Added: May 01, 2008 12:40 pm
Request for Information (RFI): VA-101-08-RI-0165 Clearing House to Support Health Care Electronic Data Interchange
The Department of Veterans Affairs (VA), Veterans Health Administration (VHA) is planning for the acquisition of Health Care Clearing House (HCCH) services to support the electronic exchange of health care transactions between health care providers and plans. VHA is unique as a HIPAA covered entity and has both a Health Care Provider and Health Plan/Payer component to its business operations.
VHA has identified multiple capabilities and/or services that will be required of the HCCH and is issuing this Request for Information to enable vendors to submit capability statements. Capability statements will be used to assist VA in defining its acquisition strategy and identify sources able to provide the services requested. VHA requires an HCCH that can provide the following services/capabilities:
1. Provide connectivity between VHA and healthcare entities for incoming and outgoing electronic healthcare transactions. Submit and receive HIPAA compliant electronic transactions on behalf of VHA and translate proprietary transaction formats to and from HIPAA compliant transactions on behalf of VHA.
2. Provide a HIPAA (version 4010A1) compliant solution to submit and receive in real-time the following transactions:
" 270/271 Health Care Eligibility Benefit Inquiry and Response;
" 276/277 Health Care Claim Status Request and Response;
" 278 Health Care Services Review - Request for Review and Response
3. Receive batch 270 Health Care Eligibility Inquiries from State Medicaid providers;
4. Have at time of award EHNAC (Electronic Healthcare Network Accreditation Commission) accreditation, as well as CORE (Committee on Operating Rules for Information Exchange) certifications. Maintain these certifications for the duration of the contract.;
5. Provide a Medicare Crossover Claim Solution, for Medicare secondary payers, for receipt of 837 Institutional and Professional health care claims from the Coordination of Benefits Contractor (COBC), including connectivity, transmission of the CMS required eligibility files, error reporting and billing;
6. Provide print and mail services for paper health care claims and associated explanation of benefits that cannot be sent electronically according to the specifications of National Uniform Claim Committee (NUCC), the National Uniform Billing Committee (NUBC) and the National Council for Prescription Drug Programs (NCPDP);
7. Create and maintain Payer Specific Front End Edits by Payer ID for 837 claims received from submitters/providers;
8. Provide access to payers with whom VHA currently conducts e-business (Tier 1 Payers), as well as expand access to additional payers;
9. Provide a comprehensive provider/submitter network of institutional, professional and dental providers for use by the VHA Payer Programs. These programs include in Fee Basis program, Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and the Spina Bifida Health Care Program. This network should include providers/submitters in the District of Columbia, each of the United States, and the following territories, American Samoa, Guam, Puerto Rico and the U.S. Virgin Islands.
10. Provide assistance to drive full implementation of EDI between VHA and its business partners, e.g. health care providers, health plans/payers, third party administrators, pharmacy benefits managers, other clearing houses;
11. Provide assistance with implementation of electronic standards not currently in use (e.g. claims attachment transaction, 275.);
12. Timely transition to future versions of the electronic standards;
13. Provide an encrypted interconnection to VHA. Provide compliance with required encryption standards including FIPS 140-2.
14. Provide compliance with applicable federal laws and regulations, including FISMA and OMB A-130, and applicable NIST Special Publications and Federal Information Processing Standards, including for Certification and Accreditation of systems and Continuity of Operations Planning.
15. Provide ability to partner with Service Disabled Veteran-Owned Small Businesses, Small Businesses, Women-Owned Small Businesses, Veteran-Owned Small Businesses, and Small Disadvantaged Businesses in performing the services identified. Included shall be information pertaining to successful achievement of subcontracting goals/plans on previous requirements.
Interested vendors may submit their capabilities and qualifications to provide the services identified via email to Shaundra Duggans at Shaundra.Duggans@va.gov not later than 4:00 PM EST May 8, 2008. Vendors are asked to provide three past performance references for the capabilities identified. Include the Project title, Description of the project, Contract number, Contract amount, Government Agency/Organization and Point of Contact, and phone number/email address. Do you hold a GSA contract? If so, please identify Schedule and Contract number? Telephone inquiries will NOT be accepted. All correspondence shall be sent via email to both addresses identified and shall reference the RFI number and title in the subject line.
