Loren Data's SAM Daily™

FBO DAILY - FEDBIZOPPS ISSUE OF APRIL 18, 2018 FBO #5990
DOCUMENT

Q -- Medical Care Claims Processing - Attachment

Notice Date

4/16/2018
 

Notice Type

Attachment
 

NAICS

524292 — Third Party Administration of Insurance and Pension Funds
 

Contracting Office

Department of Veterans Affairs;Commodities & Services Acquisition Svc;(003B6E);555 Corporate Circle;Golden CO 80401-5621
 

ZIP Code

80401-5621
 

Solicitation Number

36C79118Q9210
 

Response Due

4/27/2018
 

Archive Date

5/7/2018
 

Point of Contact

james.moran3@va.gov
 

E-Mail Address

james.moran3@va.gov
(james.moran3@va.gov)
 

Small Business Set-Aside

N/A
 

Description

INTRODUCTION: This RFI (Request for Information) is issued solely for information and planning purposes and does not constitute a solicitation. This RFI is intended to get industry feedback for the Department of Veteran s Affairs (VA). This RFI is in regard to the pricing of medical care claims processing services and support. The VA is not seeking proposals at this time and will not consider unsolicited proposals provided in response to this RFI. All responses will be in the form of information and materials. This announcement serves as a notice and invitation to ask for industry assistance in responding to the questions below. All information received in response to this RFI that is marked as proprietary will be handled accordingly. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. BACKGROUND: VHA s Non-VA Medical Care Program allows the VA to refer eligible Veterans to non-VA providers for health care related services when the VA cannot provide the necessary services due to the capacity of the VA, the nature of the services required, the geographic availability of such services and the emergent need for services. When the VA refers an eligible Veteran to the community providers for non-VA medical care, the non-VA providers bill the VA for the care they provide. These bills are submitted to the referring VA facility via Electronic Data Interchange (EDI) as a Health Insurance Portability and Accountability Act (HIPAA) compliant transaction or through the mail via paper invoice on a CMS 1450 or CMS 1500. When claims are received by the local VA medical center or consolidated payment center, they are put into VA s claims processing system and processed by administrative staff for payment to the appropriate community health care provider. The claims processing activity requires general knowledge of health care billing and Veteran eligibility for non-VA medical care. Office of Community Care (OCC) provides procedure guides and SOPs for the processing of claims. Contracted resources would be required to enable remote processing capabilities in multiple VA locations from their work location. PURPOSE: The VA intends to gain a better understanding of typical industry unit pricing and pricing structures for the processing of medical care claims. The VA estimates that monthly inbound claims volume will be in the range of 1,300,000 to 1,700,000 claims for Fiscal Year (FY) 2018 and FY 2019. WRITTEN RESPONSES: Please provide a brief explanation in response to each question below. Responses can be submitted to james.moran3@va.gov. Responses are due 12PM Mountain Time, April 27, 2018. The VA requests that interested parties provide the following information: Type of pricing structure (e.g. hourly rate, per claim rate, percentage rate) your company typically uses for medical care claims processing and why this structure is used. If responding with a pricing structure other than per claim rate above, could your company propose a per claim rate? What does your company estimate its per claim rate to be for FY 2018 and FY 2019? (The VA anticipates that these are rough estimates and based on limited information. The VA will not hold any interested party to the rates provided.) Does your company use range pricing for medical care claims processing unit prices? Based on the monthly inbound claims volume above, approximately what ranges and unit prices would your company propose? What is the average and range of claims your company processes monthly and annually in its current capacity? Does your company currently possess the capacity to process the monthly inbound claims volume mentioned above or would it require additional personnel and facilities? Please explain. Approximately how many claims processors would your company need on staff to successfully meet the VA s monthly inbound claims volume requirement mentioned above? What is the average number of claims a claims processor processes daily and monthly at your company? What is the typical hourly rate claims processors are paid at your company? This RFI does not obligate the VA to release a solicitation. DISCLAIMER This RFI is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to this RFI that is marked as proprietary will be handled accordingly. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI.
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/spg/VA/VADDC791/VADDC791/36C79118Q9210/listing.html)
 

Document(s)

Attachment
 

File Name: 36C79118Q9210 36C79118Q9210.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=4231620&FileName=36C79118Q9210-000.docx)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=4231620&FileName=36C79118Q9210-000.docx

 

Note: If links are broken, refer to Point of Contact above or contact the FBO Help Desk at 877-472-3779.
 

Record

SN04889903-W 20180418/180416230537-668f58dfa52ce82a2698eed7cf3a5863 (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
(may not be valid after Archive Date)

---

| FSG Index  |  This Issue's Index  |  Today's FBO Daily Index Page |