SOURCES SOUGHT
R -- Administrative Support to provide health care administration services for a group of Saudi military personnel assigned to the United States and Canada and their authorized dependants.
- Notice Date
- 10/22/2010
- Notice Type
- Sources Sought
- NAICS
- 524292
— Third Party Administration of Insurance and Pension Funds
- Contracting Office
- N00189 FISC NORFOLK, PHILADELPHIA OFFICE 700 Robbins Avenue, Building 2B Philadelphia, PA
- ZIP Code
- 00000
- Solicitation Number
- N0018911SRSNF
- Response Due
- 11/5/2010
- Archive Date
- 11/5/2010
- Point of Contact
- See Below
- Small Business Set-Aside
- N/A
- Description
- The Fleet and Industrial Supply Center (FISC) Norfolk, Contracting Department, Philadelphia Office announces a Sources Sought Synopsis Number N00189-11-S-RSNF, to support the Naval Education and Training Security Assistance Field Activity (NETSAFA), Pensacola, FL. This announcement is issued for informational and planning purposes only. This synopsis is not to be construed as a commitment by the Government to issue a solicitation or ultimately to award a contract on the basis of this synopsis. Responses to the synopsis will not serve as proposals, bids, or offers that could be accepted by the Government to form a binding contract. NETSAFA requests information from interested parties that are capable of providing a response to the following descriptions. Under the anticipated contract, the Administrator (also known as the Third Party Administrator) will provide health care administration services for a group of Saudi military personnel assigned to the United States and Canada and their authorized dependants. This requirement is for administration and bill paying only and is not for the medical insurance itself. The Administrator will provide a claim system for the submittal of claims by various health care providers, screen the claims to determine if the coverage under the benefit conforms and are considered reasonable and customary, and promptly pay the provider accordingly. The Administrator will be reimbursed for claims paid out through the contract. The Administrator must have access to a working fund from which initial payments for claims will be made pending reimbursement under the contract. RESPONSIBILITIES OF CONTRACTOR. 1.Role as Administrator. Contractor will act as the Administrator for the Royal Saudi Naval Forces Medical Plan. The following are the principal duties of the Administrator: a.CONTRACTOR will receive bills for medical, dental, and related health services provided to Plan members. These bills will be screened to determine that the services provided are eligible under the Plan, that the amounts billed do not exceed Reasonable and Customary (R&C) costs for the geographical area where provided, and make payments to providers accordingly. b.CONTRACTOR will have responsibility for management of approval action for all types of pre-treatment plans developed by providers in accordance with the requirements of this Plan. Dental treatment plans, which require case-by-case approval will be analyzed by the CONTRACTOR and forwarded, with appropriate recommendation, to Assistant Defense Attache for Naval Affairs (ADANA). Orthodontic treatment plans will be handled as outlined in the Schedule of Benefits, Section H. c.A Utilization Review (UR) manager will be contracted for by the CONTRACTOR. The UR manager will have responsibility for the validation of medical need in cases where inpatient care is ordered by an authorized health professional. The UR manager will determine the need for second opinion, the appropriateness of the planned length of hospital stay, and hospital status in a Preferred Provider Organization (PPO), all conditions for authorizing admission. d.CONTRACTOR will advise the sponsor (or NETSAFA if the sponsor cannot be contacted) in any case where admission is denied based on the above criteria. In these cases the CONTRACTOR will also provide the names of alternative hospital(s) if appropriate. e.The Administrator will not mandate use of PPO physicians by members, but will restrict admission to hospitals, which are members of a qualified PPO, when reasonably available. f.All inquiries regarding hospitalization should be directed to the CONTRACTOR. g.CONTRACTOR will have sole responsibility for the performance of subcontractors it employs in executing the requirements of the Administrator's contract. h.CONTRACTOR will maintain a membership data base in accordance with direction received from NETSAFA in order to be able to confirm to provider's membership inquiries. CONTRACTOR will also provide Medical Plan ID cards, Paid Prescription cards, Reimbursement Claim Forms, and Summary Plan Description (SPD) copies to NETSAFA for distribution to new members. i.CONTRACTOR will automatically advise providers whose charges for services exceed R&C levels, providing appeal options should the provider not agree with the payment level. CONTRACTOR will also respond to subsequent inquiries made by providers or their agents who seek to make collections of any kind, if provided the appropriate correspondence. NETSAFA will provide health care administration services (in accordance with the anticipated contract) for Royal Saudi Naval Forces (RSNF) personnel assigned for periods longer than 60 days to training and training supervisory and support duties in the United States and Canada and their authorized dependents. Typically the majority of RSNF students are located for training at U.S. Navy or other U.S. Department of Defense installations in the continental U.S. The present composition of the group to be served includes a total of approximately 200 military personnel and an additional 375 dependents. It is expected that the total number of persons in these categories will increase over the life of the contract. This group is usually distributed in about 15 geographic locations across the U.S. with the largest single area of concentration occurring in the Pensacola, FL area where approximately 50% of the group is located. RSNF students are usually assigned to training sequences in the U.S. ranging from 6 to 30 months and may change individual training sites several times during this period. It is desired to provide a broad selection of high quality health care services to the RSNF personnel (sponsors) and their authorized dependents. Ideally these services will be available to group members without the necessity that the services be paid for at the time of delivery or that the sponsor be required to file the claim for payment. The claim system will require the health care provider to perform the necessary claim completion and submission to the group Administrator who, in turn, will screen the claim to determine coverage under the benefit plan and the conformance of charges to what ™s reasonable and customary as defined by a recognized national data base of prevailing fees which is routinely updated, and promptly pay the providers accordingly. Therefore, interested parties will be required to have a $350K working capital to allow full payment on all claims before being submitted to the Navy. Estimated medical expenses are about $3.6-4.1M per year. All responding sources shall provide a summary of their company ™s capabilities including organization name, address, description of facilities, personnel, and past experience; and a point of contact, telephone number, facsimile number, email address, business size, DUNs number, and CAGE Code. All submissions must be received by close of business 5 November 2010. Responses to the Sources Sought are required in writing, to Ms. Stephanie Wilson, 270.2Y, 700 Robbins Avenue, Bldg 2B, Philadelphia, PA 19111, or email address Stephanie.wilson1@navy.mil.
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