Loren Data's SAM Daily™

FBO DAILY ISSUE OF FEBRUARY 25, 2011 FBO #3380
DOCUMENT

70 -- Non-VA Care_Program Integrity Tools - Attachment

Notice Date

2/23/2011
 

Notice Type

Attachment
 

NAICS

541519 — Other Computer Related Services
 

Contracting Office

Department of Veterans Affairs;Center for Acquisition Innovation-Austin;1701 Directors Blvd;Suite 600;Austin TX 78744
 

ZIP Code

78744
 

Solicitation Number

VA798A11RI0085
 

Response Due

3/2/2011
 

Archive Date

3/9/2011
 

Point of Contact

Lateefah S Parker
 

E-Mail Address

ct
 

Small Business Set-Aside

N/A
 

Description

Introduction: THIS IS NOT A SOLICITATION. In accordance with FAR Part 10, Market Research, and as part of VA's market research process, this is a request for information (RFI) to assist us in developing an acquisition strategy for VA's claims processing systems. This RFI is for information and planning purposes only and shall not be construed as a solicitation or as an obligation on the part of the VA. The purpose of this RFI is to identify qualified sources able to meet VA requirements, to assist in planning possible future technical requirements, determine the appropriate acquisition strategy, and understand commercial pricing practices and other market information readily available. Telephone inquiries and responses will not be accepted at this time since there is no further information available. This announcement is based upon the best information available and is subject to future modification. VA will not be responsible for any costs incurred by responding to this RFI. Overview: The Veterans Health Administration (VHA) Chief Business Office (CBO) is engaging activities to establish a Transactional Repository to decrease fraud/waste/abuse, improve accuracy of payments and facilitate use of industry standard tools that allow automated assessment of payment data. The CBO requires integration services to assure the most robust commercial off the shelf (COTS) product is implemented. The repository will provide a view to all Purchased Health Care Claims data to facilitate goals for development of a robust fraud/waste/abuse program, decreasing improper payments, utilize industry standard health care claims tools and provide a broad view of payments across VHA Programs. The tool sets will include both pre and post payment capabilities. To assure the most timely and effective impact to our payer programs, CBO requires a phased approach to deployment. This phased approach requires: Phase 1: Deployment of the COTS fraud/waste/abuse tool and predictve modeling sets integrated with current claims processing systems at locations across VHA including decentralized sites and a centralized payment processing location; includes a local transactional repository to incorporate pre/post payment edits and business intelligence applications. Phase 2: Deployment of the COTS fraud/waste/abuse and predictive modeling tool sets to be implemented at an enterprise-wide transactional repository that allows analytics and application of tools sets across all payment transactions. There are multiple components that describe a coordinated approach to the development and or acquisition of the desired level of performance: 1.A repository will be fed from multiple systems, this may require real time or near real time data transfers. The repository will include a business intelligence (BI) application that will accommodate end user browsing and analysis, standardized reports, ad hoc queries and reports and business intelligence extractions which we anticipate will be used to manipulate dimensional presentation of data. 2.A health care claims predictive modeling application principally used for Fraud/Waste/Abuse detection. 3.A fraud/waste/abuse or claims scoring application to be used at the repository location to detect and deter fraud/waste and abuse. Background: VHA is comprised of 21 Veterans Integrated Service Networks (VISN) that are each responsible for managing health care activities within their geographic area that can include six to ten medical facilities and a number of supporting outpatient facilities. Details can be found at http://www.va.gov/directory/guide/division_flsh.asp?dnum=1. VA medical centers within a VISN work together to provide efficient, accessible health care to Veterans in their areas. With 163 VAMCs nationwide, VHA manages one of the largest health care systems in the United States. At times, Department of Veterans Affairs (VA) facilities cannot provide the entire necessary outpatient, inpatient, dental, and pharmaceutical care and services required by its patients. Additionally, the Veteran may not be able to access VA health care facilities based on geographic constraints or due to medical emergencies; or it could be economically advantageous for the VA to provide treatment to Veterans within the community they reside. In these cases, the VA may authorize and pay for medical care to private sector providers for those Veterans who meet the eligibility requirements. This concept is referred to as Fee Basis (or non-VA purchased) care. With the exception of some medical emergencies, outpatient Fee care must be authorized before Veterans receive services from non-VA facilities/providers. In addition, CBO Purchased Care manages large health care payer programs, centralized in Denver. These include the Civilian Health and Medical Program of the VA (CHAMPVA), Spina Bifida (SB), and Foreign Medical Program (FMP). These health care payer programs also require similar tool sets and will be included in the enterprise transactional repository. Across all Purchased Care Programs, VA has seen significant issues with improper payments. Currently VA lacks industry standard automated tool sets to identify and take action on improper payments including fraud/waste/abuse. CBO seeks assistance with implementing the appropriate tools to improve our program. The goals for the RFI include: oImprove operational efficiency "Eliminate improper payments "Observe and track field operational best practices "Operate as a tightly integrated, operational system o Centralize control of business rules and fraud waste and abuse detection o Improve efficient processing, payment or denial, of health care claims submitted by non-VA providers For the purpose of this RFI, "enterprise" is defined as deployment across all Purchased Care Program sites. Solutions to be considered shall include: application software and all necessary hardware (servers). Requirements: 1.Assessment of capabilities to perform requirements noted in the RFI 2.Assessment of the types of changes required to accomplish the goals 3.Approach to be utilized to develop necessary changes to the systems to meet the organizational goals 4.Draft schedule to complete necessary changes. 5.System functionality shall include: a.Enterprise-wide transactional repository with associated business intelligence applications b.COTS predictive modeling tool c.COTS health care claims scoring tool d.Reduced Non-VA expenditures e.A single national level view to all Non VA Purchased Care claims activity including everything from operational activity to individual claim detail. 6.Ability to create all required interfaces (from end-to-end) in accordance with industry standards to communicate with VA information (legacy) systems: a.Examples of the type of interface issues to be considered: 1.Programming M code (i.e. MUMPS - Massachusetts General Hospital Utility Multi-Programming System), to add/modify within the VistA application 2.Use of a government provided VistA test environment 3.Ability to capture interface details through the creation of a formal Interface Control Document (ICD) 4.SQL Server extract/transform/load functions 5.Wide area transmission of extracted data from 33 FBCS (SQL) Servers 6.CHAMPVA systems Information Requested from Industry: In response to the RFI, interested contractors shall submit the following information: 1.Company Information/Socio-Economic Status - a.Provide the company size, the CAGE code, and the POC information (name, email address, telephone, and fax numbers). Identify the NAICS (North American Industry Classification System) code your company believes best represents the predominate work to accomplish the requirements. b.Indicate whether your company, subcontractors, teaming partners, joint ventures have a Federal Socio-Economic status, e.g., Small Business, Service-Disabled Veteran Owned Small Business, Veteran Owned Small Business, Woman-Owned Small Business, Disadvantaged Small Business, and Hub Zone. If Service-Disabled or Veteran Owned Small Business, is your company and or partners registered in VA's VetBiz repository? 2.Background/Past Experience - Provide the following information on a maximum of three similar projects in a healthcare environment completed within the last three years for which the responder was a prime or subcontractor. a.The name, address, and value of each project b.The Prime Contract Type, Firm Fixed-Price, Cost Reimbursement or Time and Material c.The name, telephone and address of the owner of each project d.A description of each project, including difficulties and successes e.Your company's role and services provided for each project. 3.Capabilities/Qualifications - Overview of proposed solution(s). a.Include a description of the capabilities/qualifications/skills your company possesses to perform the identified requirements. 4.Teaming Arrangements - Description of Teaming Partners, Joint Ventures that your company would consider to perform the work. 5.Price information - Provide your commercial price history and rough order of magnitude for the same or similar products/solutions. 6.Other Market Information - Provide any other relative information, however this information must be included within the 15 page limitation. 7.Other Federal Experience - Identify the federal contract vehicles to which you are party. SPECIFIC RESPONSE INSTRUCTIONS: Please submit your response to this RFI in accordance with the following: 1) No more than 15 pages (excluding transmittal page). Include the name, email address and phone number of the appropriate representative of your company; 2) Address each of the 7 sections described above; 3) Submit your response via email to Lateefah.parker@va.gov; 4) Submit your response by 2:00 P.M. Central Time on March 2, 2011; 5) Mark your response as "Proprietary Information" if the information is considered business sensitive. 6) NO MARKETING MATERIALS ARE ALLOWED AS A PART OF THIS RFI. The Government will not review any other data, attachments that are in excess to the 15 pages.
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/notices/bbbf70f72753362dfd88a23df249b172)
 

Document(s)

Attachment
 

File Name: VA798A-11-RI-0085 VA798A-11-RI-0085.doc (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=178258&FileName=VA798A-11-RI-0085-000.doc)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=178258&FileName=VA798A-11-RI-0085-000.doc

 

Note: If links are broken, refer to Point of Contact above or contact the FBO Help Desk at 877-472-3779.
 

Record

SN02385479-W 20110225/110223234151-bbbf70f72753362dfd88a23df249b172 (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
(may not be valid after Archive Date)

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