SOLICITATION NOTICE
R -- Automated Reporting and Workflow system for Enterprise-wide Medical Claims Denials Management. Develop a mangement system to identify, monitor, and assist medical centers in processing primary and secondary denied claims.
- Notice Date
- 12/18/2008
- Notice Type
- Presolicitation
- NAICS
- 541611
— Administrative Management and General Management Consulting Services
- Contracting Office
- Department of Veterans Affairs, VA Health Administration Center, Department of Veterans Affairs Health Administration Center, Department of Veterans Affairs;Health Administration Center;3773 Cherry Creek Drive North, Suite 450;Denver CO 80209
- ZIP Code
- 80209
- Solicitation Number
- VA-741-09-RP-0011
- Response Due
- 12/31/2008
- Archive Date
- 3/1/2009
- Point of Contact
- Richard Macklin, Contracting OfficerVHA Health Administration Center<br />
- Small Business Set-Aside
- N/A
- Description
- 1. Title of Project: Automated Reporting and Workflow system for Enterprise Denial Management (EDMP) 2. Background: The Veterans Health Administration's (VHA) Chief Business Office (CBO) is responsible for developing a denial management system to 1) identify, 2) monitor and 3) assist in the processing of primary and secondary claims that are denied payment. Third-party denials are the number-one cause for non-payment and/or underpayment. Until recently, providers did not have the ability to identify, report or process denials on a consistent basis because insurance companies use different adjudication systems and payment reporting techniques. With the advent of Healthcare Insurance Portability and Accountability Act (HIPAA) and the ASC X12N 835 for Health Care Claim Payment/Remitance Advice, providers have the ability to capture and organize denial information in a systemic fashion. Utilizing technology enables providers to better identify root causes for denials, accelerate the resubmission of denied claims and eventually reduce the amount of revenue written-off as a result of timely filing, medical necessity and eligibility related denials. At this time, the CBO is interested in moving towards identifying supporting solutions for 1) identifying, 2) monitoring, and 3) reworking denied claims. 3. Scope of Work: The system will capture third-party Explanation of Benefits (EOBs) (and/or remittance advices) that are received electronically using the HIPAA ASC X12N 835 format. By capturing and analyzing 835 transactions, the technology component will translate complex data structures into meaningful business reports by payer, denial category, denial type and source of denial within a provider or provider department. The system will also provide for distributed reporting capability and security among multi-users; provide reporting flexibility at both a summary and detail level to include sorting and parsing of data by the end user; support the importing of user data into multiple packages (e.g. excel, acrobat, etc.); generate reports by health plan to allow for payer performance analysis and provide user defined database fields. In addition, CBO requires Contractor services that provide the use of their technology, classroom instruction in the use of system output, and support for the use of such technology by multiple users and multiple organizational levels. Training should enable the VHA staff to produce reports, utilize workflow tools and have a thorough understanding of the specific HIPAA ASC X12N 835 standards, terms and data elements. CBO requires system follow up support including: Telephone and modem support to answer coding questions and resolve technical problems Revisions and system updates should be supplied on a timely basis to stay current with industry standards. Such program modifications may include, but not be limited to, third-party revisions to Medicare and non-Medicare denial categories. 4. Performance Period: The period of performance (POP) shall be from date of award for a period of 12 months. 5.Type of Contract: Indefinite Delivery Indefinite Quantity Task Order
- Web Link
-
FedBizOpps Complete View
(https://www.fbo.gov/?s=opportunity&mode=form&id=92dc8b48f03eb7209f7c1d4815c1416e&tab=core&_cview=1)
- Place of Performance
- Address: VHA Chief Business Office;1722 Eye Street NW;Washington, DC 20006<br />
- Zip Code: 20006<br />
- Zip Code: 20006<br />
- Record
- SN01721300-W 20081220/081218215546-92dc8b48f03eb7209f7c1d4815c1416e (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
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