Pharmacy Point-Of-Service Billing System

The Washington State Department of Labor & Industries (L&I) is seeking an Electronic Data Interchange (EDI) transaction services provider for its Pharmacy Point-of-Service Billing System through Request for Proposals (RFP) K5761. The procurement aims to establish a contract for processing real-time prescription claims using electronic National Council for Prescription Drug Programs (NCPDP) transactions between pharmacies and L&I's point-of-sale system. Key deliverables include providing connectivity, transmission services, customer support, system maintenance, disaster recovery, and monthly network activity reporting. The contract will cover multiple Washington state jurisdictions and is scheduled to run from February 18, 2025, through December 31, 2031. The evaluation criteria include Methodology & Approach (35%), Qualifications & Experience (35%), Cost (15%), Executive Order 18-03 Certification (5%), and Washington Veteran-owned and/or Washington Small Business preference (10-20%). Key dates include a bid due date of January 17, 2025, with potential oral presentations during the week of February 10, 2025. The estimated transaction volume is 50,000 transactions every two months, though L&I provides no volume guarantees.

The solicitation includes voluntary diversity goals of 10.80% for minority-owned, women-owned, and small businesses, and 2.23% for veteran-owned businesses. Current infrastructure involves MPOS (Medical Information Payment System), an in-house mainframe system integrated with MIPS for payment processing through the state's AFRS system, with OPTUM/Change Health Care serving as the current EDI service provider. The contractor will receive no direct compensation from L&I, with transaction costs paid by submitting pharmacies. Bidders must demonstrate experience with real-time EDI services, provide system reliability, maintain a substantial network, and show robust transaction processing capabilities. Insurance requirements include $1 million in commercial general liability, automobile liability, and professional liability insurance. The contractor must also complete a security design review by WaTech, as the VPN connects between the switch vendor and WaTech, with the mainframe operated by Ensono. All contractors must comply with NCPDP D.0 standards and provide comprehensive technical and support capabilities to ensure seamless prescription billing adjudication.