Q– Non-VA Community Care and CHAMPVA Claims Processing Support

Notice Type: Presolicitation Notice

Posted Date: 11-OCT-18

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

Subject: Q-- Non-VA Community Care and CHAMPVA Claims Processing Support

Classification Code: Q - Medical services

Solicitation Number: 36C79118R0009

Contact: Rebecca Beitz mailto:[email protected] [[email protected]]

Setaside: Veteran-Owned Small BusinessVeteran-Owned Small Business

Description: Department of Veterans Affairs

VA Denver Acquisition & Logistics Center

Department of Veterans Affairs Denver Acquisition & Logistics Center

SYNOPSIS:

THIS IS A PRE-SOLICITATION ANNOUNCEMENT TO RAISE AWARENESS FOR POTENTIAL OFFERORS. THIS IS NOT A SOLICITATION FOR OFFERS AND NO CONTRACT WILL BE AWARDED FROM THIS ANNOUNCEMENT. Please reference Request for Proposal (RFP) number 36C79118R0009. The Department of Veterans Affairs (VA) Commodities & Services Acquisition Service (CSAS), in support of the Veteran Health Administration (VHA), Office of Community Care intends to contract with qualified claims processors for the complete processing of community-based medical care claims for VA using eligibility criteria in Title 38 U.S.C. '' 1703 (Authorized care), 38 U.S.C. '' 1728 (Unauthorized care), 38 U.S.C. '' 1725 (Millennium Bill Act) or 38 U.S.C. '' 1786 (Newborn care); and the complete processing of medical claims for Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). This includes processing claims for the aged claims inventory and any current claims.

OVERVIEW AND PURPOSE:

The OCC, Claims Adjudication and Reimbursement (CAR) Directorate, through the CSAS, intends to contract with qualified claims processors for the complete processing of community-based medical care claims for VA using eligibility criteria in Title 38 U.S.C. '' 1703 (Authorized care), 38 U.S.C. '' 1728 (Unauthorized care), 38 U.S.C. '' 1725 (Millennium Bill Act) or 38 U.S.C. '' 1786 (Newborn care); and the complete processing of medical claims for CHAMPVA. This includes processing claims for the aged claims inventory and any current claims.

The VHA s Veteran Affairs Community Care Program allows the VA to refer eligible Veterans to community providers for health care related services when VA cannot provide the necessary services due to the capacity of the VA s medical facilities, the nature of the services required, the geographic availability of such services and the emergent need for the medical services. All VA medical centers are permitted to use this program when needed. The use of this program as a means to provide community-based care to Veterans is governed by federal laws and regulations; such as, 38 USC 1703 and 38 CFR 17.52. These contain eligibility criteria and specify when and why it can be used. A pre-authorization for treatment in the community is required -- unless the medical event is an emergency. When the VA refers an eligible Veteran for community medical care, the providers bill the VA for their medical services. These bills are submitted as claims 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 Centers for Medicare and Medicaid (CMS) 1450 or CMS 1500. When claims are received by the local VA medical center or consolidated payment center, they are put into the VA s claims processing system.

VA claims processing utilizes the Center for Medicare & Medicaid Services (CMS) claims editing guidelines and submission requirements for Medicare and other on-line claims processing and query systems. VA adjudication and supporting information systems include the Fee Basis Claims System (FBCS), Computerized Patient Record System (CPRS), Joint Legacy Viewer, VistA, Claims Processing & Eligibility claims system (CP&E), and the EDI Web Viewer. CHAMPVA claims will also require knowledge of beneficiary eligibility for community care.

CONTRACTING OFFICE ADDRESS:

Commodities & Services Acquisition Service, 555 Corporate Circle, Golden, CO 80401.

SOLICITATION DETAILS:

The North American Classification Code is 524292 Third Party Administration of Insurance and Pension Funds and the Small Business Size Standard is $32.5M. This will be a competitive, total set-aside to Veteran-Owned Small Businesses (VOSB). Only qualified, experienced, and knowledgeable business entities, which can meet the requirements should respond to the solicitation. The Government anticipates the award of a firm fixed-price contract with one base period and four option periods.

The base contract period will be from the date of contract award through September 30, 2019, with four one-year option periods to be exercised at the discretion of the Government.

Solicitation documents should be available electronically on or about October 25, 2018 at the FedBizOpps website at http://www.fbo.gov. NO HARD COPIES OF THE SOLICITATION WILL BE ISSUED. The anticipated closing date is on or about November 26, 2018 and the anticipated award date is on or about February 28, 2019.

The point of contact for this notice is Rebecca Beitz. Offerors interested in responding to this solicitation should provide their email addresses and contact information to [email protected]. The only terms and conditions that will apply to the solicitation and any resultant contracts shall come from the Contracting Officer through the release of the final RFP and any amendments. Information received from other than the Contracting Officer, to include other VA sources, is not binding on the VA.

All contractors must be registered through the System for Award Management (SAM), which is found at https://www.sam.gov/portal/public/SAM.-- Please be sure your company is registered at this website.--Prospective offerors should complete electronic annual representations and certifications, which is also part of the SAM.--Due to the limited time offerors have to respond, it is encouraged, but not required, to register in advance.

This announcement is not a request for proposal and does not bind the Government to award any contract.

Link/URL: https://www.fbo.gov/spg/VA/VADDC791/VADDC791/36C79118R0009/listing.html