SOURCES SOUGHT
R -- Medical Claims Review and Processing - RFI
- Notice Date
- 5/15/2018
- Notice Type
- Sources Sought
- NAICS
- 541611
— Administrative Management and General Management Consulting Services
- Contracting Office
- Department of State, Office of Acquisitions, Acquisition Management, 1735 N. Lynn St., Arlington, Virginia, 22209, United States
- ZIP Code
- 22209
- Solicitation Number
- 19AQMM18N0060
- Archive Date
- 6/13/2018
- Point of Contact
- William Thuman, Phone: (703) 875-6992
- E-Mail Address
-
ThumanWG@state.gov
(ThumanWG@state.gov)
- Small Business Set-Aside
- N/A
- Description
- Request For information - Medical Claims Review and Processing Request for Information (RFI) The United States Department of State Medical Claim Review Services 1.PURPOSE: Sources Sought Notices (herein referred to as a Request for Information) are issued by the Department of State (DOS) when performing market research to determine industry interest and capabilities. The Department of State is interested in the capabilities of industry (especially small business) to perform medical claim review and processing services. This is a Request for Information (RFI) announcement only. This is not a solicitation or request for proposal and in no way commits the Government to award a contract. The Government does not intend to award a contract based solely on the submission of this Request for Information nor does it intend to pay for any costs incurred in response to this announcement. The Department of State reserves the right to terminate this request and change its requirements if needed. Responding to this Request for Information does not guarantee participation in future Department activities. Responses to the RFI will not be returned. In accordance with FAR 15.201(e), responses to this RFI are not offers and cannot be accepted by the Government to form a binding contract. Responses to this RFI will assist the DOS in determining the potential level of interest, competition adequacy, and technical capabilities of commercial industry to provide the required products and services. The Government does not guarantee any action beyond this RFI. 2.BACKGROUND: The Bureau of Medical Services' (MED) mission is to safeguard and promote the health and well-being of America's diplomatic community. Section 904 of the Foreign Service Act of 1980 provides the Secretary of State with the authority to establish a Health Care Program for members of the Foreign Service, other designated eligible government employees and eligible members of their families. From this authority, MED provides preventive medical services and health care to American Citizen Employees of the U.S. Government and their eligible family members stationed overseas. At present MED has responsibility for overseeing the health care of about 70,000 employees and eligible family members. At this time, the Department is seeking sources capable of providing medical claims review and processing services. Business Size: Preference for Small Business Facility Clearance Requirement: N/A Personnel Security Clearance Requirement: No security clearance (MRPT needed) Required NAICS Code: 541611, Administrative Management and General Management Consulting Services Organizational Conflict of Interest: The Contractor will be expected to support the Government, (the Department of State, Bureau of Medical Services in independently evaluating medical claims received from employees and medical providers, handling and advising on the processing and outcome of the claims. The contractor will be required to access private (sensitive but unclassified / SBU) medical information. Furthermore, the contractor must be independent of other service teams within DOS to allow it to serve as an impartial party when performing the required services. Department of State experience: Required past experience supporting Department of State or other federal government agencies. 3.Requirements: The contractor will be required to receive, handle, review and process medical claims for pre-employment clearance examination, in-service clearance examination, separation clearance examination, and for medevaced patients hospitalized in the U.S. for 24 or more hours. The contractor will be required to adjudicate the claim per current policy and regulation and prepare a voucher for approval by a U.S Government approving official. The contractor will perform most of the duties that are currently performed by federal and contract employees on-site in MED, with the exception of final approval, adding fiscal data to the voucher and entering the claim into the Global Financial Management System. The contractor will be required to process medical claims from start to finish (initial receipt, review, claimant contact, healthcare provider contact, completion of voucher for approval, etc.). Contractor will be required to provide a dedicated telephone number for customers to get information in reference to their claim. If required documentation is missing, the contractor will return the claim to the claimant immediately with a cover letter stating why the claim was returned. If all required documentation is attached, the contractor will process the claim. Upon completion of processing, the contractor will forward the completed voucher to the designated MED government employee for final review and approval. The Contractor will receive medical claims from the following customers: •Current Department of State employees and their eligible family members •Department of State Pre-Employment Candidates •Current ICASS paying Other Government Agency employees and eligible family members •Other ICASS paying Government Agencies pre-employment candidates The contractor must receive the following documents in order to process a medical claim: •An authorization (Form DS 3069, or Form DS 3067, or Form DS 616) •An itemized bill from the provider •Explanation of Benefits (EOB) from an insurance carrier and •Proof of payment by employee (if any) If any one of the above documents are missing, the claim package is "incomplete". Incomplete claim is returned to the claimant with a letter stating specifically why it is returned and what is required to process the claim the second time around. When incomplete claim is returned to the claimant, it is counted as "processed" claim. Examples of all required documentation and response letters will be provided to the contractor. For the last five years, the number of medical claims processed by the bureau of Medical Services has remained stable. Annually, the bureau adjudicates 4,500 to 5,000 medical claims submitted by employees and providers. Currently, six employees (four full time and two contract) are responsible for processing the 4,500 to 5,000 medical claims. RESPONSE INSTRUCTIONS: RFI responses should conform to the format below and provide the following information: Section 1 - Cover Letter. The cover letter shall include the following: a.Company information - Include company name, point of contact and contact information (name, address, phone number, website URL, if available, email address, and fax number), Cage Code, DUNS Number, and a short description of the company (history, experience in similar identity management systems, etc.), and any current Facility Clearance Level; b.Certifications - Include any certifications the company and/or its key personnel hold. Such as Program/Project Management Professional (PMI). c.Current Security Clearance level (if any); d.Submit estimated range of costs for performing the services for a base and four option years; e.List GSA Schedules or GWACs available for use by Company and f.Small and Disadvantaged Business categorization(s) under NAICS Code 541611, if applicable. Section 2 -Sample Service/Capability Statement. The purpose of this section is to provide information that will assist the State Department to decide how to contract for the required services. The MED Bureau requires reviewing and processing medical claims, as indicated in the Requirements section above. For each of these services (as applicable to your company), provide a description of your corporate capabilities regarding the services. Additionally, describe your capability to handle a large number of medical claims on day one of the contract. Section 3 - Past Performance. Please briefly describe at least one and no more than three of your projects/contracts of similar size and scope description of where and how you have provided these services in the past. Within the page count described below, you may include as many examples as necessary to convey the breadth and depth of your corporate capabilities. Please include: i)Client organization and point(s) of contact ii)Brief description of the scope of the work and the results achieved iii)Contract and task order number iv)Dollar value of services provided v)State whether your company was a prime or sub-contractor SUBMISSION INSTRUCTIONS: Responses to this RFI shall be limited to 20 letter-size pages, single-spaced, MS Word or PDF format, Times New Roman 12-point font. Text included in graphics, tables, and figures can be no smaller than 9 point. The cover page, cover letter, and table of contents, are not included in the total page count. The submissions shall be in sufficient detail and clarity to provide DOS with the information it needs to assess the capabilities of responding vendors. Please be advised that all submissions become Government property and will not be returned. The Government will not entertain telephone calls or questions for this RFI. Please provide an electronic version of your written response to: Glenn Thuman (acquisition consultant contractor) at thumanwg@state.gov, no later than May 29, 2018. No phone calls related to this Request for Information will be accepted. All correspondence shall be via email. Please identify sources sought/RFI number in your email subject line.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/State/A-LM-AQM/A-LM-AQM/19AQMM18N0060/listing.html)
- Place of Performance
- Address: Washington, DC Metropolitan Area, Washington, District of Columbia, United States
- Record
- SN04923550-W 20180517/180515230927-9d35049a8fa6bf4e43e42b17c92bf1ca (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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