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70 -- RFI for EDI Transacion Management Software

Notice Date
Notice Type
Sources Sought
511210 — Software Publishers
Contracting Office
Department of Veterans Affairs;OA&MM / Austin Acquisition Staff;1701 Director's Blvd;Austin, TX 78744
ZIP Code
Solicitation Number
Response Due
Archive Date
Small Business Set-Aside
A. BACKGROUND: The Department of Veterans Affairs (VA) Financial Services Center (FSC) provides financial services within the Department and to other government agencies (OGAs). One of these services is the processing of electronic data interchange (EDI) transactions using the HIPAA ASC X12 standard business language format. As such, the VA FSC provides centralized EDI services for all Veterans Health Administration (VHA) Chief Business Office (CBO) healthcare "eProjects" and serves as the sole interface for data exchange with the VHA CBO external partners. Specifically: 1. The CBO EDI transactions that are processed by the VA FSC include healthcare electronic claims (X12N 837 and NCPDP), electronic remittance advice and EFT information (X12N 835) and electronic eligibility inquiries and responses (X12N 270/271). These transactions are currently routed through the Emdeon and PNC Bank clearinghouses. These transactions are received and sent in a flat file format from the VA Medical Centers. The VA FSC translates the data to and from the flat file format to X12N/NCPDP transaction sets. 2. The VA FSC receives approximately 650,000 835s (107,000 commercial 835s and 540,000 MRA 835s) and 8,000 835 electronic fund transfers (EFTs) per month (as of June 2006). Additionally, the CBO is not live with 835s for pharmacy claims. Given that more and more payers are returning 835s electronically and with the introduction of electronic Pharmacy 835s, the CBO expects this volume to increase significantly. 3. The VA FSC processes nearly 2 million 837 transactions and 80,000 NCPDP transactions per month. The 837 volume has been gradually increasing as medical centers print fewer claims locally. In addition, a project is underway to increase the percentage of Medicare secondary claims sent electronically end-to-end to the payers. This volume of electronic claims is expected to reach 2.5 million in FY07. The CBO is currently beta testing customized e-Pharmacy software. National rollout is scheduled for June - November 2007. Anticipated NCPDP volume in FY07 is approximately 500,000 per month. 4. The VA FSC sends and receives approximately 40,000 eligibility inquiries and responses (270/271) transactions per month. Enhancements to the electronic insurance verification software are planned for Fall 2007. The CBO expects that connections with new payers along with the software enhancements will result in a tripling of the volume. Operational management of the VA FSC's EDI infrastructure requires sophisticated, proven tools. The VA FSC needs a software tool, which has the ability to track and audit the flow of HIPAA data, monitor patterns and variability within the eBusiness transactions, and establish triggers and alerts for exception handling. This software tool must accomplish the following: 1. Reduce the incidence of lost or misplaced data 2. Improve transactional data quality 3. Increase first pass transactions acceptance rates with payers which directly impacts revenue cycle metrics and revenue stream 4. Improve VA's ability to identify payer adjudication anomalies B. OBJECTIVE: The VA FSC requires an EDI transaction management/analysis software solution for processing, monitoring, storing, reporting on and analysis of electronic transaction data within the VA FSC. C. ASSUMPTIONS: 1. The Contractor shall: a. Establish and maintain a liaison with the VA FSC Financial Support Service (FSS) staff to ensure that the services provided will meet the VA FSC's requirements. D. VA-FSC TECHNICAL OVERVIEW The VA FSC IT software environment of the VA FSC consists of Microsoft Operating Systems (OS) such as (Windows XP and Windows 2003 Enterprise Server) and of applications such as Oracle enterprise edition; Microsoft SQL Server; Microsoft Visual Basic; Microsoft Visual Studio .NET; and Microsoft Internet Information Services (IIS). The IT hardware environment is comprised of Dell servers; Dell Storage Area Network (SAN) with associated disk arrays, Cisco switches and tape backup system The VA FSC Healthcare EDI technical environment is complex and dynamic. VA FSC currently supports EDI transactions for institutional and professional claims (X12N 837), claims payments and remittance advices (X12N 835), eligibility verification (X12N 270/271), and retail pharmacy claims (NCPDP 5.1). In addition to the EDI transactions, the VA FSC Healthcare EDI has developed reporting applications and is responsible for data interfaces with other parts of the organization, including the national network of VA Medical Centers. The following provides an overview of the technology currently in use, including high-level process flows of the key applications. This information is considered accurate as of the issuance of this solicitation. 1. Hardware: 837 and 835 Processing - " IBM Mainframe z/900 " Windows Servers " Reporting and VA FSC EDI Portal - " Windows Servers 2. Software: a. 837 and 835 Processing - " Sterling Gentran Basic - version 6.3 " Foresight InStream " Sterling Connect:Direct " File Transfer Protocol (FTP) " COBOL Enterprise - version 2.1 " Inovis Trusted Link Enterprise (TLE) b. Reporting and VA FSC EDI Portal - " SQL Server 2000 " ASP.Net - version 1.1 portal site " C# " SQL Reports Server - Report generation and delivery software E. FUNCTIONAL REQUIREMENTS: (All items must be addressed in the response) 1. Specification Library At a minimum, the preferred solution will contain configuration management tools that provide "out of the box" libraries of specifications in both human-readable and machine-readable formats for the following standards, including support for relevant code sets as applicable, on a monthly schedule (excluding the NDC code set, which may be supported quarterly): HIPAA: 270, 271, 276, 277, 835, 837 Institutional, 837 Professional HL7 NCPDP VA Proprietary file format: Ability to support both Positional Flat Files and Delimited Flat Files XML 2. Customization The preferred solution will allow for control and modification of specific properties for elements, loops, segments, etc. as necessary. The solution will allow for lexical format and regular expression customization for specific elements. The solution will allow for both customization using "if, then, else" scripting for more complex rules, as well as allow for registration of external classes of rules to be invoked. Full support for WEDI-SNIP types 1-6 must be included, with ability to relax error types by category, as well as ability to accommodate type 7 edits as necessary. 3. Publication The preferred solution will allow for publication, in human-readable form, both the library standard, as well as the customized standard, as well as allow for publication of "change only" versions of the standard. 4. Testing The preferred solution will contain tools for testing different transaction types against the standards or customized versions of the standards, and provide a Graphical User Interface for display of the errors encountered, as well as allow for editing of the data to perform re-testing. The solution will also be able to produce test data for internal use, and provide control over data dictionaries for used to create test data. The solution will also contain tools to be used to de-identify production data to produce realistic scenario-based testing files, without compromising patient Protected Health Information. 5. Server-based Run-Time Components Integration with Configuration Management Tools The preferred solution will enable the runtime environment to remain in sync with the configuration management tools' customization of specifications, to support trading partner specific requirements being executed during production transaction flow. This solution should have the ability to define complex edits and rules as outlined above, and should work with the runtime engine mechanism, and be able to determine success or failure on that set of edits as defined in the specification. 6. Server-based Run-Time Components The preferred solution will have the capability to consume the machine-readable specification, and execute the rules associated with that specification, delivering human-readable and machine-readable outputs that indicate the compliance success or failure against the appropriate specification at any point in the transaction. The solution should also have the ability to split "good" from "bad" transactions, as well as split based upon any content in the transaction, re-batch and re-balance the appropriate segments to create fully compliant files as output. Full support for WEDI-SNIP types 1-6 must be included, with ability to relax error types by category, as well as ability to accommodate type 7 edits as necessary. 7. ETL (Extract, Transform and Load) The preferred solution will be able to process and load the necessary business information from the outputs of the run-time engine into a relational database with business-normalized schema, and store the original file, the associated errors and any splitting required through a robust ETL process to the data storage mechanism. 8. Repository The preferred solution MUST do the following for HIPAA transactions outlined in E.1 above: " Consume the outputs in items E.6 and E.7 above " Store the original unaltered file " Store the transaction data in a fully normalized database, organized around business concepts contained in the content of those transactions (such as provider, claim, subscriber, dependent, service, etc.) " Normalize 100% of the content of those transactions into discrete table structure (including qualifiers as contained in the transactions, as these will be required for axes of analysis of transaction data) " Index the data according to VA-defined requirements around the ISA sender and Receiver IDs, and or the claim submitter or billing provider IDs. Provide secure access to search for and view the details of data only to authorized personnel with a direct need to review specific data sets within the repository. " Provide the ability to link transactions (inbound and outbound) based on rules defined by VA " Link acknowledgements to those transactions " Consume and record events fired by other systems with ability to link to individual transactions business items or files " Provide a data access layer as the basis for data marts, reporting and analytic purposes " Support the concept of Operational Data Store vs. Historical Data Warehouse, with configurability of when to move data between the two stores " Full audit trail recording each time a user logs on to the system. 9. Application Layer Functions/Features The preferred solution will provide an application layer on top of the repository, which will provide the following functions and features: " Web-based Graphical User Interface supporting Internet Explorer 6.0 or higher and Firefox 1.0 or higher. " Administrative Tools (including ability to delegate administrative capability), User Profiles and Management, registration, log-in and password administration, security and access controls, single sign-on integration " Store and manage trading partner profile information, including the ability to record National Provider Identifiers and other identifiers. " Transaction search (down to business item level) " Alerts and Notifications (based on configurable alerting function for such items as "expected file not received", "unexpected file received", alerts based on some specific content in the data or threshold exceeded events " Subscription model for reports. " Ad-Hoc reporting capability " "Business-friendly" view of individual business items in the transaction (such as claim, claim payment) " View of original transaction data " Errors associated at appropriate levels of transaction/file (for instance, if there are errors associated with a transmitted file, view errors associated with that file, or if there are errors associated with a claim or claim payment within the file, view the errors associated with that item) NOTE: Detailed Functional Requirements are documented in spreadsheet format in ATTACHMENT 1, where each requirement is flagged to associate it with one or more of the topical sections described in the Purpose section of this Request For Information. Vendors are invited to tailor their responses to address one or more of these topical sections. Responses should clearly state which topical sections are being addressed, and why. For any topical section included, every flagged requirement should be addressed. 10. Implementation and Delivery Model: a. Does the Company's organization have an established implementation methodology? If so, please describe. b. What is the typical timeframe required for customers to implement and deploy solutions relating to solution components. Please be specific as to how these timelines vary across different installations. c. Are the Company's products on a strict release timeline? " Describe how future development will be prioritized and how releases / documentation will be offered to VA for deployment. " Please briefly describe the Company's flexibility in adjusting release timing to meet VA needs for functionality. d. Describe training that will be necessary for VA staff involved in the implementation, installation and maintenance of the Company's products and services. e. Do you provide services to integrate your software or will VA be responsible for integration? f. What is your fully blended average implementation and training services rate? F. COMPANY OVERVIEW 1. General Organization Information a. Please provide the corporate information: " Name of organization " Type of organization (public, private, partnership, corporation) " Address of company headquarters " Additional facilities/sites " GSA Schedule? b. Describe the Company's core competencies and how it is differentiated in the marketplace. c. Describe the Company's business model. d. Describe each of the Company's major products and/or lines of business e. List key large payers, provider organizations and software vendors/services partners with which the company is currently contracted or partnered with for solution delivery (please group by category as outlined below). " Payer (Government): " Payer (non-Government): " Provider (Government): " Provider (non-Government): " Software Vendor/Services Partners: 2. List any legal actions that the Company is involved in that could have a significant adverse impact on your ability to deliver the required solution. 3. Partners and Strategic Alliances a. Please identify all partners and strategic alliances, including: " Any organizations that hold a material interest of at least 5% in the Company, either as owners, stockholders, or joint venture partners, including the obligations of each party when describing all third-party relationships. Provide the corporate name, address. b. Describe the Company's strategic relationships with third parties relating to the development of the Company's products/services, including key resources that each partner and strategic alliance brings to the Company in the following areas: " The partnership infrastructure, including the potential roles that each partner may play in the development of applications 4. Management Overview a. Provide an overview of executive leadership, with a brief biography on senior executives, including their experience: 5. Relevant Experience and References a. Given the broad range of needs of VA FSC and CBO with regard to electronic transaction services, we are looking for vendors that can bring substantive expertise in either some or all of the areas of the RFI. To demonstrate the Company's capabilities, please list specific projects that best describe the Company's experience and capabilities. For each example, please identify the following: " Name of the client (if it can be disclosed) and contact information " Overall project description and timeline 6. Technology a. What are the proposed components of the overall solution (please provide schematic indicating where components would fall in a solution architecture, and key functions supported by individual components). b. What are the supported Platforms (Hardware, OS) for the components of the solution proposed? c. What is the Application Architecture technology (J2EE, .NET, other, Application Server(s))? d. How is Application Security (Authentication and Authorization) managed? e. What is the support for Systems Management and Monitoring? f. What are the supported Databases? g. How is RAS (Reliability, Availability, and Scalability) supported? h. What are network/connectivity requirements? i. What is the technology to support analytics/reporting requirements? j. How often will software upgrades typically occur? k. Please describe the solution's ability to interface with multiple legacy systems. G. SUPPORTING INFORMATION AND ADDITIONAL REQUIREMENTS: 1. Rights in Data: The Department of Veterans Affairs shall have unlimited rights to and ownership of all deliverables provided under this contract, including reports, recommendations, logos, charts, brochures, work plans, back-up documentation and work-sheets, data, software, and any other deliverable. This includes the deliverables provided under the basic task and any optional additional deliverables that are exercised by the Contracting Officer. The definition of "unlimited rights" is contained in Federal Acquisition Regulation (FAR) 27.401, Definitions. 2. Data Security & Confidential Treatment of Sensitive Information: In accordance with FAR 52.227-14(b), the Contractor shall guarantee strict confidentiality of the information/data that it is provided by the Government during the performance of the contract. The Government has determined that the information/data that the Contractor will be provided during the performance of the contract is of a sensitive nature and cannot be disclosed in any manner. The Contractor, in whole or in part, can only make disclosure of the information/data after the Contractor receives prior written approval from the Contracting Officer. Whenever the Contractor is uncertain with regard to the proper handling of information/data under the contract, the Contractor shall obtain a written determination from the Contracting Officer. 3. HIPAA Requirements: The Contractor shall comply with any applicable HIPAA requirements that are in force during this contract. Contractor staff will have access to sensitive and confidential protected health information (PHI). The Contractor shall prevent the unauthorized use and disclosure of health information obtained by staff during the performance of work required by this contract. The Contractor shall ensure that employees are aware of and receive Privacy Act/ HIPAA Privacy training that restrict the use and disclosure of PHI. H. ADDITIONAL INFORMATION: 1. Although no firm decisions have been made regarding the characteristics of the potential contract, a firm fixed price type contract for commercial items is contemplated for this project. 2. This RFI is not a Request for Proposal, nothing shall be construed herein or through the RFI process to commit or obligate the Government to further action as a result of the RFI. In addition contractors responding to this RFI shall bear all risk and expense of any resources used to provide the requested information. The information collected through this process is considered to be market research as described by FAR 2.101 and in accordance with FAR 10.002(b)(2)(iii).
Place of Performance
Address: Department of Veterans Affairs;Financial Services Center;1615 Woodward Street;Austin, TX
Zip Code: 78772
Country: USA
SN01340576-W 20070714/070712220957 (fbodaily.com)
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