SOURCES SOUGHT
R -- Accounts Receivable Follow-upand Disputed Claims Appeals
- Notice Date
- 5/8/2007
- Notice Type
- Sources Sought
- NAICS
- 524291
— Claims Adjusting
- Contracting Office
- Network Contracting Activity;Department of Veterans Affairs;Western New York Healthcare System;3495 Bailey Ave.;Buffalo NY 14215
- ZIP Code
- 14215
- Solicitation Number
- VA-528-07-RP-0145
- Response Due
- 5/18/2007
- Archive Date
- 7/17/2007
- Description
- The Department of Veterans Affairs in VISN 2 (Upstate New York) has a requirement for services to provide accounts recievable follow-up and disputed claims appeal activities. The VA is currently seeking all Veteran Owned Small Businesses (VOSB) and Service Disabled Veteran Owned Small Businesses (SDVOSB) that may be interested in provided these services. Those interested parties should submit evidence of satisfying the technical requirements stated below to the Contracting Officer. Please provide a company profile, a list of key personnel that can be dedicated to this requirement, and past performance documentation that displays successful performance of similar contracts. An overview of the requirement is as follows: ACCOUNTS RECIEVABLE - The contractor shall provide collection and follow-up on all open accounts receivable assigned to the contractor by the VA. Follow-up and collection activities shall be accomplished in such a way as to achieve optimum collection from the insurance carrier(s) and in accordance with all applicable VA directives. This will include a review of VISTA reports as well as appropriate processing of correspondence including insurance remittances or explanation of benefits (EOBs). The contractor shall provide the service with a thorough understanding of electronic documentation requirements, coding requirements, and appeal processes. DISPUTED CLAIMS APPEALS - The Contractor shall leverage the use of advanced technology to maximize the appeals process for disputed active healthcare claims. The contractor solution shall interface with the appropriate insurance entities, in a timely and efficient manner, to facilitate faster dispute resolution and payment. With continuous updates, the system shall use the current state-specific guidelines to accelerate the processing time. The solution shall provide informative reports that can be used to measure performance and potential areas of improvement for the claims preparation process. This solution must maintain a rule database matrix for processing disputed healthcare claims appeals for all 50 states as well as applicable federal mandates. The database contains the following requirements: (1) where the appeal must be sent for each level of appeals review; (2) the timeframe for an insurer's response (3) escalation procedures; (4) the regulatory agencies with oversight responsibility; and (5) the preferred format of the appeal. The database shall be regularly updated as the rules are modified. The solution must allow VA total control of claims to be processed. The following technical capabilities must be presented in order to be considered for this contract: (1) The Contractor shall demonstrate an expert level knowledge of the code, files and operations of VA FileMan, including expert knowledge of the application structure, abilities and limitations of VA FileMan software, expert experience in authoring and repairing the routines that comprise the VA FileMan database management system (DI*) with no impact to data quality or the quality of care provided to the patient, in depth knowledge and experience of the Veterans Integrated Software Technology Application (VistA) hospital computer system in general, experience with current (1995) M Standards, experience with M computing environment, VA's Kernel, MailMan and basic database infrastructure, and experience to be performed by personnel with expert level knowledge of the code files and operations of VA FileMan. (2) Knowledge of the Veterans Health Information Systems and Technology Architecture (VistA) Information & Security Service (IIS) and the current technical environment in which these systems currently reside, as well as knowledge of health information management processes and principals. (3) Knowledge of Information Security practices and principles, technical knowledge of the security management within VistA, technical knowledge of federal information security laws, directives, polices, and best practices, expert knowledge of IT security and privacy requirements as specified by HIPAA (Health Insurance Portability and Accountability Act). All submissions should be received no later than 4:00pm on Friday, May 18, 2007, send to the attention of Scott Fiscus, Contract Specialist at Scott.Fiscus@va.gov.
- Place of Performance
- Address: 3595 Bailey Avenue;Buffalo, NY
- Zip Code: 14215
- Country: United States
- Zip Code: 14215
- Record
- SN01289566-W 20070510/070508220439 (fbodaily.com)
- Source
-
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