and e-catalog as it pertains to 522320 – Financial Transactions Processing, Reserve, and Clearinghouse Activities.
6. Provide Unique Entity Identifier (UEI) created in SAM.gov registration.
7. Identify Business Size:  Small Business Indian Firm, Small Businesses or a Large Indian-Owned Firm.
8. GSA/FSS contract holders – provide GSA/FSS/VA or other GWAC contract number, only if applicable.