A.2 CONTRACT ADMINISTRATION DATA - Veterans Affairs

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FedBizOppsCombined Synopsis/Solicitation Notice*******CLASSIFICATION CODESUBJECTCONTRACTING OFFICE'S ZIP-CODESOLICITATION NUMBERRESPONSE DATE (MM-DD-YYYY)ARCHIVE DAYS AFTER THE RESPONSE DATERECOVERY ACT FUNDSSET-ASIDENAICS CODECONTRACTING OFFICE ADDRESSPOINT OF CONTACT(POC Information Automatically Filled from User Profile Unless Entered)DESCRIPTION*See AttachmentAGENCY'S URLURL DESCRIPTIONAGENCY CONTACT'S EMAIL ADDRESSEMAIL DESCRIPTION ADDRESSPOSTAL CODECOUNTRYADDITIONAL INFORMATIONGENERAL INFORMATIONPLACE OF PERFORMANCE* = Required FieldFedBizOpps Combined Synopsis/Solicitation NoticeRev. March 2010RHealth Care Clearing House Revenue Transactions63123VA777-17-R-010306-29-201790N518210Department of Veteran AffairsPCAC-ST. LOUIS11152 South Towne SquareSaint Louis MO 63123Linda EleyContracting OfficerWashington, DC20006United Stateslinda.eley@linda.eley@linda.eley@linda.eley@This is a combined synopsis/solicitation for commercial services, prepared in accordance with format in FAR 12.6 as supplemented with additional information included in this notice. Solicitation VA777-17-R-0103 attached applies and is part of this announcementThe North American Industry Classification System code is 518210 and the business size standard is $32.5MOnly one award will be made as a result of this solicitation. This will be awarded as an Indefinite Delivery Indefinite Quantity (IDIQ) contract.PAGE 1 OF1. REQUISITION NO. 2. CONTRACT NO.3. AWARD/EFFECTIVE DATE4. ORDER NO.5. SOLICITATION NUMBER6. SOLICITATION ISSUE DATEa. NAMEb. TELEPHONE NO. (No Collect Calls)8. OFFER DUE DATE/LOCALTIME9. ISSUED BYCODE10. THIS ACQUISITION IS UNRESTRICTED ORSET ASIDE: % FOR:SMALL BUSINESSHUBZONE SMALLBUSINESSSERVICE-DISABLEDVETERAN-OWNEDSMALL BUSINESSWOMEN-OWNED SMALL BUSINESS(WOSB) ELIGIBLE UNDER THE WOMEN-OWNEDSMALL BUSINESS PROGRAMEDWOSB8(A)NAICS:SIZE STANDARD:11. DELIVERY FOR FOB DESTINA-TION UNLESS BLOCK ISMARKEDSEE SCHEDULE12. DISCOUNT TERMS 13a. THIS CONTRACT IS A RATED ORDER UNDERDPAS (15 CFR 700)13b. RATING14. METHOD OF SOLICITATIONRFQIFBRFP15. DELIVER TO CODE16. ADMINISTERED BYCODE17a. CONTRACTOR/OFFERORCODEFACILITY CODE18a. PAYMENT WILL BE MADE BYCODETELEPHONE NO.DUNS:DUNS+4:PHONE:FAX:17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKEDSEE ADDENDUM19.20.21.22.23.24.ITEM NO.SCHEDULE OF SUPPLIES/SERVICESQUANTITYUNITUNIT PRICEAMOUNT(Use Reverse and/or Attach Additional Sheets as Necessary)25. ACCOUNTING AND APPROPRIATION DATA26. TOTAL AWARD AMOUNT (For Govt. Use Only)27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDAAREARE NOT ATTACHED.27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDAAREARE NOT ATTACHED28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFERCOPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIEDSET FORTH HEREIN IS ACCEPTED AS TO ITEMS:30a. SIGNATURE OF OFFEROR/CONTRACTOR31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT)30c. DATE SIGNED31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT)31c. DATE SIGNEDAUTHORIZED FOR LOCAL REPRODUCTION(REV. 2/2012)PREVIOUS EDITION IS NOT USABLEPrescribed by GSA - FAR (48 CFR) 53.2127. FOR SOLICITATIONINFORMATION CALL:STANDARD FORM 1449OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS213VA777-17-R-010306-21-2017Linda Eley314-894-6656 X6510606-29-20174:00pm cst00776Department of Veteran AffairsPCAC-ST. LOUIS11152 South Towne SquareSaint Louis MO 63123x518210$32.5 MillionXN/AXSee AttachedDepartment of Veteran AffairsEmployee Education System (EES)11152 South Towne SquareSaint Louis MO 6312300776Department of Veterans AffairsPCAC-ST. LOUIS11152 South Towne SquareSt. Louis MO 63123 Department of Veterans AffairsFinancial Services CenterInvoices To Be Submitted Electronicallyus/en/veterans-affairs/e-Invoice Setup Info Phone 877-489-6135 PHONE: 877-353-9791FAX: 512-460-5429See Schedule of Services & Performance Work StatementRevenue Transaction ProcessingThe Business Associate Agreement (BAA) is required eitherwith the offer or before the beginning of performance.XXTC "SECTION A" \l 1TC "A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS" \l 2Table of Contents TOC \o &quot;1-4&quot; \f \h \z \u \x HYPERLINK \l "_Toc256000045" SECTION A PAGEREF _Toc256000045 \h 3 HYPERLINK \l "_Toc256000046" A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS PAGEREF _Toc256000046 \h 3 HYPERLINK \l "_Toc256000047" A.2 CONTRACT ADMINISTRATION DATA PAGEREF _Toc256000047 \h 6 HYPERLINK \l "_Toc256000048" A.3 PRICE/COST SCHEDULE PAGEREF _Toc256000048 \h 7 HYPERLINK \l "_Toc256000049" ITEM INFORMATION PAGEREF _Toc256000049 \h 7 HYPERLINK \l "_Toc256000050" A.4 SCHEDULE OF SUPPLIES/SERVICES: PAGEREF _Toc256000050 \h 10 HYPERLINK \l "_Toc256000051" A.5 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011) PAGEREF _Toc256000051 \h 148 HYPERLINK \l "_Toc256000052" A.6 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011) PAGEREF _Toc256000052 \h 148 HYPERLINK \l "_Toc256000053" A.7 52.203-3 GRATUITIES (APR 1984) PAGEREF _Toc256000053 \h 148 HYPERLINK \l "_Toc256000054" A.8 52.203-12 LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (OCT 2010) PAGEREF _Toc256000054 \h 149 HYPERLINK \l "_Toc256000055" A.9 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2017) PAGEREF _Toc256000055 \h 153 HYPERLINK \l "_Toc256000056" A.10 52.216-18 ORDERING (OCT 1995) PAGEREF _Toc256000056 \h 160 HYPERLINK \l "_Toc256000057" A.11 52.216-19 ORDER LIMITATIONS (OCT 1995) PAGEREF _Toc256000057 \h 160 HYPERLINK \l "_Toc256000058" A.12 52.216-22 INDEFINITE QUANTITY (OCT 1995) PAGEREF _Toc256000058 \h 161 HYPERLINK \l "_Toc256000059" A.13 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) PAGEREF _Toc256000059 \h 161 HYPERLINK \l "_Toc256000060" A.14 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) PAGEREF _Toc256000060 \h 162 HYPERLINK \l "_Toc256000061" A.15 52.227-1 AUTHORIZATION AND CONSENT (DEC 2007) PAGEREF _Toc256000061 \h 162 HYPERLINK \l "_Toc256000062" A.16 52.227-14 RIGHTS IN DATA—GENERAL (MAY 2014) ALTERNATE V (DEC 2007) PAGEREF _Toc256000062 \h 163 HYPERLINK \l "_Toc256000063" A.17 52.227-17 RIGHTS IN DATA—SPECIAL WORKS (DEC 2007) PAGEREF _Toc256000063 \h 167 HYPERLINK \l "_Toc256000065" A.18 52.203-99 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS (DEVIATION) (FEB 2015) PAGEREF _Toc256000065 \h 169 HYPERLINK \l "_Toc256000066" A.19 52.233-3 PROTEST AFTER AWARD (AUG 1996) PAGEREF _Toc256000066 \h 169 HYPERLINK \l "_Toc256000067" A.20 52.237-3 CONTINUITY OF SERVICES (JAN 1991) PAGEREF _Toc256000067 \h 170 HYPERLINK \l "_Toc256000068" A.21 52.223-6 DRUG-FREE WORKPLACE (MAY 2001) PAGEREF _Toc256000068 \h 171 HYPERLINK \l "_Toc256000069" A.22 52.239-1 PRIVACY OR SECURITY SAFEGUARDS (AUG 1996) PAGEREF _Toc256000069 \h 173 HYPERLINK \l "_Toc256000070" A.23 52.246-4 INSPECTION OF SERVICES—FIXED-PRICE (AUG 1996) PAGEREF _Toc256000070 \h 173 HYPERLINK \l "_Toc256000071" A.24 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) PAGEREF _Toc256000071 \h 174 HYPERLINK \l "_Toc256000072" A.25 52.233-2 SERVICE OF PROTEST (SEP 2006) PAGEREF _Toc256000072 \h 174 HYPERLINK \l "_Toc256000073" A.26 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) PAGEREF _Toc256000073 \h 174 HYPERLINK \l "_Toc256000074" A.27 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992) PAGEREF _Toc256000074 \h 175 HYPERLINK \l "_Toc256000075" A.28 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009) PAGEREF _Toc256000075 \h 175 HYPERLINK \l "_Toc256000076" A.29 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM REQUIREMENTS (DEC 2009) PAGEREF _Toc256000076 \h 175 HYPERLINK \l "_Toc256000077" A.30 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012) PAGEREF _Toc256000077 \h 176 HYPERLINK \l "_Toc256000078" A.31 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) PAGEREF _Toc256000078 \h 177 HYPERLINK \l "_Toc256000079" A.32 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (SEPT 2007) PAGEREF _Toc256000079 \h 177 HYPERLINK \l "_Toc256000080" A.33 52.209-5 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (DEVIATION)(MAR 2012) PAGEREF _Toc256000080 \h 178 HYPERLINK \l "_Toc256000081" A.34 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013) PAGEREF _Toc256000081 \h 178 HYPERLINK \l "_Toc256000082" A.35 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014) PAGEREF _Toc256000082 \h 179 HYPERLINK \l "_Toc256000083" A.36 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (JAN 2017) PAGEREF _Toc256000083 \h 188 HYPERLINK \l "_Toc256000084" A.37 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION) PAGEREF _Toc256000084 \h 209 HYPERLINK \l "_Toc256000085" A.38 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) PAGEREF _Toc256000085 \h 209 HYPERLINK \l "_Toc256000086" A.39 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) PAGEREF _Toc256000086 \h 210 HYPERLINK \l "_Toc256000087" A.40 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) PAGEREF _Toc256000087 \h 210 HYPERLINK \l "_Toc256000088" A.41 52.203-98 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS—REPRESENTATION (DEVIATION) (FEB 2015) PAGEREF _Toc256000088 \h 210 HYPERLINK \l "_Toc256000089" A.42 52.216-1 TYPE OF CONTRACT (APR 1984) PAGEREF _Toc256000089 \h 211 HYPERLINK \l "_Toc256000090" A.43 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003) PAGEREF _Toc256000090 \h 211A.2 CONTRACT ADMINISTRATION DATA(continuation from Standard Form 1449, block 18A.) 1. Contract Administration: All contract administration matters will be handled by the following individuals: a. CONTRACTOR: b. GOVERNMENT: Contracting Officer 36C777 Department of Veteran AffairsPCAC-ST. LOUIS11152 South Towne SquareSaint Louis MO 63123 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:[X]52.232-34, Payment by Electronic Funds Transfer—Other Than System For Award Management, or[]52.232-36, Payment by Third Party 3. INVOICES: Invoices shall be submitted in arrears: a. Quarterly[] b. Semi-Annually[] c. Other[X] Monthly in arrears 4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.Department of Veterans AffairsFinancial Services CenterInvoices To Be Submitted Electronicallyus/en/veterans-affairs/e-Invoice Setup Info Phone 877-489-6135 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:AMENDMENT NODATEA.3 PRICE/COST SCHEDULEITEM INFORMATIONITEM NUMBERDESCRIPTION OF SUPPLIES/SERVICESQUANTITYUNITUNIT PRICEAMOUNT0001This contract will fund the work specified and performed under the revenue transaction processing solicitation. The contract will provide a healthcare clearinghouse to electronically process medical claims transactions. Contract Period: BasePOP Begin: 07-16-2017POP End: 07-15-20181.00YR____________________________________1001This contract will fund the work specified and performed under the revenue transaction processing solicitation. The contract will provide a healthcare clearinghouse to electronically process medical claims transactions. Contract Period: Option 1POP Begin: 07-16-2018POP End: 07-15-20191.00YR____________________________________1002This contract will fund the work specified and performed under the revenue transaction processing solicitation. The contract will provide a healthcare clearinghouse to electronically process medical claims transactions. Contract Period: Option 2POP Begin: 07-16-2019POP End: 07-15-20201.00YR____________________________________GRAND TOTAL__________________Continuation of Block 16: Task Order administration matters shall be handled by:Block 16 GOVERNMENT:Department of Veterans AffairsContracting Officer - 00776PCAC – ST. LOUISAttn: Linda D. Eley11152 South Towne SquareTelephone No: (314)894-6656 x65106St. Louis, MO 63123Continuation of Block 17: Task Order administration matters shall be handled by:Block 17a CONTRACTOR’S NAME/ADDRESS/CITY-STATE-ZIP:Contractor Name:Address:City/State/Zip: Contact Name:Telephone Number:Fax Number:Email:CONTRACTOR REMITTANCE ADDRESS: CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the Contractor will be made in accordance with: [X]52.232-33, Payment by Electronic Funds Transfer -System for Award ManagementINVOICES: Invoices shall be submitted in arrears: c. Other[Monthly in Arrears]IMPORTANT NOTE TO OFFERORS: This procurement shall use the procedures in subsection FAR Part 16.504. The Government shall use an Indefinite Delivery/Indefinite Quantity (IDIQ) contract due to an anticipated recurring need. The Government will award one Contract resulting from this Solicitation to the responsible Offeror’s whose offer conformning to the Solicitation will be most advantageous to the Government, price and other factors considered. All non-price factors, when combined, are significantly more important than price. The method of award shall be by issuance of an unrestricted Firm Fixed Price (FFP) Indefinite Delivery Indefinite Quantity (IDIQ) Best Value Trade-Off scheme under NAICS code 518210 PANY INFORMATION/SOCIO-ECONOMIC STATUS: Provide the company size, Cage Code, Duns No and POC information (name, e-mail, address, telephone, and fax numbers).??????????? To receive a Government contract, Contractors SHALL register in the System for Award Management database (SAM). A SAM check will be performed prior to award ( HYPERLINK "" )PERIOD OF PERFORMANCE (POP): The POP shall be from the date of award for a 1 (one) 12 (twelve) month base period-year, and 2 (two) consecutive 12 (twelve) month option periods-years. REPRESENTATIONS AND CERTIFICATIONS: The Offeror’s shall submit a copy of their representations and certifications in accordance with 52.209-5, 52.209-7, and 52.212-3 (see section E of the Solicitation). ORDERING INSTRUCTIONS: The method of award shall be by issuance award for a 1 (one) 12 (twelve) month base period-year, and 2 (two) consecutive 12 (twelve) month option periods-years. MINIMUM & MAXIMUM ORDERS: The minimum order for the life of the IDIQ shall be one thousand dollars ($1,000) per Awardee. The maximum ceiling for the life of the IDIQ shall be Six Million Nine Hundred and Ninety Nine Thousand Dollars ($6,999,000) per one (1) Awardee.A.4 SCHEDULE OF SUPPLIES/SERVICES:BASE YEAR:B4.1 Monthly pricing for less than 1,500,000 batch transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0001Price per batch transactions processed each month.PWS 11.11EachB4.2 Monthly pricing for more than 1,500,000 but less than 2,500,000 batch transactions processed each month.CLINTASKQUANTITYUNITUNIT PRICE0002Price per batch transactions processed each month.PWS 11.21EachB4.3 Monthly pricing for more than 2,500,000 batch transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0003Price per batch transactions processed each month.PWS 11.31EachB4.4 Monthly pricing for less than 1,500,000 real time transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0004Price per real time transactions processed each month.PWS 11.41EachB4.5 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time transactions processed each month.CLINTASKQUANTITYUNITUNIT PRICE0005Price per real time transactions processed each month.PWS 11.51EachB4.6 Monthly pricing for more than 2,500,000 real time transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0006Price per real time transactions processed each month.PWS 11.61EachB4.7 Monthly pricing for less than 1,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0007NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.7.1 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0008NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.7.2 Monthly pricing for more than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0009NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.7.3 Monthly pricing for less than 1,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0010NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachB4.7.4 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0011NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachB4.7.5 Monthly pricing for more than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE0012NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachOPTION YEAR 1:B4.8 Monthly pricing for less than 1,500,000 batch transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1001Price per batch transactions processed each month.PWS 11.11EachB4.9 Monthly pricing for more than 1,500,000 but less than 2,500,000 batch transactions processed each month.CLINTASKQUANTITYUNITUNIT PRICE1002Price per batch transactions processed each month.PWS 11.21EachB4.10 Monthly pricing for more than 2,500,000 batch transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1003Price per batch transactions processed each month.PWS 11.31EachB4.11 Monthly pricing for less than 1,500,000 real time transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1004Price per real time transactions processed each month.PWS 11.41EachB4.12 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time transactions processed each month.CLINTASKQUANTITYUNITUNIT PRICE1005Price per real time transactions processed each month.PWS 11.51EachB4.13 Monthly pricing for more than 2,500,000 real time transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1006Price per real time transactions processed each month.PWS 11.61EachB4.14 Monthly pricing for less than 1,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1007NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.14.1 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1008NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.14.2 Monthly pricing for more than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1009NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.14.3 Monthly pricing for less than 1,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1010NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachB4.14.4 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1011NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachB4.14.5 Monthly pricing for more than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE1012NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachOPTION YEAR 2:B4.15 Monthly pricing for less than 1,500,000 batch transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2001Price per batch transactions processed each month.PWS 11.11EachB4.16 Monthly pricing for more than 1,500,000 but less than 2,500,000 batch transactions processed each month.CLINTASKQUANTITYUNITUNIT PRICE2002Price per batch transactions processed each month.PWS 11.21EachB4.17 Monthly pricing for more than 2,500,000 batch transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2003Price per batch transactions processed each month.PWS 11.31EachB4.18 Monthly pricing for less than 1,500,000 real time transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2004Price per real time transactions processed each month.PWS 11.41EachB4.19 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time transactions processed each month.CLINTASKQUANTITYUNITUNIT PRICE2005Price per real time transactions processed each month.PWS 11.51EachB4.20 Monthly pricing for more than 2,500,000 real time transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2006Price per real time transactions processed each month.PWS 11.61EachB4.21 Monthly pricing for less than 1,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2007NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.21.1 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2008NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.21.2 Monthly pricing for more than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2009NCPDP Pharmacy Transactions B1, B2, B3, E1 PWS 12.161EachB4.21.3 Monthly pricing for less than 1,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2010NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachB4.21.4 Monthly pricing for more than 1,500,000 but less than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2011NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachB4.21.5 Monthly pricing for more than 2,500,000 real time pharmacy transactions processed each month. CLINTASKQUANTITYUNITUNIT PRICE2012NCPDP Card Finder? Eligibility transactions via web or E1 PWS 12.161EachTotal Estimated Price – Base Year $_____________Total Estimated Price – Option Year 1 $__________Total Estimated Price – Option Year 2 $__________In the event that the contract is extended through FAR clause 52.217-8 Option to Extend Services, the pricing proposed for the final contracted period of performance will apply for the extension.PERFORMANCE WORK STATEMENTHealth Care Clearing House (HCCH) Revenue Transactions ProcessingScope: The Veteran’s Health Administration (VHA) CBO RO is looking to establish a follow-on Contract with a Health care Clearing House (HCCH) to continue to increase connectivity and further decrease paper processing time for Revenue Transaction Processing. The VHA CBO, as a proponent of administrative simplification, currently exchanges transactions from health care entities to third (3rd) party carriers. The Contractor shall provide support for all of VHA’s current electronic transactions across the United States and its territories. The Contractor shall assist the VHA in continuing its mission to implement electronic transactions and to support printing of standard claim forms in certain situations where electronic transmission is not feasible. As such, VHA is required to comply with the Health Insurance Portability and Accountability (HIPPA) Act of 1996 Transaction and Code Set (TCS) regulations.The Contractor shall work with the Program Office (PO) and Contracting Officer Representative (COR) to provide connectivity for incoming and outgoing electronic transactions. At no time shall the Contractor direct, change, or engage in the formulation of VHA policy. The VHA is solely responsible to review the Contractor’s recommendations and to make decisions concerning the formulation of policyBackground: As a Health Care Provider, VHA has initiated a number of projects to increase the number of transactions that are completed electronically in order to comply with legislation and to facilitate administrative simplification. The VHA currently utilizes a Contractor to transmit the majority of its incoming and outgoing electronic transactions to the national Payer community. Various transaction formats are utilized, such as HIPAA Healthcare Claim Payment (X12N- 5010) and National Council for Prescription Drug Program (NCPDP) transactions. VHA transactions are completed as batch and real-time transfers. The Contractor provides reports to VHA on transaction activity for reconciliation, auditing and billing purposes.Period of Performance (POP): The POP shall be from the date of award for a one (1) twelve(12) month base year period, and four (4) consecutive twelve (12) month option years.Place of Performance: The majority of the work shall take place at the Contractor’s site, however where specifically stated in this Performance Work Statement (PWS), some functions may be performed at various Government facilities. No work at any Government site shall take place on Federal holidays or weekends, unless directed by the Contracting Officer (CO).Tasks: The Contractor shall:***Note: All tasks and deliverables that mention, outline or utilize the word(s) “payer” or “payers” throughout the entire PWS shall include, but are not limited to participating and non-participating payers, authorized agents and/or representatives *** 5.1 Transmit HIPAA compliant X12 and NCPDP transactions via batch and real-time transfer and translate proprietary formats to and from HIPAA compliant transactions on behalf of VHA. And support any future industry standards that may be released (i.e. such as HL7)Provide connectivity to health care Payers or their authorized agents.Support VHA current and future electronic transaction volumes by providing access to Payers with whom it currently conducts electronic healthcare revenue transactions.Ensure connection to a wide variety of Payers by date of award for any respondent to maintain the current level of business.Expand access to additional Payers, as new Payers are established or identified.Assist VHA in its effort to submit electronic secondary claims to Payers(s) according to the Payer model of Coordination of Benefits (COB).Provide services to print and mail compliant Institutional National Uniform Billing Claim Form (NUBC)/(UB04), National Uniform Claim Committee (NUCC) form CMS 1500 Professional Provider Forms and as well as a paper representation of the Medicare-equivalent Remittance Advice when applicable.Assist VHA in transitioning to future HIPAA regulations including implementation of legislative mandates and requirements.Assist VHA in identifying and implementing additional transactions and process improvements.6. Performance Work Statement Governance, Key General Requirements, and Assumptions: The Prime Contractor (and sub-contractor where applicable) shall:6.1 Shall be a fully “Accredited Healthcare Network” (HNAP-EHN and ePAP-EHN accredited) by the Electronic Healthcare Network Accreditation Commission (EHNAC) () at the time of proposal submission and maintain accreditation for the duration of the Contract. 6.2 Be certified by the Council for Affordable and Quality Healthcare (CAQH), as a CORE Phase II Certified Contractor for both batch and real-time eligibility benefits HIPAA Eligibility Transactions (270/271) at the time of award and maintain certification for the duration of the Contract.6.3 Work towards future Committee of Operating Rules and Information Exchange (CORE Phase III) and any other future phase certifications within a mutually specified timeframe.6.4 Adhere to Veterans Affairs (VA) security and data requirements as outlined in Section C - General Security Requirements6.5 Indicate their connectivity to existing Payers and provide a list of targeted Payers they are working with for future connectivity. Provide a detailed list of all (VA) payers that do not have an electronic connection, time out or fail resulting in them being dropped to paper on a monthly basis. Upon request of the COR, provide any other relevant report(s) on an as needed basis within 5 business days.6.6 Develop and provide a detailed implementation plan to include a phase-in process for VHA entities within thirty (30) business days of award. 6.7 Provide VHA technical points of contact, as well as back-ups, for the coordination of activities associated with the development, implementation and sustainment phases.6.8 Provide transactions transmission service at a mutually agreed upon level which will include at a minimum; data transmission, timeliness, accuracy and system availability metrics.6.9 Ensure connectivity between VHA and the Contractor will be a site-to-site Virtual Private Network (VPN) that meets VA security requirements. Ensure data is encrypted To FIPPS IFPS 140.2 standards prior to entry into the VPN Tunnel.6.10 Ensure to work with appropriate VA/VHA personnel to complete and sign a VA Interconnection Security Agreement and Memorandum of Understanding (ISAMOU) and Business Associate Agreement (BAA) upon contract award.6.11 Work with the Financial Services Center (FSC) and Austin Information Technology Center (AITC) on connectivity requirements.6.12 Meet NACHA (National Automated Clearinghouse Association) standards for transactions, specifically Cash Concentration or Disbursement (CCD+) and will not impose non-standard payment options or transactions such as credit cards in lieu of standard Electronic Funds Transfers (EFT’s).6.13 Meet all HIPAA and Patient Protection and Affordable Care Act (PPACA) standards for 835’s and will not impose non-standard transaction options, such as ‘on-line remits’, in lieu of standard 835’s.6.14 Pursue 835’s from their Payers sending paper remits; ensuring the Payer sends a ‘compliant’ 835.6.15 Understand that an “on line” Electronic Remittance Advice (ERA) is not a compliant 835 and is considered non-compliant.6.16 Pursue compliant CCD+ EFTs from their Payers, as requested by the Provider.6.17 Attach Payer appendices to the Solicitation.6.18 VA shall be charged only once for each successful transaction (i.e. Not charged for any transaction that times out, fails validation, rejects during processing, or are duplicates).6.19 Contractor shall support any new industry standards and transaction types by the compliance date specified in Regulations or other controlling documents or legislation.6.20 When PII/PHI data is transferred from VA/VHA to the Health Care Clearing House (HCCH), it immediately becomes HCCH data, and the HCCH is responsible for obeying all applicable Federal Information Security Management Act (FISMA) and HIPAA rules and regulations. As a covered entity under HIPAA, HCCHs are bound by and must comply with all HIPAA requirements, including requisite Security and Health Information Technology for Economic and Clinical Health Act (HITECH) reporting requirements. 6.21 The services outlined in the PWS are considered essential to the revenue operations cycle process. Should the contractor not be able to process transactions for any reason as outlined in the PWS; contractor shall provide a backup means of processing transactions until they can resolve any connectivity issue(s). At the end of the contracts period of performance, should the incumbent not be awarded any potential follow-on contract award; contractor shall provide continuity of services as outlined by the contracting officer in section “C” of this contract referenced under clause 52.237-3 “Continuity of Service”. 6.22 An Interconnection Security Agreement (ISA)/Memorandum of Understanding (MOU) (ISA/MOU) and Business Associate Agreement (BAA) are required and contractor agrees to work with the necessary VA staff (i.e. FSC Austin etc…) to complete these documents upon contract award. And support the approval process for the ISA/MOU. 6.23 Projections do not take into account changes in Veteran demographics or impact of the economy. 6.24 Understand that an “on line” Eligibility & Enrollment information site is not a compliant 270/271 and is considered non-compliant.6.25 The Contractor shall support VHA efforts to inform Payers of non-compliant transactions and/or data content and assist VHA in ensuing Payers become compliant.6.26 Coordinate with VA/VHA any changes to system, applications, network, security, privacy, procedure, policies, or any other item that may impact the services provided as indicated by this PWS. At least a 60 day notification prior to the change shall be provided to VA/VHA and VA/VHA must concur before the change is implemented. Section- 508 Compliance: In December 2000, the Architectural and Transportation Barriers Compliance Board (Access Board), pursuant to Section 508(2) (A) of the Rehabilitation Act Amendments of 1998, established Information Technology accessibility standards for the Federal Government.Section 508(a)(1) requires that when Federal departments or agencies develop, procure, maintain, or use Electronic and Information Technology (EIT), they shall ensure that the EIT allows individuals with disabilities who are Federal employees to have access to and use of information and data that is comparable to the access to and use of the information and data by Federal employees who are not individuals with disabilities; and individuals with disabilities who are members of the public seeking information or services from a Federal department or agency to have access to and use of information and data that is comparable to the access to and use of the information and data by such members of the public who are not individuals with disabilities.The Contractor shall comply with the following technical standards:- 1194.21 - Software Applications and Operating Systems- 1194.22 - Web Based Intranet and Internet Information and Applications- 1194.23 - Telecommunication Products- 1194.24 - Video and Multimedia Products- 1194.25 - Self Contained Closed products- 1194.26 - Desktop and Portable Computers- 1194.31 - Functional Performance Criteria- 1194.41 - Information, Documentation and SupportIn order to validate conformance to the above standards the COR shall complete the VA’s Section 508 Determination and Findings Document.The VA’s Section 508 PO has developed a Conformance Validation Statement (CVS).The CVS shall be completed by the responsible requiring/procurement official as part of their market research to validate the conformance of the E&IT project ((See Section ten (10) in the Section 508 Determination and Findings Document)).7.4. If at any time the responsible requiring/procurement official finds that an exception shall apply, the Contractor shall complete and have the Section 508 EIT Exceptions Certification Document signed by the VA Section 508 Coordinator. Once the E&IT is determined to meet all applicable Section 508 standards, the E&IT is validated by the VA’s Section 508 PO in the Department’s Section 508 Testing and Training Center using the information provided by the CVS.In the case the VA decides to purchase an application, product or service that cannot be validated for Section 508 prior to purchase, the Contractor agrees to accept all costs for ensuring conformance working with the A Section 508 PO. For future releases or upgrades all steps using the CVS are required and upon validation a signed approval shall be given to the VA Point of Contact (POC) from the VA Section 508 Coordinator.Section 508 information is available at HYPERLINK "" The VA Directive and Handbook 6221, Accessible Electronic and Information Technology are posted at: VA Handbook 6221: 8. Reporting Requirements: The Contractor shall:Provide a monthly summary to the COR; identifying inconsistencies and irregularities that impact ongoing deliverables.Propose modifications to the reporting requirements to the COR.Explain, in writing, to the COR (if for any reason a deliverable cannot be met within the scheduled time frame or adherence to the established schedules cannot be met) the following:Reasons for the delayModified delivery dateImpact on the overall projectA revised project plan with all adjusted dates8.4 The COR shall brief the incident to the CO, who shall issue a response pursuant to applicable regulations.Level of Effort: The Contractor is encouraged to propose a response consistent with their technical approach for accomplishment of all performance objectives/standards set forth above.Performance Standards:ObjectivesMeasuresStandardsEach task shall be priced independently and billed according to described tiers and within the described standard.PWS 11Review and acceptance by the GovernmentDeliverables provided IAW the Government approved standard/frequency standard. Documentation shall be comprehensive, accurate, and written in a format and text that is understandable to a wide range of users.Each sub-task shall increase connectivity and decrease of paper processing for Revenue Transaction Processing and completed within the described standard.PWS 12Review and acceptance by the GovernmentDeliverables provided IAW the Government approved standard/frequency standard. Documentation shall be comprehensive, accurate, and written in a format and text that is understandable to a wide range of users and within the described monthly accuracy standard.Deliverables Specific to This Order: Each deliverable shall be priced independently and billed as for each:Note: The term “processed” shall mean “Only transactions that have made it to the contractor claim processing system (exclude those that were received but somehow failed to go thru validation and following steps; exclude dups, retransmissions, and other previously described)”Less than 1,500,000 batch transactions processed each month.More than 1,500,000 but less than 2,500,000 batch transactions processed each month.More than 2,500,000 batch transactions processed each month.Less than 1,500,000 real time transactions processed each month.More than 1,500,000 but less than 2,500,000 real time transactions processed each month.More than 2,500,000 real time transactions processed each month.11a. Deliverables Specific to This Order: Each deliverable shall be priced independently and billed as follows:DeliverableStandard/FrequencyMedium/FormatSubmit ToLess than 1,500,000 batch transactions processed each month.PWS 11.1Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 1,500,000 but lessthan 2,500,000 batch transactions processed each monthPWS 11.2Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 2,500,000 batch transactions processed each monthPWS 11.3Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamLess than 1,500,000 real time transactions processed each month.PWS 11.4Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 1,500,000 but lessthan 2,500,000 real time transactions processed each monthPWS 11.5Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 2,500,000 real time transactions processed each monthPWS 11.6Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project Team12. Deliverable Sub-Tasks Specific to This Order: The Contractor shall increase connectivity and decrease paper processing with a ninety nine point nine percent (99.9%) monthly accuracy. The Contractor shall provide an electronic Monthly Status Report to the COR and e-Business Project Team. The following performance metrics are associated with this deliverable.12.1 Support Current and Future VHA Transaction Volumes: The Contractor shall:Process transactions at current volumes.Process transactions at increasing volumes throughout the duration of the Contract.Invoice monthly and enumerate processed transactions by type and category.12.2 Establish Reconciliation and Production Failure Protocols in coordination with VA/VHA: The Contractor shall:Develop reconciliation reports.Establish protocols in case of production failure.Provide mutually defined metrics.Recommend content, frequency and formats for reconciliation reports.Provide machine readable reports for disbursement.Provide timely production failure notifications based on a mutually agreed priority system.Provide production failure protocol notifications to include root cause analysis, corrective action plans and future mitigation initiatives to prevent reoccurrence of failures to AITC, FSC and the Chief Business Office (CBO) within 2 hours of such failure. Provide a Production Communication Plan for VA/VHA concurrence; including service and severity levels for production levels within thirty (30) business days of Contract award.Notify the VHA when 100% of all transactions are not processed within twenty four (24) hours.12.3 Coordination of System Changes: The Contractor shall:Notify VA/VHA 60 days in advance of any changes to the vendor systems, applications, network, security, processes, procedures, and any other item that would impact the services provided by this contract.Coordinate receipts prior to VHA implementation.Coordinate with VA/VHA necessary testing to validate changes will not have anegative impact contractor’s services to VA/VHAObtain VA/VHA concurrence before implementing changes that may impactcontractor’s services to VA/VHASubmit notification of changes that impact assessments, thirty (30) business days prior to the planned implementation date.Provide testing results of changes made to VHA systems, within thirty (30) daysof implementation date.Provide the VHA with transaction results, thirty (30) business days prior to theplanned implementation date.Provide a testing environment to accommodate future versions of HIPPA and other legislative mandated transaction sets.Provide VHA with test-bed ability to send and receive future mandated transactions.Provide testing environment within thirty (30) business days of industry notification changes.Support National Provider Identifier (NPI) and Health Plan Identifier (HPID):The Contractor shall:Support submission and receipt of transactions for HPID readiness.Test Payer readiness prior to submitting HPID only.Provide completed test transactions within thirty (30) business days.Operational Support: The Contractor shall:Provide the following dedicated functional area resources:Operational SupportHealth Care Analyst SupportBusiness AnalysisTechnical DevelopmentEnsure pricing for these services are included as part of their transaction charge.Ensure the following services are provided:Dedicated operational support staff contact(s) that shall provide technical support for day-to-day operational activities for all transactions.Technical support from 8:00 AM to 5:00 PM, Monday through Friday, with the exception of Federal Government holidays, covering Eastern, Central, Mountain and Pacific Time Zones. Provide a Central Point of Contact for support after regular work hours with the ability to address any production processing issues or problems or elevate to appropriate higher tier support personnel.A copy of a schedule that allows unattended operations for the transmission and receipt of the data/transactions. The Offeror shall obtain VHA approval of the operations schedule and any subsequent changes to the schedule.Monitor and document inbound and outbound data exchanges to identify exceptions in timing and content.Provide on-line problem and transaction submission/response tracking systems within thirty (30) business days of Contract award.Provide information for enhancement and systems changes at least twenty (20) business days prior to deployment.Maintenance of ongoing Payer connections as necessary to support uninterrupted data exchange.Hardware and software maintenance as necessary to support ongoing delivery of consistent services with minimal interruption(s).Regular backups as necessary to support timely recovery for failed equipment and/or problem research.Recovery Point Objective (RPO): 12 hoursRecovery Time Objective (RTO): 72 hoursA secure environment that prevents access from unauthorized physical or electronic sources, and which meets all applicable federal regulations, legislations, or laws.Transaction processes to include reformatting, routing, encrypting and other data management processes as may be necessary to help ensure proper application of data.Maintenance of production environment where all internal processes occur.Monitor Payer communications and industry developments to determine changes that are applicable to the scope of these services.Staffing that is not outsourced.Provide a Help Desk service to support 3rd Party payers using thecontractor clearinghouse services for VA transactions.12.7 Health Care Transaction Services: The Contractor shall:Receive, process, and transmit health care transactions in HIPAA X12 and NCPDP formats, VHA approved formats, or any formats specifically acceptable for electronically-enabled Payers and agreed upon by VHA and the contractor.Support and process, at a minimum, the following transactions and relevant code sets:12.7.2.1 Batch Transactions:Primary, Secondary and Tertiary Professional Healthcare Claim (837) Health Care Claims (Institutional, Professional, and Dental).Health Care Claim Payment/Advice - 835.File Acknowledgements – 997 and 999.Claim acknowledgement – 277CA, 277 RFAI.Interchange Acknowledgements – TA1.VA Proprietary file formats.12.7.2.2 Real-time Transactions:12.7.2.2.1 HIPAA 270/271 Healthcare Eligibility Inquiry and Response.12.7.2.2.2 NCPDP Pharmacy Transactions B1, B2, B3, and E1.12.7.2.2.3 278’s 12.7.3 Provide testing or certification mechanisms for validation of current batch (B) and real time (RT) transactions in the current HIPAA X12 and NCPDP versions within thirty(30) business days of award date.Send and receive electronic acknowledgements for X12 Interchange envelopes and standard conformance for HIPAA X12 transactions to and from VHA or its submitters.Provide a acknowledgement transaction upon receipt of HIPAA mandated transactions (999).Provide and support comprehensive version control for all mandated industry standards, specifically the capability to up or down code transactions to accommodate VHA industry compliant transactions regardless of Payer compliance status.12.8 Access to Payers: The Contractor shall:12.8.1 Provide connectivity to Payers.Provide processing and transmission of transactions VHA currently employs with Payers.Maintain an accurate master list of Payers with their associated identification numbers, including Payers Tax Identification Numbers (TIN’s) available to VHA through either direct connection or internet.Establish a mechanism to keep the VHA's and contractor’s Payer list synchronized.Maintain and update all lists.Update the Payer dictionary, website, companion guide, and any other site used for communication about requirements/specifications within three (3) business days of any change.Provide the VHA with a master list of Payer and associated identification numbers within thirty (30) business days of award.Maintain electronic Payer’s identifiers (ID) for all VHA connected Payers accessed.Ensure to add identifiers to transactions submitted by VHA where the Payer ID has been omitted.Return Payer ID’s electronically for incorporation into Veterans Health Information Systems and Technology Architecture (VISTA).Provide an electronic format for uploading transactions into VISTA.12.9 Additional Access to Additional Payers: The Contractor shall:Provide connectivity to Payers currently without connection in an effort to increase number of Payers with electronic processing capability.Provide a project plan for the establishment of connectivity, processing and transmission of electronic transactions to these Payers upon notification of intent from the Payer.Submit VA Medicare equivalent Claims to the Medicare Administrative Contractor (MAC): The Contractor shall:Submit VHA Medicare equivalent claims through the MAC vendor responsible for the JH & DME Medicare Administrative Contract segments, in order to receive an Explanation of Benefit (EOB) 835 file herein referred to as electronic Medicare-Equivalent Remittance Advice (eMRA).Provide completed sample transaction to document correct processing of eMRA (non-payment) without NPI’s.Submit VHA Medicare equivalent claims to the MAC and receive MRA's from Medicare with legacy Payer identifiers. Medicare, due to its relationship with VHA as a Government entity, requires that VHA continue to submit legacy Payer without NPI’s on Medicare claims.Present a monthly invoice itemizing number of transactions by Real Time and Batch transaction types.12.11 Implement Medicare-equivalent Remittance Advice (MRA): The Contractor shall:Implement the use of MRA data within secondary 837 transactions for additional non-primary Payers within a mutually agreed upon timeframe.Present a project management plan within fifteen (15) business days of start of Contract that details how the secondary connection will be accomplished.12.11.13 Monitor secondary connection, identify and establish new connections and provide itemize report monthly.12.12 Print Facsimile Medicare EOB’s (eMRA): The Contractor shall:Extract data from Medicare 837’s submitted by VHA for the purpose of printing facsimile Medicare EOB’s to be mailed with paper secondary claims.Ensure all data required to print EOB’s is contained in the industry standard Professional Healthcare Claim Standard (837-5010), this requires the addition of data fields to VHA proprietary inbound maps in order to successfully print Medicare EOB’s.12.2.3 Create a mechanism to collect additional data fields required for printing of EOB’s.12.13 Provide Paper Claims to Non-Electronic Carriers: The Contractor shall:Submit claims via paper media to the Payer through the postal carrier for those Payers not accepting electronic submission of health care claims.Ensure claim formats to be printed follow NUCC CMS 1500, NUBC UB-04 claimform standards.Print additional data on paper claims not contained in the 837.Ensure that Provider Social Security Numbers are not printed.Monitor and maintain a list of non-electronic Payers and actively pursue connectivity.12.14 Monitor Claims: The Contractor shall:12.14.1 Monitor and report back to VHA all claim rejections.Register facilities where rejections are due to the establishment of a new VHA facility or Community Based Outpatient Clinics (CBOC).Provide electronic claim rejection reports.12.15 Facilitate Enrollment and Registration: The Contractor shall:Facilitate and coordinate enrollment with Payers, for all pletion of appropriate authorization forms and letters as required by Payer specific guidelines within a mutually agreed upon timeframe.Provide an updated list as new Payers are added. Support VHA Claims.Provide dedicated support to VHA for claims including payer relations and rejections/denials.Provide VHA access to online access to electronic claims submissions and reports. Online access should include the ability to review claim submissions by batch, date of submission or date of service, payer and /or facility and the ability to search for individual claims by date of service, date submitted, payer, facility, patient name, subscriber ID or claim number. Tool should provide the claim status of accepted or rejected with the specific rejection message(s) and provide the ability to view the information and data submitted on each claim. Support Real Time Authorization Transactions.Provide Companion guides that detail the 278 transaction fields required for electronic pharmacy transactions for each Payer.Submit Payer sheets to the project lead and the Financial Services Center (FSC) in machine readable code format for our 278 transaction and Payers.Provide ongoing support to ensure payers and utilization management organizations are supporting the use of the HIPAA X12 278 transaction. This includes establishing new payer and UMO connectivity, facilitating relationship building between HCCH, payer and VA, and resolution of issues with payers related to 278 processing. 12.16 Support Pharmacy Claims: The Contractor shall:Support the Pharmacy team by granting them access to the pharmacy transition database to look at individual transaction data.Provide access instructions to the pharmacy team and maintain a list of everyone who has received access.Provide Payer sheets that detail the NCDPD fields required for electronic pharmacy transactions for each Payer.Submit Payer sheets to the project lead and the Financial Services Center (FSC) in machine readable code format for our Pharmacy Benefits Managers (PBM) and Payers.12a. Deliverable Sub-Tasks Specific to This Order: The below performance metrics are associated with this deliverable:DeliverableStandard/FrequencyMedium/FormatSubmit ToSupport Current & Future VHA Transaction VolumesPWS 12.1Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamEstablish Reconciliation & Production Failure ProtocolsPWS 12.2Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status Report Electronically in Microsoft 2007 or higherCORe-Business Project TeamCoordination of System ChangesPWS 12.3Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamSupport National Provider Identifier (NPI) and Health Plan Identifier (HPID)PWS 12.5Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamHealth Care Transaction ServicesPWS 12.7Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamAccess to PayersPWS 12.8Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamAdditional Access to Additional PayersPWS 12.9Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamSubmit VAClaims toMedicarePWS 12.10Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractorshall provide aMonthly StatusReportElectronically inMicrosoft 2007 orhigherCORe-Business ProjectTeamImplement Medicare- equivalent Remittance Advice (MRA)PWS 12. 11Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamPrint Facsimile Medicare EOB’sPWS 12.12Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamProvide Paper Claims to Non- Electronic CarriersPWS 12.13Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMonitor ClaimsPWS 12.14Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamFacilitate Enrollment and RegistrationPWS 12.15Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamSupport Pharmacy ClaimsPWS 12.16Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamGovernment Responsibilities: If applicable, the Government shall provide workspace, computers and telephone service when Contractor personnel are working on-site.The Contractor shall maintain a financial inventory accounting system for Government Furnished Equipment, Government Furnished Software, other Government Furnished Tools, and provide the COR and PO with stated information necessary to manage this task.At a minimum, the inventory shall track: serial number, quantity, locations, description, custodian, date of receipt, and expected date of return.Security Requirements: The Contractor shall:Not divulge or disclose information received and/or discussed regarding data considered proprietary to other Contractors collaborating on or with this effort.Be required to complete mandated VA privacy and security training.Be required to negotiate agreements with commercial system Contractor’s relating to non-disclosure of Contractor-proprietary information.If the Contractor uses copyright or otherwise licensed software in any deliverable under this order, the Contractor shall secure unlimited use rights for the Government.Forward all software licenses on to the Government within thirty (30) business days after completion of the tasks.Limit access to the minimum number of employees necessary to perform tasks that are considered sensitive or proprietary in nature.Contact the COR, if the Contractor is uncertain of the sensitivity of any information obtained.Indoctrinate all personnel employed by the Contractor and any Sub-Contractors involved on their roles and responsibilities for proper handling and nondisclosure of sensitive Government or proprietary information.Not engage in any other action, venture or employment wherein sensitive informationshall be used for the profit of any party other than those furnishing the ply with VA and VHA Security requirements.Currently, the Contractor does not have access to each site's VISTA system. The Contractor provides their software to each site and the site's IT staff then installs the Contractor’s software. Once the Contractor’s software has been installed at each site, that software is tasked to run the extracts and to convert the results (from the global) into usable buffer uploads and rmation System Hosting, Operation, Maintenance or Use: Government-owned (facility or equipment) Contractor-operated systems, third (3rd) party or business partner networks require memorandums of understanding and interconnection agreements (MOU- ISA) which detail what data types are shared, who has access, and the appropriate level of security controls for all systems connected to VA networks.Inspections and Acceptance: All reports shall be approved by the COR e-Business Project Managers.Contract Award Meeting: The Contractor shall not commence performance on the tasks described in the PWS until the CO has conducted a kick off meeting or has advised the Contractor that a kick off meeting has been waived. The Government shall not reimburse the Contractor for any expenses associated with preparing for or executing a kick-off meeting.Changes to the PWS: Any changes to this PWS shall be authorized and approved only through written correspondence from the CO. A copy of each change shall be kept in a projectfolder along with any other products of the project. Costs incurred by the Contractor, through the actions of parties other than the CO, shall be borne by the Contractor alone.18. Security and Privacy - Information and Records: The Contractor shall: 18.1 Return all information and records provided to Contractor by the VA, in whatever medium, as well as all information and documents, including drafts, emails, back-up copies, hand-written notes and copies that contain such information and records gathered or created by Contractor (collectively referred to as “VA information”) in the performance of this Contract, regardless of storage media, are the exclusive property of the VA. The Contractor shall not retain any property interest in these materials and shall not use them for any purpose other than performance of this Contract. Provide, upon completion or termination of the Contract, all copies of any VA information that it used during work it performed of the Task Order or certify that it any/all information it obtained has destroyed. Where immediate return or destruction of the information is not practicable, the Contractor shall return and/or destroy the information within thirty (30) business days of completion or termination of the Contract. All provisions of this Contract concerning the security and protection of VA information that is the subject to this Contract shall continue to apply to the VA information for as long as the Contractor retains it, regardless of whether the Contract has been completed or terminated. Not destroy, prior to termination or completion of this Contract, any VA information received from the VA, gathered and/or created in the performance of the Task Order without prior written approval by the VA.Receive, gather, store, backup, maintain, use, disclose and/or dispose of VA information only in accordance with the terms of the Task Order and any applicable federal, VA, confidentiality, security laws, regulations or policies.Not make copies of VA information except as necessary to perform duties required of the Task Order or to preserve electronic information stored on Contractor electronic storage media for restoration in case any electronic equipment or data used by the Contractor needs to be restored to an operating state.Provide access only to VA information to employees, Sub-Contractors, and affiliates to:The extent necessary to perform the services specified of the Task Order.Perform necessary maintenance functions for electronic storage or transmission media necessary for performance of the Task Order.Individuals who first satisfy the same conditions, requirements and restrictions that are comparable VA employees shall meet in order to have access to the same VA information.Restrictions include the same level of Background Investigations, where applicable.Store, transport or transmit VA information only in an encrypted form, using an encryption application that meets the requirements of Federal Information Processing Standards (FIPS) 140-2 or is approved for use by the VA.Only use or disclose, except for uses and disclosures of VA information authorized by this Contract for performance of the Contract in response to an order of a court of competent jurisdiction, or with VA’s prior written authorization. The Contractor shall refer all requests for, demands for production of, or inquiries about, VA information to the VA for response.Include the statement, “Contractor shall not release information protected by either 38 USC 5705 or 7332 in response to a court order, and shall immediately refer such court orders to VA for response,” if VA information subject to the Task Order includes information protected by 38 USC 7332 or 5705.Promptly notify the VA, prior to any disclosure pursuant to a court order, of a court order upon its receipt by the Contractor.Notify the COR by phone and provide the VA a copy of the court order by fax or e-mail within one (1) business day.If the Contractor cannot notify the VA before being compelled to produce the information under court order, the Contractor shall notify the VA of the disclosure as soon as practical and provide a copy of the court order, a description of the records provided pursuant to the court order, and to whom the Contractor provided the records to under the court order.The notice shall include the following information to the extent that the Contractor knows it, if it does not show on the face of the court order: the records disclosed pursuant to the order, to whom, where, when, and for what purpose, and any other information that the Contractor reasonably believes is relevant to the disclosure.If the VA determines that it is appropriate to seek retrieval of information released pursuant to a court order before Contractor notified the VA of the court order, Contractor shall assist the VA in attempting to retrieve VA information rm the VA, by the most expeditious method available to Contractor, of any incident of suspected or actual access to, or disclosure, disposition, alteration or destruction of, VA information not authorized under this Contract (“incident”) within one (1) hour of learning of the incident.An incident includes the transmission, storage or access of VA information by Contractor or Sub-Contractor employees in violation of applicable VA confidentiality and security requirements.To the extent known by the Contractor, the Contractor’s notice to the VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information was placed at risk or compromised), and any other information that the Contractor considers relevant.Simultaneously report the incident to the appropriate law enforcement entities or jurisdiction. The Contractor, its employees, and its Sub-Contractors and their employees shall cooperate with the VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violations associated with any incident.Cooperate with the VA in any civil litigation to recover VA information, to obtain monetary or other compensation from a third (3rd) party for damages arising from any incident, or to obtain injunctive relief against any third (3rd) party arising from, or related to, the incident.In addition to notifying the COR, the VA shall provide the Contractor with the name, title, telephone number, fax number and email address of the VA official to whom the Contractor shall provide all notices required by this Task Order.The VA has the right during normal business hours to inspect the Contractor’s facility, information technology systems and storage and transmission equipment, and software utilized to perform the Contract to ensure that the Contractor is providing for the security of VA data and computer systems in accordance with the terms of this Contract.Receive, gather, store, backup, maintain, use, disclose and/or dispose of VA information only in compliance with all applicable FIPS and Special Publications (SP) issued by the National Institute of Standards and Technology (NIST) concerning VA information that is the subject of this Contract. If NIST issues or updates an applicable FIPS or SP after execution of this Contract, the parties agree to negotiate in good faith to implement the FIPS or SP in this Contract.Provide appropriate administrative, technical, and physical safeguards to ensure the confidentiality and security of the Veteran’s data and to prevent unauthorized use or access to it.Sensitive VA information shall not be transmitted by remote access unless VA approved protection mechanisms are used.All encryption modules used to protect VA data shall be validated by NIST to meet the current version of FIPS 140 (See HYPERLINK "" for a complete list of validated cryptographic modules).Only approved encryption solutions using validated modules shall be used when protecting data during transmission.19.15. 4 Additional security controls are required to guard VA sensitive information stored on computers used outside VA facilities.19.15. 5 All VA data shall be stored in an encrypted partition on the hard drive and shall be encrypted with FIPS 140 validated software.19.15.6 The application shall be capable of key recovery and a copy of the encryption keys shall be stored in multiple secure locations.The Contractor agrees that the data shall not be physically moved or transmitted in any way from the site without first being encrypted and obtaining prior written approval from the VA data owner.A determination by VA that the Contractor has violated any of the information confidentiality and security provisions of this Contract, including a violation of any applicable FIPS or SP, shall be a basis for VA to terminate the Contract for cause.If anyone performing this Contract, including employees of Sub-Contractors, accesses VA computer systems or data in the performance of the Contract, the VA shall monitor and record all such access activity.If VA monitoring reveals any information of suspected or potential criminal law violations; the VA shall refer the matter to the appropriate law enforcement authorities for rm its employees and other individuals performing any part of this Contract that VA shall monitor their actions in accessing or attempting to access VA computer systems and the possible consequences to them for improper access, whether successful or not.Ensure that any Sub-Contractors or others acting on behalf of or for the Contractor in performing any part of this Contract inform their employees, associates or others acting on their behalf that VA shall monitor their access activities. Execution of this Contract, Sub- Contract or agreement that constitutes consent to VA monitoring applies.Ensure that all individuals who shall access VA data or systems in performing the Contract are appropriately trained in the applicable VA confidentiality and security requirements. The Contractor shall document those who have completed the VA training. The Contractor shall contact the COR regarding access to the required VA training.Mitigate, to the extent practicable, any harmful effect on individuals whose VA information was accessed or disclosed in an incident.Require Sub-Contractors, agents, affiliates or others to whom Contractor provides access to VA information for the performance of this Contract to agree to the same VA information confidentiality and security restrictions and conditions that apply to the Contractor before providing access.20. Protection of Individual Privacy: The Contractor shall:Abide by FAR clauses 52.224-1 and 52.224.2.Abide by FAR clauses 52.239-1 for Privacy or Security Safeguards.Not publish or disclose in any manner, without the CO’s written consent, the details of any safeguards either designed or developed by the Contractor under this Contract or otherwise provided by the Government.To the extent required to carry out a program of inspection to safeguard against threats and hazards to the security, integrity, and confidentiality of Government data, the Contractor shall afford the Government access to the Contractor’s facilities, installations, technical capabilities, operations, documentation, records, and databases.If new or unanticipated threats or hazards are discovered by either the Government or the Contractor, or if existing safeguards have ceased to function, the discoverer shall immediately bring the situation to the attention of the other partyUtilize only employees, Sub-Contractors or agents who are physically located within a jurisdiction subject to the laws of the U.S.Ensure that it does not use or disclose Personal Health Information (PHI) received from a Covered Entity in any way that shall remove the PHI from such jurisdiction.Ensure that its employees, Sub-Contractors and agents do not use or disclose PHI received from Covered Entity in any way that shall remove the PHI from such jurisdiction.Ensure, if the work of the Contractor is deemed to meet the definition of research from the HHS Office of Human Research Protections (OHRP) as well as the Common Rule (38 CFR 16), then the Contractor as well as any Sub-Contractors or collaborating institutions shall be covered under Federal Wide Assurances (FWA) or other assurances acceptable to the VA, and the research protocol shall be reviewed and approved by the Contractor’s Institutional Review Board (IRB) of record as well as by IRBs of the collaborating institutions.Sub-Contractors engaged in research shall also hold FWA’s or be covered by the Contractor’s FWA. If all the entities engaged in research are covered under one FWA with a common IRB of record then it would not be necessary to involve more than one IRB.At its discretion the VA shall submit the research protocol prior to its initiation for review to a VA ad-hoc peer-review committee. This review shall be conducted to ensure that the research incorporates or takes into consideration all VA and Veteran specific concerns and issues that shall impact on the scientific rigor of the study.All subjects enrolled in the research shall receive protections equivalent or greater as those required by VHA policies including VHA Handbook 1200.5 including appendixes and other applicable VHA 1200 series handbooks. If vulnerable subjects shall be entered into the research, appropriate safeguards shall be in place.If the research project is eligible for a Certificate of Confidentiality, one shall be obtained from HYPERLINK ")" NIH ( HYPERLINK ")" coc)Recruitment of Veteran’s into research projects shall follow the recruitment plan as approved by the IRB.20.7.5.1 The plan shall require that initial contact with the Veteran be in person or by letter prior to any telephone contact.20.7.5.2 If a letter is sent to the Veteran it shall provide a telephone number of other means that the Veteran can use to verity the validity of the contact and the study. Social security numbers shall not be requested during a phone contact.20.7.6 All investigators and research staff interacting with research subjects or working with identifiable health information shall receive training in the ethical conduct of human subject’s research that is equivalent to or exceeds the requirement for VA investigators and research staff. (See handbook VHA 1200.5 for the Requirements for Protections of Human Subjects in Research that is available at HYPERLINK ")" ).21. Information System Security: The Contractor shall:Ensure adequate LAN/Internet, data, information, and system security in accordance with VA standard operating procedures and standard Contract language, conditions laws, and regulations.Firewall and web servers shall meet or exceed the Government minimum requirements for security.All Government data shall be protected behind an approved firewall.Any security violations or attempted violations shall be reported to the VA project manager and the VHA Headquarters Information Security Officer as soon as possible.21.2 Follow all applicable VA policies and procedures governing information security, especially those that pertain to certification accreditation.22. Information System Design and Development: Information systems are designed or developed for or on behalf of VA at non-VA facilities shall comply with all VA policies developed in accordance with the Federal Information Security Management Act (FISMA), HIPAA, NIST, and related VA security and privacy control requirements for Federal Information Systems. This includes standards for the protection of electronic PHI, outlines in 45 C.F.R. Part 164, Subpart C, information and system security categorization level designations in accordance with FIPS 199 and FIPS 200 with implementation of all baseline security controls commensurate with the FIPS 199 System Security Categorization (reference Appendix A of VA Handbook 6500, VA information Security Program). During the development cycle, a privacy impact assessment shall be completed, provided the COR, and approved by the VA Privacy Service in accordance with VA Privacy Impact Assessment Handbook 6500.3.The security controls shall be designated, developed, approved by the VA, and implemented in accordance with the provisions of the VA Security System development life cycle as outlined in NIST Special Publication 800-37 and VA Handbook 6500.The Contractor shall be required to design, develop, and operate a System of Records or individuals to accomplish an agency function subject to the Privacy Act of 1974, (as amended), Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations.Violation of the Privacy Act may involve the imposition of criminal and civil penalties.Invoicing Acceptance: All payments by the Government to the Contractor shall be made in accordance with Far Clause 52.232-33 – Payment by Electronic Funds Transfer – System for Award Management. All invoices shall be submitted in arrears.Task Order Termination: The VA has the right to terminate any Task Order, in whole or in part, at any time in accordance with the Contract termination clauses. The Contractor shall be paid only for the services rendered up to the point of receiving the termination notice, and then only to the extent that those services meet the requirements of this PWS.Contract Administration: All inquiries and correspondence relative to the administration of the Contract shall be addressed to:COR: Amanda BishopTelephone Number: (304) 267-5780 E-mail: HYPERLINK "mailto:amanda.bishop@" amanda.bishop@PO: Ruth-Ann PhelpsTelephone Number: (202) 382- 2510 E-mail: HYPERLINK "mailto:ruth-ann.phelps@" ruth-ann.phelps@CO: Telephone Number: E-mail: Inspection and Acceptance: All reports shall be approved by the COR and PO and are due thirty (30) calendar days after the Contract award date.Quality Assurance: The Contractor shall develop and maintain an effective quality control program in accordance with their approved Management Oversight Plan (MOP) to ensure services are performed in accordance with the PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s Quality Control Program (QCP) is the means to assure that the work complies with the requirement of the Contract. As a minimum, the Contractor shall develop QCP that address the areas identified in the Quality Assurance Surveillance Plan (QASP).Performance Assessment: The Government shall evaluate the Contractor’s performance under this Contract in accordance with the QASP in a separate document. This plan is primarily focused on what the Government shall do to ensure that the Contractor has performed in accordance with the performance standards. The QASP what shall be monitored, how monitoring shall take place, who shall conduct the monitoring, and how monitoring efforts and results shall be documented.Attachment A IndexHealth Care Clearing House (HCCH) Revenue Transactions ProcessingAcronymMeaning270/271Eligibility Transactions278Health Care Services Review and Response and Inquiry and Response (Authorization Transactions)837Professional Healthcare Claim837-5010Professional Healthcare Claim StandardX12N-5010Healthcare Claim PaymentAITCAustin Information Technology CenterAQLAcceptable Quality LevelBBatchCAQHCouncil for Affordable Quality HealthcareCBOChief Business OfficeCBOCCommunity Based Outpatient ClinicsCCD+Cash Concentration or DisbursementCDRContract Discrepancy ReportCMS 1500Non-institutional Provider FormCOContracting OfficerCOBCoordination of BenefitsCVSConformance Validation StatementCORContracting Officer RepresentativeCORE Phase IICommittee of Operating Rules and Information ExchangeDISCODefense Industrial Security Clearance OrganizationDMEPOSDurable Medical Equipment, Prosthetics, Orthotics and Supplies.DSSDefense Security ServiceE-BUSeBusinessEDIElectronic Data InterchangeEFT’sElectronic Funds TransferEHNACElectronic Healthcare Network Accreditation CommissionEITElectronic and Information TechnologyEOBExplanation of BenefitERAElectronic Remittance AdviceFARFederal Acquisition RegulationFSCFinancial Services CenterFTRFederal Travel RegulationsHIPPAHealth Insurance Portability and AccountabilityHPIDHealth Plan IdentifierHRPHuman Research ProtectionsIDIdentifiersIRBInstitutional Review BoardNCPDPNational Council for Prescription Drug ProgramNPINational Payer IdentifierMACMedicare Administrative ContractorMOPManagement Oversight PlanMRAMedicare-Equivalent Remittance AdviceNACINational Agency Check with InquiriesNACHANational Automated Clearinghouse AssociationOCSOffice of Cyber SecurityOPMOffice of Personnel ManagementPBMPharmacy Benefits ManagersPHIPersonal Health InformationPPACAPatient Protection and Affordable Care ActPOProgram OfficePOCPoint of ContactPOPPeriod of PerformancePWSPerformance Work StatementQASPQuality Assurance Surveillance PlanQCPQuality Control ProgramRTReal TimeRORevenue OperationRTReal TimeSICSecurity and Investigations CenterTCSTransaction and Code SetTINTax Payer Identification NumberUB04Uniform Billing Claim FormVAVeterans AdministrationVAMCVeterans Administration Medical CenterVHAVeterans Health AdministrationVISTAVeterans Health Information Systems and Technology ArchitectureVPNVirtual Private NetworkAttachment BAnnual Provider Transaction VolumesHealth Care Clearing House (HCCH) Revenue Transactions Processing (*Estimated annual transaction volumes*)Annual Provider Transaction Volumes835:6,400,000NCPDP:13,200,000270/271: 984,000837:13,800,000Attachment C Current VHA Claim File Specs837 Transmission DataHealth Care Clearing House (HCCH) Revenue Transactions Processing(*To include but not limited to the following transactions*)VHA Medicare Claims and NPIDue to the intergovernmental agency relationship with CMS, VHA does not submit NPI data elements on Medicare claims nor receive them on Medicare Equivalent Remittance Advice (MRA). VHA will continue to submit tax ID and other legacy Medicare ID numbers on these transactions for the foreseeable future.Additional X12 Data Elements Provided by VHA to HCCHThe following data elements submitted as part of the VHA claim file have been identified as not part of the HIPAA 4010A1, 5010 standards. These additional data elements are included in current transactions in order to meet current functionality requirements.X12Field nameMax lengthPrint location(837I) 2000B/SBR/08CURRENT INSURED EMPLOYMENT STATUS2 ALPHA-NUM(837P) 2000C/PAT/03EMPLOYMENT STATUS2 ALPHA-NUM1500 – BOX 82010BA/PER/04 Set PER/01 = ICand PER/03=TEINSURED PHONE20 ALPHA- NUM1500 – BOX 72010BE/NM1/03 Set NM1/01 = 84 NM1/02 = 2CURRENT INSURED EMPLOYER NAME30 ALPHA- NUM1500 – BOX 11b UB04 – FL 65(837I) 2010BE/N3/01CURRENT INSURED EMPLOYER STREET ADDRESS20 ALPHA- NUM2010BE/N4/01CURRENT INSURED EMPLOYER CITY30 ALPHA- NUM2010BE/N4/02CURRENT INSURED EMPLOYER STATE2 ALPHA-NUM(837I) 2010BE/REF/02 Set REF01 = BBTREATMENT AUTHORIZATION CODE35 ALPHA- NUM1500 – BOX 23 UB04 – FL 63(837I) 2010BE/REF/02 Set REF/01 = X9CURRENT INSURED FORM LOCATOR 37 (ICN/DCN)20 ALPHA- NUMUB04 – FL 64(837P) 2010CA/DMG/04PATIENT MARITAL STATUS1 ALPHA-NUM1500 – BOX 8(837P) 2010CA/PER/04PATIENT PHONE20 ALPHA- NUM1500 – BOX 5(837I)2300/REF/02Set REF/01 = SUCLAIM STATUS2 ALPHA-NUM(837I) 2300/REF/02Set REF/01 = ZZDRG USED10 A/N(837I)2300/DTP/03Set DTP/01= 232DTP02 = D8(837P)2300/DTP/03Set DTP01 = 141DTP02 = D8STATEMENT COVERSFROM DATE(Also used for the Signaturedate in Box 12 of 1500 form )8 NUM(CCYYMMDD)1500 – BOX 12DateUB04 – FL 6(837I)2300/AMT/02(837P)2300/AMT/02Set AMT01 = C5BALANCE DUE15 NUM(ASSUME 2DECIMALS)1500 – BOX 30UB04 – FL 55(837P) 2310B/NM106ATTENDING/RENDERING PHYSICIAN CREDENTIALS3 ALPHA-NUM1500 – Box 31(837I)2330C/N4/01EMPLOYER CITY30 ALPHA-NUM2330C/NM1/03 Set NM1/01 = 84 NM1/02 = 2EMPLOYER NAME35 ALPHA- NUM1500 – Box 9c UB04 – FL 65(837I) 2330C/N4/02EMPLOYER STATE2 ALPHA-NUM(837I)2330C/N3/01OTHER INSUREDEMPLOYER STREETADDRESS20 ALPHA-NUM(837I) 2300/NTE/02 Set NTE/01 = ADD NTE/02:2 = MRA37COB COVERED DAYS3 NUM2320/AMT/02 Set AMT/01 = C4OTHER INSURANCE COMPANY PRIOR PAYMENT15 NUM(ASSUME 2 DECIMALS)1500 – Box 29 UB04 – FL 54(837P) 2400/SV1/06TYPE OF SERVICE2 ALPHA-NUM2430/CASPaper Medicare secondary information. If the action reason code = AAA then the amount represents the Medicare allowed amount. If the group code = LQ then the action reason codes are the remark codes for the 2100 LQ segment.VHA HCCH Claim Transaction SpecificationVHA currently submits claim data to the HCCH for conversion to paper formats or HIPAA compliant 837s in the following format.File HeaderX12Field nameMax lengthPrint locationBHT/03REFERENCE #10 NUMNO PRINTBHT/04TRANSACTION DATE8 NUM (CCYYMMDD)NO PRINT1000A Submitter InformationX12Field nameMax lengthPrint location1000A NM1 set NM1/02 = 41NM1/03 = 2SUBMITTER NAME18 ALPHA- NUMNM1/09Set NM1/08=46SUBMITTER ID NUMBER80 ALPHA- NUM1000A PER/03 SET PER/01 = IC PER/02 = TEEDI CONTACT10 NUM1000B Receiver informationX12Field nameMax lengthPrint location1000A NM1 set NM1/02 =40NM1/03 = 2RECEIVER NAME18 ALPHA- NUMNM1/09Set NM1/08=46RECEIVER ID NUMBER80 ALPHA- NUMLOOP 2010AA Billing Provider – Main Facility IDX12Field nameMax lengthPrint location2010AA/NM1/03Set 2010AA/NM1/01 = ‘85’ 2010AA/NM1/02 = ‘2’BILLING PROVIDER NAME30 ALPHA-NUM1500 – BOX 33 UB04 – FL12010AA/N3/01BILLING PROVIDER STREET ADDRESS35 ALPHA-NUM1500 – BOX 33 UB04 – FL 12010AA/N3/02BILLING PROVIDER ADDRESS LINE 2 (COULD BE USED FOR AGENT CASHIER MAIL ROUTING SYMBOL)30 ALPHA-NUM2010AA/N4/01BILLING PROVIDER CITY30 ALPHA-NUM1500 – BOX 33 UB04 – FL 12010AA/N4/02BILLING PROVIDER STATE2 ALPHA-NUM1500 – BOX 33 UB04 – FL 12010AA/N4/03BILLING PROVIDER ZIP CODE9 NUM1500 – BOX 33 UB04 – FL 12010AA/PER/04 Set PER/01 = ICand PER/03=TEEDI CONTACT OR AGENT CASHIER PHONE20 ALPHA-NUM1500 – BOX 33 UB04 – FL 1If Medicare or no NPI submitted then 2010AA/NM1/09Set 2010AA/NM1/08= ‘24’Else 2010AA/REF/02FEDERAL TAX ID NUMBER17 ALPHA-NUM1500 – BOX 25 UB04 – FL 5(837I) 2010AA/NM1/09; Set NM108 = XX (837P) 2010AA/NM1/09; Set NM108 = XXBilling Provider NPI10 NUM1500 – Box 33a Ub04 – FL 562010AA/REF/01‘G5’ - SITE SUFFIX OR FACILITY ID QUALIFIER2 ALPHA-NUM2010AA/REF/02SITE SUFFIX OR FACILITY ID(4010: Site/Div ID for sorting– always 4 characters)20 ALPHA-NUM2010AA/REF/01BILLING PROVIDER REFERENCE ID QUALIFIERAllow up to seven occurrences2 ALPHA-NUM1500 – BOX 33b UB04 – FL 572010AA/REF/02BILLING PROVIDER SECONDARY ID NUMBERAllow up to seven occurrences20 ALPHA-NUMLOOP 200B – Subscriber / PatientX12Field nameMax lengthPrint location2000B/SBR/01BILL DESIGNATION1 ALPHA-NUMNO PRINT2000B/SBR/02 ifself or 2000C/PAT/01 ifother than selfRELATIONSHIP TO INSURED2 ALPHA-NUM1500 – BOX 6 UB04 – FL 592000B/SBR/03CURRENT INSUREDGROUP #20 ALPHA-NUM1500 – BOX 11UB04 – FL 622000B/SBR/04CURRENT INSURED GROUP NAME30 ALPHA-NUM1500 – BOX 11c UB04 – FL 61(837P) 2000B/SBR/05CURRENT INSURANCE TYPE X12 CODE2 ALPHA-NUM1500 – BOX 1 if GROUP(837I) 2000B/SBR/08CURRENT INSURED EMPLOYMENT STATUS2 ALPHA-NUM2000B/SBR/09TYPE OF PAYER/SOURCE OF PAY2 ALPHA-NUM1500 – BOX 1(837P) 2000C/PAT/03EMPLOYMENT STATUS2 ALPHA-NUM1500 – BOX 8(837P) 2000B/PAT/06 or (837P) 2000C/PAT/06PATIENT’S DATE OF DEATH8 NUM (CCYYMMDD)(837P) 2000B/PAT/07 or2000C/PAT/07UNIT OR BASIS FOR MEASUREMENT CODE (“01”)2 ALPHA-NUM(837P) 2000B/PAT/08 or2000C/PAT/08PATIENT WEIGHT10 NUM(837P) 2000B/PAT/09 or2000C/PAT/09PREGNANCY INDICATOR1 ALPHA-NUMLOOP 2010BA SubscriberX12Field nameMax lengthPrint location2010BA/NM1/03Set 2010BA/NM1/01= IL 2010BA/NM1/02= 1INSURED LAST NAME30 ALPHA-NUM1500 – BOX 4and BOX 13 UB04 – FL 582010BA/NM1/04INSURED FIRST NAME20 ALPHA-NUM1500 – BOX 4and BOX 13 UB04 – FL 582010BA/NM1/05INSURED MIDDLE NAME25 ALPHA-NUM1500 – BOX 4and BOX 13 UB04 – FL 582010BA/NM1/07INSURED NAME SUFFIX10 ALPHA-NUMUB04 – FL 582010BA/NM1/08QUALIFIER FOR SUBSCRIBER PRIMARY ID3 ALPHA-NUM2010BA/NM1/09SUBSCRIBER PRIMARY ID30 ALPHA-NUM1500 – Box 1a UB04 – FL 602010BA/N3/01INSURED STREET ADDRESS LINE 135 ALPHA-NUM1500 – BOX 72010BA/N3/02CURRENT INSURED STREET ADDRESS 230 ALPHA-NUM1500 – BOX 72010BA/N4/01INSURED CITY30 ALPHA-NUM1500 – BOX 72010BA/N4/02INSURED STATE2 ALPHA-NUM1500 – BOX 72010BA/N4/03INSURED ZIP CODE5 NUM1500 – BOX 72010BA/DMG/02INSURED BIRTH DATE8 NUM (CCYYMMDD)1500 – BOX 3 UB04 – FL 12010BA/DMG/03INSURED GENDER1 ALPHA-NUM1500 – BOX 32010BA/PER/04INSURED PHONE20 ALPHA-NUM1500 – BOX 72010BA/REF/01QUALIFIER FOR SUBSCRIBER SECONDARY IDAllow up to three occurrences3 ALPHA-NUM2010BA/REF/02SUBSCRIBER SECONDARY IDAllow up to three occurrences30 ALPHA-NUMLOOP 2010BC/2010BB Current PayerX12Field nameMax lengthPrint location(837I)2010BC/NM1/03(837P)2010BB/NM1/03Set NM1/01 = PRNM1/02 = 2CURRENT INSURANCENAME30 ALPHA-NUM1500 – TOP RTUB04 – FL 38(837P)2010BB/NM1/08(837I)2010BC/NM1/08QUALIFIER FOR PAYERPRIMARY ID3 ALPHA-NUM(837P) 2010BB/NM1/09 (837I) 2010BC/NM1/09PAYER PRIMARY ID20 ALPHA-NUM(837I)2010BC/N3/01(837P)2010BB/N3/01CURRENT INSURANCESTREET ADDRESS -LINE 135 ALPHA-NUM1500 – TOP RTUB04 – FL 38(837I)2010BC/N3/02(837P)2010BB/N3/02CURRENT INSURANCESTREET ADDRESS –LINE 235 ALPHA-NUM1500 – TOP RTUB04 – FL 38(837I)2010BC/N4/01(837P)2010BB/N4/01CURRENT INSURANCECITY30 ALPHA-NUM1500 – TOP RTUB04 – FL 38(837I) 2010BC/N4/02 (837P) 2010BB/N4/02CURRENT INSURANCE STATE2 ALPHA-NUM1500 – TOP RT UB04 – FL 38(837I)2010BC/N4/03(837P)2010BB/N4/03CURRENT INSURANCEZIP CODE5 NUM1500 – TOPRT/LINE 3/4UB04 – FL84/LINE 3/4(837P)2010BB/REF/01(837I)2010BC/REF/01QUALIFIER FOR PAYERSECONDARY IDAllow up to threeoccurrences3 ALPHA-NUM(837P)2010BB/REF/02(837I)2010BC/REF/02PAYER SECONDARY IDAllow up to threeoccurrences30 ALPHA-NUMLOOP 2010BD/2010BC Responsible PartyX12Field nameMax lengthPrint location(837I)2010BD/NM1/01(837P)2010BC/NM1/01ENTITY IDENTIFIERCODE (“QD”)2 ALPHA-NUM(837I)2010BD/NM1/02(837P)2010BC/NM1/02ENTITY TYPEQUALIFIER (1 = Person;2 = Non-person)1 NUM(837I)2010BD/NM1/03(837P)2010BC/NM1/03LAST NAME ORORGANIZATION NAME35 ALPHA-NUM(837I) 2010BD/NM1/04 (837P) 2010BC/NM1/04FIRST NAME25 ALPHA-NUM(837I) 2010BD/NM1/05 (837P) 2010BC/NM1/05MIDDLE NAME25 ALPHA-NUM(837I) 2010BD/NM1/07 (837P) 2010BC/NM1/07NAME SUFFIX10 ALPHA-NUM(837I) 2010BD/N3/01 (837P) 2010BC/N3/01ADDRESS LINE 150 ALPHA-NUM(837I) 2010BD/N3/02 (837P) 2010BC/N3/02ADDRESS LINE 235 ALPHA-NUM(837I) 2010BD/N4/01 (837P) 2010BC/N4/01CITY30 ALPHA-NUM(837I) 2010BD/N4/02 (837P) 2010BC/N4/02STATE2 ALPHA-NUM(837I) 2010BD/N4/03 (837P) 2010BC/N4/03ZIP CODE15 ALPHA-NUMLOOP 2010BE Current Insured Group/EmployerX12Field nameMax lengthPrint location2010BE/NM1/03 Set NM1/01 = 84 NM1/02 = 2CURRENT INSURED EMPLOYER NAME30 ALPHA-NUM1500 – BOX 11b UB04 – FL 65(837I) 2010BE/N3/01CURRENT INSURED EMPLOYER STREET ADDRESS20 ALPHA-NUM2010BE/N4/01CURRENT INSURED EMPLOYER CITY30 ALPHA-NUM2010BE/N4/02CURRENT INSURED EMPLOYER STATE2 ALPHA-NUM(837I) 2010BE/REF/02 Set REF/01 = BB(837P) 2300/REF/02 Set REF/01 = G1TREATMENT AUTHORIZATION CODE35 ALPHA-NUM1500 – BOX 23 UB04 – FL 63(837I) 2010BE/REF/02 Set REF/01 = X9CURRENT INSURED FORM LOCATOR 37 (ICN/DCN)20 ALPHA-NUMUB04 – FL 64LOOP 2010CA PatientX12Field nameMax lengthPrint location(837P) 2010CA/PER/04PATIENT PHONE20 ALPHA-NUM1500 – BOX 52010CA/NM1/03 Set NM1/01 = QC NM1/02 = 1PATIENT LAST NAME30 ALPHA-NUM1500 – BOX 2,BOX 12 UB04 – FL 8b2010CA/NM1/04PATIENT FIRST NAME20 ALPHA-NUM2010CA/NM1/041500 – BOX 2,BOX 12 UB04 – FL 8b2010CA/NM1/05PATIENT MIDDLE NAME25 ALPHA-NUM1500 – BOX 2,BOX 12 UB04 – FL 8b2010CA/NM1/07PATIENT NAME SUFFIX10 ALPHA-NUM1500 – Box 2 UB04 – 8b2010CA/NM1/08QUALIFIER FOR PATIENT PRIMARY ID3 ALPHA-NUM2010CA/NM1/09PATIENT PRIMARY ID30 ALPHA-NUMUB04 – FL 8a2010CA/N3/01PATIENT STREET ADDRESS LINE 135 ALPHA-NUM1500 – BOX 5 UB04 – FL 9a2010CA/N3/02PATIENT STREET ADDRESS LINE 235 ALPHA-NUM1500 – BOX 5 UB04 – NO PRINT2010CA/N4/01PATIENT CITY30 ALPHA-NUM1500 – BOX 5 UB04 – FL 9b2010CA/N4/02PATIENT STATE2 ALPHA-NUM1500 – BOX 5 UB04 – FL 9c2010CA/N4/03PATIENT ZIP CODE5 NUM1500 – BOX 5 UB04 – FL 9d2010CA/DMG/02 or2010BA/DMG/02 Set DMG/01 = D8PATIENT BIRTH DATE8 NUM (CCYYMMDD)1500 – BOX 3 UB04 – FL 102010CA/DMG/03 or2010BA/DMG/03PATIENT GENDER1 ALPHA-NUM1500 – BOX 3 UB04 – FL 11(837P) 2010CA/DMG/04PATIENT MARITAL STATUS1 ALPHA-NUM1500 – BOX 82010CA/REF/01QUALIFIER FOR PATIENT SECONDARY IDAllow up to three occurrences3 ALPHA-NUM2010CA/REF/02PATIENT SECONDARY IDAllow up to three occurrences30 ALPHA-NUMLOOP 2300 Claim DataX12Field nameMax lengthPrint location2300/CLM/01PATIENT CONTROL NUMBER (BILL #)38 ALPHA-NUM1500 – BOX 26 UB04 – FL 3a2300/CLM/02TOTAL CHARGES15 NUM(ASSUME 2 DECIMALS)1500 – BOX 28 UB04 – FL Line 23 TOTALS(837I) 2300/CLM- 05:1LOCATION OF CARE(Type of Bill)1 ALPHA-NUMUB04 – FL 4(837I) 2300/CLM-05:2BILL CLASSIFICATION(Type of Bill)1 ALPHA-NUMUB04 – FL 4 (837I) 2300/CLM- 05:3FREQUENCY(Type of Bill)1 ALPHA-NUMUB04 – FL 42300/CLM/06PROVIDER SIGNATURE ON FILE1 ALPHA-NUM1500 – BOX 312300/CLM/07MEDICARE ASSIGNMENT CODEA = AssignedC = Not Assigned1 ALPHA-NUM2300/CLM/08 (837I) 2320/OI/03ASSIGNMENT OF BENEFITS1 ALPHA-NUM1500 – BOX 13 UB04 – FL 53MRA (B) – Field 212300/CLM/09 (837I) 2320/OI/06RELEASE OF INFORMATION1 ALPHA-NUM1500 – BOX 12 UB04 – FL 52(837P) 2300/CLM/11:1CONDITION REL. TO AUTO ACCIDENT2 ALPHA-NUM1500 – BOX 10b(837P) 2300/CLM/11:1CONDITION REL. TO EMPLOYMENT2 ALPHA-NUM1500 – BOX 10a(837P) 2300/CLM/11:1CONDITION REL. TO OTHER ACCIDENT2 ALPHA-NUM1500 – BOX 10c(837P) 2300/CLM/11:4STATE CODE FOR AUTO ACCIDENT2 ALPHA-NUM1500 – BOX 10b UB04 – FL 29(837P) 2300/CLM/12SPECIAL PROGRAM INDICATOR2 ALPHA-NUM1500 – Box 19(837I) 2300/CLM/18EXPLANATION OF BENEFITS INDICATOR1 ALPHA-NUMLOOP 2300 Claim DatesX12Field nameMax lengthPrint location(837I) 2300/DTP/03 Set DTP/01= 232 DTP02 = D8(837P) 2300/DTP/03 Set DTP01 = 141 DTP02 = D8STATEMENT COVERS FROM DATE(Also used for the Signature date in Box 12 of 1500 form )8 NUM (CCYYMMDD)1500 – BOX 12DateUB04 – FL 6(837I) 2300/DTP/03 Set DTP01 = 233 DTP02 = D8STATEMENT COVERS TO DATE8 NUM (CCYYMMDD)UB04 – FL 6(837P) 2300/DTP/03 Set DTP/01 = 454 DTP/02 = D8INITIAL TREATMENT DATE8 NUM (CCYYMMDD)(837P) 2300/DTP/03 Set DTP/01= 304 DTP02 = D8DATE LAST SEEN8 NUM (CCYYMMDD)1500 – Box 19(837P) 2300/DTP/03 Set DTP/01 = 431DTP/02 = D8DATE OF ILLNESS/EVENT DATE8 NUM (CCYYMMDD)1500 – BOX 142300/DTP/03 Set DTP/01 = 453 DTP/02 = D8DATE ACUTE MANIFESTATION8 NUM (CCYYMMDD)(837P) 2300/DTP/03 Set DTP/01= 438 DTP02 = D8FIRST DATE OF SIMILAR ILLNESS8 NUM (CCYYMMDD)1500 – BOX 15(837P) 2300/DTP/03 Set DTP/01 = 439 DTP/02 = D8ACCIDENT DATE8 NUM (CCYYMMDD)1500 – BOX 14(837P) 2300/DTP/03 Set DTP/01 = 484 DTP/02 = D8LAST MENSTRUAL DATE8 NUM (CCYYMMDD)1500 – BOX 14(837P) 2300/DTP/03 DTP/01 = 455 DTP/02 = D8LAST X-RAY DATE (WHEN CLAIM INVOLVES SPINAL MANIPULATION)8 NUM (CCYYMMDD)1500 – Box 192300/DTP/03Set DTP/01 = 471 DTP/02 = D8HEARING AND VISION PRESCRIPTION DATE8 NUM (CCYYMMDD)(837P) 2300/DTP/03 Set DTP/01= 360 DTP02 = D8DATE UNABLE TO WORK FROM8 NUM (CCYYMMDD)1500 – BOX 16(837P) 2300/DTP/03 Set DTP/01= 361 DTP02 = D8DATE UNABLE TO WORK TO8 NUM (CCYYMMDD)1500 – BOX 16(837I) 2300/DTP/03 (837P) 2300/DTP/03 Set DTP01 = 435 DTP02 = D8ADMISSION/START OF CARE DATE8 NUM (CCYYMMDD)1500 – BOX 14and 18UB04 – FL 12(837I) 2300/DTP/03ADMISSION HOUR2 NUMUB04 – FL 13(837P) 2300/DTP/03 Set DTP/01= 096 DTP02 = D8DISCHARGE DATE8 NUM (CCYYMMDD)1500 – BOX 18(837I) 2300/DTP/03 Set DTP/01 = 096 DTP/02 = TMDISCHARGE HOUR2 NUMUB04 – FL 16LOOP 2300 HospitalX12Field nameMax lengthPrint location(837I) 2300/CL1/01TYPE OF ADMISSION1 ALPHA-NUMUB04 – FL 14(837I) 2300/CL1/02SOURCE OF ADMISSION1 ALPHA-NUMUB04 – FL 15(837I) 2300/CL1/03PATIENT STATUS2 ALPHA-NUMUB04 – FL 17(837I) 2300/QTY/02 Set 2300/QTY/01 = CA2300/QTY/03 = DACOVERED DAYS3 NUM (837I) 2300/QTY/02 Set 2300/QTY/01 = NA2300/QTY/03 = DANON-COVERED DAYS3 NUM(837I) 2300/QTY/02 Set 2300/QTY/01 = CD2300/QTY/03 = DACO-INSURANCE DAYS3 NUM(837I) 2300/QTY/02 Set 2300/QTY/01 = LA2300/QTY/03 = DALIFETIME RESERVED DAYS3 NUM(837I) 2300/REF/02 Set REF/01 = EAHEALTH RECORD NUMBER20 ALPHA-NUMUB04 – FL 3bLOOP 2300 Claim other informationX12Field nameMax lengthPrint location(837I) 2300/AMT/02 (837P) 2300/AMT/02 Set AMT01 = C5BALANCE DUE15 NUM(ASSUME 2 DECIMALS)1500 – BOX 30 UB04 – FL 55(837P) 2300/REF/02 Set REF/01 = EWMAMMOGRAPHY CERTIFICATION NUMBER30 ALPHA-NUM(837P) 2300/CR2/08SPINAL MANIPULATION NATURE OF CONDITION CODEA = Acute Condition C = Chronic Condition D = Non-acuteE = Non-Life Threatening F = RoutineG = SymptomaticM = Acute Manifestation of a Chronic Condition1 ALPHA-NUM(837P) 2300/CRC/02HOMEBOUND INDICATOR1 ALPHA-NUM1500 – Box 19LOOP 2300 Claim notesX12Field nameMax lengthPrint location2300/NTE/01QUALIFIER FOR REMARKS3 ALPHA-NUM2300/NTE/02REMARKS80 ALPHA-NUM1500 – Box 19 UB04 – FL 80LOOP 2300 LabX12Field nameMax lengthPrint location(837P) 2300/AMT/02 Set AMT/01 = NETOTAL OUTSIDE LAB CHARGES15 NUM(ASSUME 2 DECIMALS)1500 – BOX 20(837P) 2300/REF/02 Set REF/01 = X4LABORATORY’S CLIA #10 ALPHA-NUM1500 – BOX 23LOOP 2300 Present on AdmissionX12Field nameMax lengthPrint location(837I) 2300 K3/01Medicare onlyPRESENT ON ADMISSION INDICATORY – Present on admission N – Not present on admissionU – Documentation insufficient to determine if condition was present.W – Clinically undetermined1 – Exempt from POA reporting80 ALPHA-NUM.LOOP 2300 Procedure CodeX12Field nameMax lengthPrint location(837I) 2300/HI(7-8)/01-12:1PROCEDUREQUALIFIER(For 4010: HI=HCPCS,HI=ICD)2 ALPHA-NUMBP/BO = CPTBR/BQ = ICD9(837I) 2300/HI(7- 8)/01-12:2PROCEDURE-CODE10 ALPHA-NUMUB04 – FL 74, 741-e(837I) 2300/HI(7-8)/01-12:4Set HI(7-8)/01-12:3 =D8PROCEDURE-DATE8 NUM(CCYYMMDD)UB04 – FL 74,74a-eLOOP 2300 Diagnosis CodeX12Field nameMax lengthPrint location(837P) 2300/HI/01- 08:2(837I) 2300/HI(1- 2)/01-12:2Set HI01:1 to BK Set HI02-12 to BF:DIAGNOSIS CODE10 ALPHA-NUM1500 – Box 21 (1-4)UB04 – FL 67, 67A-QUB04 – ECodes 72a-c(837I) 2300/HI/01:2 Set HI01:1 = BNE-CODE DIAGNOSIS10 ALPHA-NUMUB04 – FL 72(837I) 2300/HISet qualifier to BJADMITTING DIAGNOSIS10 ALPHA-NUMUB04 – FL 69LOOP 2300 Occurrence Span CodeX12Field nameMax lengthPrint location(837I) 2300/HI/01- 12:4Set 2300/HI/01-12:3= RD8OCCURRENCE SPAN FROM DATE8 NUM (CCYYMMDD)UB04 – FL 35-36OCCURRENCE SPAN TO DATE8 NUM (CCYYMMDD)(837I) 2300/HI/01- 12:22300/HI/01-12:1 = BIOCCURRENCE CODE3 ALPHA-NUMUB04 – FL 35-36LOOP 2300 Occurrence CodeX12Field nameMax lengthPrint location(837I) 2300/HI/01- 12:4Set HI03/01-12:1 to BHHI03/01-12:3 to D8OCCURRENCE DATE8 NUM (CCYYMMDD)UB04 – FL 31-34(837I) 2300/HI/01- 12:2OCCURRENCE CODE3 ALPHA-NUMUB04 – FL 31-34LOOP 2300 Value CodeX12Field nameMax lengthPrint location(837I) 2300/HI/01- 12:2Set 2300/HI/01-12:1= BEVALUE CODE2 ALPHA-NUMUB04 – FL 39-41a-d(837I) 2300/HI/01-12:5VALUE CODE DOLLARAMOUNT9 NUMERIC,ASSUME 2DECIMALSUB04 – FL 39-41a-d(837I) 2300/HI/01-12:6VALUE CODEQUANTITY7 NUMERIC,ASSUME 2DECIMALSLOOP 2300 Condition CodeX12Field nameMax lengthPrint location(837I) 2300/HI/01- 12:2Set 2300/HI/01-12:1= BGCONDITION CODE2 ALPHA-NUMUB04 – FL 18-28LOOP 2310A/2310B Attending/Other ProviderX12Field nameMax lengthPrint location(837I)2310A/NM1/02(837P)2310B/NM1/02ATTENDING/RENDERINGENTITY TYPEQUALIFIER (1 = Person;2 = Non-person)1 ALPHA-NUM(837I)2310A/NM1/03Set NM1/01 = 71(837P)2310B/NM1/03Set NM1/01 = 82ATTENDING/RENDERINGLAST NAME20 ALPHA-NUM1500 – Box 31UB04 – FL 76(837I)2310A/NM1/04(837P)2310B/NM1/04ATTENDING/RENDERINGFIRST NAME20 ALPHA-NUM1500 – Box 31UB04 – FL 76(837P) 2310B/NM106ATTENDING/RENDERING PHYSICIAN CREDENTIALS3 ALPHA-NUM1500 – Box 31(837I)2310A/NM1/07(837P)2310B/NM1/07ATTENDING/RENDERINGNAME SUFFIX10 ALPHA-NUMIf Medicare or noNPI submitted then(837I)2310A/NM1/08(837P)2310B/NM1/08ATTENDING/RENDERING PRIMARYID QUALIFIER(34 = SSN; 24 = EIN)2 ALPHA-NUMIf Medicare or noNPI submitted then(837I)2310A/NM1/09(837P)2310B/NM1/09ATTENDING/RENDERINGPHYSICIAN PRIMARYLEGACY ID10 ALPHA-NUM(837I)2310A/NM1/09; SetNM108 = XX;(837P)2310B/NM1/09; SetNM108 = XX(837I) Attending PhysicianNPI(837P) Rendering ProviderNPI10 NUM(837I)2310A/PRV/03Set PRV02 = ZZ;(837P)2310B/PRV/03Set PRV02 = ZZ(837I) Attending PhysicianTaxonomy code(837P) Rendering ProviderTaxonomy code10 ALPH/NUM(837P) 2310B/PRV/03 Set PRV/01 = PEATTENDING/RENDERING SPECIALTY5 ALPHA-NUM (837I) 2310A/REF/01 (837P) 2310B/REF/01ATTENDING/RENDERING PROVIDER SECONDARY ID QUALIFIERAllow up to five occurrences2 ALPHA-NUMUB04 – FL 76(G2 prints or 1G if no Ins provided ID is found)(837I)2310A/REF/02(837P)2310B/REF/02ATTENDING/RENDERINGPROVIDER SECONDARYIDAllow up to five occurrences30 ALPHA-NUM1500 – Box 24J, 1-6UB04 – Box 76LOOP 2310A Referring Provider SecondaryX12Field nameMax lengthPrint location(837P) 2310A/NM1/02REFERRING ENTITY TYPE QUALIFIER (1 =Person;2 = Non-person)1 ALPHA-NUM(837P) 2310A/NM1/03 Set NM1/01 = DN NM1/02 = 1REFERRING PHYSICIAN LAST NAME20 ALPHA- NUM1500 – Box 17(837P) 2310A/NM1/04REFERRING PHYSICIAN FIRST NAME20 ALPHA- NUM1500 – Box 17(837P) 2310A/NM1/07REFERRING PHYSICIAN NAME SUFFIX10 ALPHA- NUM(837P)2310A/NM1/08REFERRING PHYSICIAN PRIMARY ID QUALIFIER(34 = SSN; 24 = EIN)2 ALPHA-NUMIf Medicare or no NPI submitted then (837P) 2310A/NM1/09REFERRING PHYSICIAN PRIMARY LEGACY ID10 ALPHA- NUM(837P) 2310A/NM1/09; Set NM108 = XXReferring Provider NPI10 NUM1500 – 17b(837P) 2310A/PRV/03 Set PRV02 = ZZReferring Provider Taxonomy code10 ALPH/NUM(837P) 2310A/REF/01REFERRING PROVIDER SECONDARY ID QUALIFIERAllow up to five occurrences2 ALPHA-NUM1500 – Box 17a(837P) 2310A/REF/02REFERRING PROVIDER SECONDARY IDAllow up to five occurrences30 ALPHA- NUM1500 – Box 17aLOOP 2310B Operating PhysicianX12Field nameMax lengthPrint location(837I) 2310B/NM1/02OPERATING ENTITY TYPE QUALIFIER (1 =Person;2 = Non-person)1 ALPHA-NUM(837I) 2310B/NM1/03 Set NM1/01 = 72Set NM1/02 = 1OPERATING PHYSICIAN LAST NAME20 ALPHA-NUMUB04 – FL 77(837I) 2310B/NM1/04OPERATING PHYSICIAN FIRST NAME20 ALPHA-NUMUB04 – FL 77(837I) 2310B/NM1/07OPERATING PHYSICIAN NAME SUFFIX10 ALPHA-NUM(837I) 2310B/NM1/08OPERATING PHYSICIAN PRIMARY ID QUALIFIER(34 = SSN; 24 = EIN)2 ALPHA-NUMIf Medicare or no NPI submitted then (837I) 2310B/NM1/09OPERATING PHYSICIAN PRIMARY LEGACY ID10 ALPHA-NUM(837I) 2310B/NM1/09; Set NM108 = XXOperating Physician NPI10 NUMUB04 – FL 77(837I) 2310B/REF/01OPERATING PHYSICIAN SECONDARY ID QUALIFIERAllow up to five occurrences2 ALPHA-NUMUB04 – FL 77(G2 prints or 1G if no Ins provided ID is found)(837I) 2310B/REF/02OPERATING PHYSICIAN SECONDARY IDAllow up to five occurrences30 ALPHA-NUMUB04 – FL 77LOOP 2310C Other ProviderX12Field nameMax lengthPrint location(837I) 2310C/NM1/02OTHER PROVIDER ENTITY TYPE QUALIFIER (1 = Person;2 = Non-person)1 ALPHA-NUM(837I) 2310C/NM1/03 Set NM1/01 = 73 NM1/02 = 1OTHER PHYSICIAN LAST NAME20 ALPHA-NUMUB04 – FL 78-79(837I) 2310C/NM1/04OTHER PHYSICIAN FIRST NAME20 ALPHA-NUMUB04 – FL 78-79(837I) 2310C/NM1/07OTHER PHYSICIAN NAME SUFFIX10 ALPHA-NUMIf Medicare or no NPI submitted then (837I) 2310C/NM1/08OTHER PROVIDER PRIMARY LEGACY ID QUALIFIER(34 = SSN; 24 = EIN)2 ALPHA-NUMIf Medicare or no NPI submitted then (837I) 2310C/NM1/09OTHER PHYSICIAN PRIMARY LEGACY ID10 ALPHA-NUM(837I) 2310C/NM1/09; Set NM108 = XXOther Provider NPI10 NUMUB04 – FL 78-79(837I) 2310C/REF/01OTHER PROVIDER SECONDARY ID QUALIFIERAllow up to five occurrences2 ALPHA-NUMUB04 – FL 78-79(G2 prints or 1G if no Ins provided ID is found)(837I) 2310C/REF/02OTHER PROVIDER SECONDARY IDAllow up to five occurrences30 ALPHA-NUMUB04 – FL 78-79LOOP 2310C Purchase ServiceX12Field nameMax lengthPrint location(837P) 2310C/NM1/02PURCHASED SERVICE ENTITY TYPE QUALIFIER1 = Person2 = Non-person1 NUM(837P) 2310C/NM1/03REMOTE VA SITE NAME/OUTSIDE LAB OR FACILITY – (WHERE SERVICES WERE RENDERED)30 ALPHA-NUM1500 – BOX 32(837P) 2310C/NM1/08PURCHASED SERVICE PRIMARY ID QUALIFIER24 = EIN; 34 = SSN2 NUMIf Medicare or no NPI submitted then (837I) 2310C/NM1/09OUTSIDE FACILITY PROVIDER LEGACY ID10 ALPHA-NUMQualifier 24 for 2310D/E(837P) 2310C/NM1/09; Set NM108 = XXPurchased Service Provider NPI10 NUM(837P) 2310C/REF/01PURCHASED SERVICE SECONDARY ID QUALIFIER Allow up to five occurrences2 ALPHA-NUM (837P) 2310C/REF/02PURCHASED SERVICE SECONDARY IDAllow up to five occurrences20 ALPHA- NUMLOOP 2310D/ 2310E Other FacilityX12Field nameMax lengthPrint location(837I)2310E/NM1/01(837P)2310D/NM1/01SERVICE FACILITYLAB/FACILITYPROVIDER CODE77 = Service LocationFA = FacilityLI = IndependentLaboratoryTL = Testing LaboratoryNote: Always “FA” for(837I)2 ALPHA-NUM(837I) 2310E/NM1/03 (837P)2310C/NM1/03 and2310D/NM1/03 Set NM1/01 = FA NM1/02 = 2REMOTE VA SITE NAME/OUTSIDE LAB OR FACILITY – (WHERE SERVICES WERE RENDERED)30 ALPHA-NUM1500 – BOX 32(837I)2310E/NM1/02(837P)2310D/NM1/02SERVICE FACILITYENTITY TYPEQUALIFIER2 = Non-person1 NUMIf Medicare or noNPI submitted then(837I)2310E/NM1/09(837P)2310D/NM1/09 and2310C/NM1/09Set NM108 = 24OUTSIDE FACILITYPROVIDER LEGACY ID10 ALPHA-NUMQualifier 24 for2310D/E(837I) 2310E/NM1/09; Set NM108 = XX (837P) 2310D/NM1/09; Set NM108 = XXService Facility Provider NPI10 NUM1500 – Box 32a(837P) 2310D/N3/01 (837I) 2310E/N3/01OTHER FACILITY STREET ADDRESS35 ALPHA-NUM1500 – BOX 32(837I) 2310E/N3/02(837P) 2310D/N3/02SERVICE FACILITYADDRESS LINE 250 ALPHA-NUM (837P) 2310D/N4/01 (837I) 2310E/N4/01OTHER FACILITY CITY30 ALPHA-NUM1500 – BOX 32(837P) 2310D/N4/02 (837I) 2310E/N4/02OTHER FACILITY STATE2 ALPHA-NUM1500 – BOX 32(837P) 2310D/N4/03 (837I) 2310E/N4/03OTHER FACILITY ZIP CODE5 NUM1500 – BOX 32(837I) 2310E/REF/01 (837P) 2310D/REF/01SERVICE FACILITY SECONDARY ID QUALIFIERLU = Location Number; X5 = State Industrial Accident;Provider Number; 1C = Medicare Number; 0B = State License Number;1A = Blue Cross Number; 1B = Blue Shield Number; 1D = Medicaid Number; 1G = UPIN;G2 = Commercial Number; 1H = CHAMPUS Number;X4 = CLIA Number Allow up to five occurrences2 ALPHA-NUM(837I) 2310E/REF/02 (837P) 2310D/REF/02SERVICE FACILITY SECONDARY IDAllow up to five occurrences20 ALPHA-NUM1500 – BOX 32bLOOP 2310E Supervising ProviderX12Field nameMax lengthPrint location(837P) 2310E/NM1/03 Set NM101 = DQ NM102 = 1SUPERVISING PROVIDER LAST NAME35 ALPHA-NUM(837P) 2310E/NM1/04SUPERVISING PROVIDER FIRST NAME25 ALPHA-NUM(837P) 2310E/NM1/05SUPERVISING PROVIDER MIDDLE NAME25 ALPHA-NUM(837P) 2310E/NM1/07SUPERVISING PROVIDER NAME SUFFIX10 ALPHA-NUM(837P) 2310E/NM1/08SUPERVISING PROVIDER ID NUMBER QUALIFIER(24 = EIN; 34 = SSN)2 NUMIf Medicare or no NPI submitted then (837P) 2310E/NM1/09SUPERVISING PROVIDER PRIMARY LEGACY ID NUMBER30 ALPHA-NUM(837P) 2310E/NM1/09; Set NM108 = XXSupervising Provider NPI10 NUM(837P) 2310E/REF/01SUPERVISING PROVIDER SECONDARY ID QUALIFIERAllow up to five occurrences2 ALPHA-NUM(837P) 2310E/REF/02SUPERVISING PROVIDER SECONDARY IDAllow up to five occurrences30 ALPHA-NUMLOOP 2320 Other SubscriberX12Field nameMax lengthPrint location2320/SBR/01PRIM/SECOND/TERTIARY INDICATOR1 ALPHA-NUM1500 – BOX 11d UB04 – NO PRINT2320/SBR/02PATIENTS RELATIONSHIP TO INSURED2 ALPHA-NUM1500 – Box 6 UB04 – FL 592320/SBR/03OTHER INSURED GROUP NUMBER20 ALPHA- NUM1500 – BOX 9a UB04 – FL 622320/SBR/04OTHER INSURED GROUP OR INS CO NAME35 ALPHA- NUM1500 – BOX 9d UB04 – FL 61(Group) FL 50 (Company Name)(837P) 2320/SBR/05INSURANCE TYPE CODE2 ALPHA-NUM2320/SBR/09TYPE OF PAYER/SOURCE OF PAY2 ALPHA-NUM2320/DMG/02Set DMG/01 = D8OTHER INSURED BIRTH DATE8 NUM (CCYYMMDD)1500 – Box 9b2320/DMG/03OTHER INSURED GENDER1 ALPHA-NUM1500 – BOX 9b2320/AMT/02 Set AMT/01 = C4OTHER INSURANCE COMPANY PRIOR PAYMENT15 NUM(ASSUME 2 DECIMALS)1500 – Box 29 UB04 – FL 54(837P) 2320/OI/04OTHER INSURANCE PATIENT SIGNATURE SOURCE CODE1 ALPHA-NUMLOOP 2330A Other Insurance SubscriberX12Field nameMax lengthPrint location2330A/NM1/03 Set NM1/01 = IL NM1/02 = 1OTHER INSURED LAST NAME30 ALPHA-NUM1500 – Box 9 UB04 – FL 582330A/NM1/04OTHER INSURED FIRST NAME20 ALPHA-NUM1500 – Box 9 UB04 – FL 582330A/NM1/05OTHER INSURED MIDDLE NAME25 ALPHA-NUM1500 – Box 9 UB04 – FL 582330A/NM1/07OTHER INSURED NAME SUFFIX10 ALPHA-NUMUB04 – FL 582330A/NM1/08QUALIFIER FOR OTHER PAYER SUBSCRIBER PRIMARY ID3 ALPHA-NUM2330A/NM1/09 Set NM1/08 = MIOTHER PAYER SUBSCRIBER PRIMARY ID NUMBER35 ALPHA-NUMUB04 – FL 602330A/N3/01OTHER INSURED ADDRESS LINE 145 ALPHA-NUM2330A/N3/02OTHER INSURED ADDRESS LINE 240 ALPHA-NUM2330A/N4/01OTHER INSURED CITY30 ALPHA-NUM2330A/N4/02OTHER INSURED STATE2 ALPHA-NUM2330A/N4/03OTHER INSURED ZIP CODE10 ALPHA-NUM2330A/REF/01OTHER INSURED ID QUALIFIER23 = Client Number; 1G = Insurance Policy Number;SY = Social Security NumberAllow up to three occurrences2 ALPHA-NUM2330A/REF/02OTHER INSURED IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330B Other InsuredX12Field nameMax lengthPrint location2330B/NM1/03 Set NM1/01 = PR NM1/02 = 2OTHER INSURANCE COMPANY NAME35 ALPHA-NUM1500 – BOX 9d UB04 – FL 502330B/NM1/08QUALIFIER FOR OTHER PAYER PRIMARY ID3 ALPHA-NUM2330B/NM1/09OTHER PAYER PRIMARY ID30 ALPHA-NUM2330B/N3/01OTHER INSURED ADDRESSLINE 155 ALPHA-NUM2330B/N3/02OTHER INSURED ADDRESSLINE 255 ALPHA-NUM2330B/N4/01OTHER INSURED CITY30 ALPHA-NUM2330B/N4/02OTHER INSURED STATE2 ALPHA-NUM2330B/N4/03OTHER INSURED ZIP CODE15 ALPHA-NUM(837I) 2330B/REF/02 (837P) 2330B/REF/02Set REF/01 = F8OTHER INSURANCE FORM LOCATOR 37 (ICN/DCN)23 ALPHA-NUMUB04 – FL 64(837I) 2330B/REF/02 Set REF/01 = G1OTHER INS TREATMENT AUTH CODE18 ALPHA-NUMUB04 – FL 632330B/REF/01QUALIFIER FOR OTHER PAYER SECONDARY IDAllow up to three occurrences3 ALPHA-NUM2330B/REF/02OTHER PAYER SECONDARY IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330C Other Insurance SubscriberX12Field nameMax lengthPrint location2330C/NM1/03 Set NM1/01 = 84 NM1/02 = 2EMPLOYER NAME35 ALPHA-NUM1500 – Box 9c UB04 – FL 652330C/NM1/01OTHER PAYER PATIENT NAME QUALIFIER (“QC”)2 ALPHA-NUM2330C/NM1/02OTHER PAYER PATIENT ENTITY TYPE QUALIFIER (“1”)1 NUM2330C/NM1/08OTHER PAYER PATIENT ID NUMBER QUALIFIERMI = Member ID Number2 ALPHA-NUM2330C/NM1/09OTHER PAYER PATIENT ID NUMBER30 ALPHA-NUM(837I) 2330C/N3/01OTHER INSURED EMPLOYER STREET ADDRESS20 ALPHA-NUM (837I) 2330C/N4/02EMPLOYER STATE2 ALPHA-NUM2330C/REF/01OTHER PAYER PATIENT ID QUALIFIER23 = Client Number; 1G = Insurance Policy Number;SY = Social Security NumberAllow up to three occurrences2 ALPHA-NUM2330C/REF/02OTHER PAYER PATIENT IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330D Other Payer Referring/PCP ProviderX12Field nameMax lengthPrint location(837P) 2330D/NM1/01OTHER PAYER REFERRING/PCP PROVIDER ID QUALIFIERDN = Referring Provider; P3 = Primary Care Provider2 ALPHA-NUM(837P) 2330D/NM1/02OTHER PAYER REFERRING/PCP PROVIDER ENTITY TYPE QUALIFIER1 = Person;2 = Non-person1 NUM(837P) 2330D/REF/01OTHER PAYER REFERRING/PCP PROVIDER ID QUALIFIERAllow up to three occurrences2 ALPHA-NUM(837P) 2330D/REF/02OTHER PAYER REFERRING/PCP PROVIDER IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330D/2330E Other Payer Attending/Rendering ProviderX12Field nameMax lengthPrint location(837I) 2330D/NM1/01OTHER PAYER ATTENDING/RENDERING2 ALPHA-NUM (837P) 2330E/NM1/01PROVIDER NAME QUALIFIER (“71” forInstitutional; “82” for Professional))(837I)2330D/NM1/02(837P)2330E/NM1/02OTHER PAYERATTENDING/RENDERINGPROVIDER ENTITY TYPEQUALIFIER1 = Person;2 = Non-person1 NUM(837I)2330D/REF/01(837P)2330E/REF/01OTHER PAYERATTENDING/RENDERINGPROVIDER ID QUALIFIERAllow up to threeoccurrences2 ALPHA-NUM(837I)2330D/REF/02(837P)2330E/REF/02OTHER PAYERATTENDING/RENDERINGPROVIDER IDAllow up to threeoccurrences30 ALPHA-NUMLOOP 2330E Other Payer Operating ProviderX12Field nameMax lengthPrint location(837I) 2330E/NM1/01OTHER PAYER OPERATING PROVIDER NAME QUALIFIER (“72”)2 ALPHA-NUM(837I) 2330E/NM1/02OTHER PAYER OPERATING PROVIDER ENTITY TYPE QUALIFIER (“1”)1 NUM(837I) 2330E/REF/01OTHER PAYER OPERATING PROVIDER ID QUALIFIERAllow up to three occurrences2 ALPHA-NUM(837I) 2330E/REF/02OTHER PAYER OPERATING PROVIDER IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330F Other Payer Purchased Service ProviderX12Field nameMax lengthPrint location(837P) 2330F/NM1/01OTHER PAYER PURCHASED SERVICE PROVIDER ID QUALIFIER (“QB”)2 ALPHA-NUM (837P) 2330F/NM1/02OTHER PAYER PURCHASED SERVICE PROVIDER ENTITY TYPE QUALIFIER1 = Person;2 = Non-person1 NUM(837P) 2330F/REF/01OTHER PAYER PURCHASED SERVICE PROVIDER ID QUALIFIERAllow up to three occurrences2 ALPHA-NUM(837P) 2330F/REF/02OTHER PAYER PURCHASED SERVICE PROVIDER IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330F Other Payer Other ProviderX12Field nameMax lengthPrint location(837I) 2330F/NM1/01OTHER PAYER OTHER PROVIDER NAME QUALIFIER(“73”)2 ALPHA-NUM(837I) 2330F/NM1/02OTHER PAYER OTHER PROVIDER ENTITY TYPE QUALIFIER1 = Person2 = Non-person1 NUM(837I) 2330F/REF/01OTHER PAYER OTHER PROVIDER ID QUALIFIERAllow up to three occurrences2 ALPHA-NUM(837I) 2330F/REF/02OTHER PAYER OTHER PROVIDER IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330G Other Payer Service FacilityX12Field nameMax lengthPrint location(837P) 2330G/NM1/01OTHER PAYER SERVICE FACILITY LOCATION ID QUALIFIER77 = Service Location; FA = Facility; LI = Independent Lab; TL = Testing Laboratory2 ALPHA-NUM(837P) 2330G/REF/01OTHER PAYER SERVICE FACILITY REFERENCE ID QUALIFIERAllow up to three occurrences2 ALPHA-NUM(837P) 2330G/REF/02OTHER PAYER SERVICE FACILITY IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330H Other Payer Service Facility ProviderX12Field nameMax lengthPrint location(837I) 2330H/NM1/01OTHER PAYER SERVICE FACILITY PROVIDER NAME QUALIFIER (“FA”)2 ALPHA-NUM(837I) 2330H/NM1/02OTHER PAYER SERVICE FACILITY PROVIDER ENTITY TYPE QUALIFIER (“2”)1 NUM(837I) 2330H/REF/01OTHER PAYER SERVICE FACILITY PROVIDER ID QUALIFIERAllow up to three occurrences2 ALPHA-NUM(837I) 2330H/REF/02OTHER PAYER SERVICE FACILITY PROVIDER IDAllow up to three occurrences30 ALPHA-NUMLOOP 2330H Other Payer Supervising ProviderX12Field nameMax lengthPrint location(837P) 2330H/NM1/01OTHER PAYER SUPERVISING PROVIDER NAME QUALIFIER (“DQ”)2 ALPHA-NUM(837P) 2330H/NM1/02OTHER PAYER SUPERVISING PROVIDER ENTITY TYPE QUALIFIER(“1”)1 NUM (837P) 2330H/REF/01OTHER PAYER SUPERVISING PROVIDER ID QUALIFIER EI =Employer ID; Allow up to three occurrences2 ALPHA-NUM(837P) 2330H/REF/02OTHER PAYER SUPERVISING PROVIDER IDAllow up to three occurrences30 ALPHA-NUMLOOP 2320 (Other Insured Claim Level COB Amounts)X12Field nameMax lengthPrint location2320/AMT/02 Set AMT/01 = F2COB PATIENT RESPONSIBILITY AMOUNT15 NUM(ASSUME 2 DECIMALS)(837P) 2320/AMT/02Set AMT/01 = AUCOB COVERED AMOUNT15 NUM(ASSUME 2 DECIMALS)(837P) 2320/AMT/02Set AMT/01 = D8COB DISCOUNT AMOUNT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/AMT/02Set AMT/01 = DYCOB DAY LIMIT AMOUNT15 NUM(ASSUME 2 DECIMALS)(837P) 2320/AMT/02 Set AMT/01 = TCOB TAX AMOUNT15 NUM(ASSUME 2 DECIMALS)(837P) 2320/AMT/02 Set AMT/01 = T2COB TOTAL BEFORE TAXES AMOUNT15 NUM(ASSUME 2 DECIMALS)2430/DTP/03 (each line item) Set DTP/01 = 573 and DTP/02 = D8DATE CLAIM PAID8 NUM (CCYYMMDD)(837P) 2320/AMT/02 Set AMT/01 = B6ALLOWED AMOUNT15 NUM(ASSUME 2 DECIMALS(837I) 2300/REF/02 Set REF/01 = SUCLAIM STATUS2 ALPHA-NUM(837I) 2300/NTE/02 Set NTE/01 = ADD NTE/02:2 = MRA37COB COVERED DAYS3 NUMLOOP 2320 MEDICARE Outpatient Adjudication COB AmountsX12Field nameMax lengthPrint location2320/MOA/01OUTPATIENT REIMBURSEMENT %3 NUM2320/MOA/02HCPCS PAYABLE AMT15 NUM(ASSUME 2 DECIMALS)2320/MOA/03REMARKS CODE15 ALPHA-NUM2320/MOA/04REMARKS CODE15 ALPHA-NUM2320/MOA/05REMARKS CODE15 ALPHA-NUM2320/MOA/06REMARKS CODE15 ALPHA-NUM2320/MOA/07REMARKS CODE15 ALPHA-NUM2320/MOA/08ESRD AMOUNT PAID15 NUM(ASSUME 2 DECIMALS)2320/MOA/09NON-PAYABLE PROFESSIONAL COMPONENT15 NUM(ASSUME 2 DECIMALS)LOOP 2320 MEDICARE Inpatient Adjudication COB AmountsX12Field nameMax lengthPrint location(837I) 2320/MIA/01COVERED DAYS/VISITS4 NUM(837I) 2320/MIA/04CLAIM DRG AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2300/REF/02 Set REF/01 = ZZDRG USED10 A/N(837I) 2320/MIA/06CLAIM DISPROPORTIONATE SHARE AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/07CLAIM MSP PASS THRU AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/08CLAIM PPS CAPITAL AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/09PPS-CAPITAL FSP DRG AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/10PPS-CAPITAL HSP DRG AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/11PPS-CAPITAL DSH DRG AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/12OLD CAPITAL AMT15 NUM(ASSUME 2 DECIMALS) (837I) 2320/MIA/13PPS-CAPITAL IME AMT4 NUM(837I) 2320/MIA/14PPS-OPERATING HOSP SPECIFIC DRG AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/15COST REPORT DAY COUNT4 NUM(837I) 2320/MIA/16PPS-OPERATING FED SPECIFIC DRG AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/17CLAIM PPS CAPITAL OUTLIER AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/18CLAIM INDIRECT TEACHING AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/19NON-PAYABLE PROFESSIONAL COMPONENT AMT15 NUM(ASSUME 2 DECIMALS)(837I) 2320/MIA/05CLAIM PAYMENT REMARK CODE-110 ALPHA-NUM(837I) 2320/MIA/20CLAIM PAYMENT REMARK CODE-210 ALPHA-NUM(837I) 2320/MIA/21CLAIM PAYMENT REMARK CODE-310 ALPHA-NUM(837I) 2320/MIA/22CLAIM PAYMENT REMARK CODE-410 ALPHA-NUM(837I) 2320/MIA/23CLAIM PAYMENT REMARK CODE-510 ALPHA-NUM(837I) 2320/MIA/24PPS CAPITAL EXCEPTION AMT15 NUM(ASSUME 2 DECIMALS)LOOP 2320 Other INS COB Claim Level AdjustmentX12Field nameMax lengthPrint location2320/CAS/01ADJUSTMENT GROUP CODE2 ALPHA-NUM2320/CAS/02ADJUSTMENT REASON CODEAllow up to six occurrences5 ALPHA-NUM2320/CAS/03ADJUSTMENT AMOUNTAllow up to six occurrences15 NUM(ASSUME 2 DECIMALS)2320/CAS/04ADJUSTMENT QUANTITYAllow up to six occurrences6 NUMLOOP 2400 Professional Service LineX12Field nameMax lengthPrint location(837P) 2400/LX/01LINE # FOR CLAIM6 NUM(837P) 2400/SV1/01:1CODE TYPE (‘CJ’=CPT ‘NU’=REV CD FOR 3051; ‘HC’ FOR 4010)2 ALPHA-NUM(837P) 2400/SV1/01:2PROCEDURE/REVENUE CODE10 ALPHA-NUM1500 – Box 24d(837P) 2400/SV1/01:3PROC MODIFIER 12 NUM1500 – Box 24d(837P) 2400/SV1/01:4PROC MODIFIER 22 NUM1500 – Box 24d(837P) 2400/SV1/01:5PROC MODIFIER 32 NUM1500 – Box 24d(837P) 2400/SV1/01:6PROC MODIFIER 42 NUM1500 – Box 24d(837P) 2400/SV1/02and (837P) 2400/CTP/CHARGE AMOUNT8 NUM(ASSUME 2 DECIMALS)1500 – Box 24f(837P) 2400/SV1/03TYPE OF UNITS2 ALPHA-NUM (MJ/UN)(837P) 2400/SV1/04UNITS OR ANESTHESIA MINUTES6 NUM1500 – Box 24g(837P) 2400/SV1/05PLACE OF SERVICE2 ALPHA-NUM1500 – Box 24b(837P) 2400/SV1/06TYPE OF SERVICE2 ALPHA-NUM(837P) 2400/SV1/07:1DIAGNOSIS CODE POINTER-11 NUM1500 – Box 24e(837P) 2400/SV1/07:2DIAGNOSIS CODE POINTER-21 NUM1500 – Box 24e(837P) 2400/SV1/07:3DIAGNOSIS CODE POINTER-31 NUM1500 – Box 24e(837P) 2400/SV1/07:4DIAGNOSIS CODE POINTER-41 NUM1500 – Box 24e(837P) 2400/SV1/09EMERGENCY INDICATOR1 ALPHA-NUM (Y/N)1500 – Box 24c(837P) 2400/SV1/11EPSDT Flag1 ALPHA-NUM1500 – Box 24H(837P) 2400/DTP/03DATE OF SERVICE FROM8 NUM (CCYYMMDD)1500 – Box 24a MRA (B) – FL 6DATE OF SERVICE TO8 NUM (CCYYMMDD)(837P) 2400/PS1/02PURCHASED SERVICE CHARGE8 NUM(ASSUME 2 DECIMALS)1500 – BOX 20(837P) 2400/CRC/02 Set CRC/01 = 70ATTENDING NOT HOSPICE EMPLOYEE1 ALPHA-NUM1500 – Box 19 (837P) 2400/NTE/02SERVICE LINE 2 DATA(Includes Qualifier and supplemental information)61 ALPHA-NUM1500 – Box 24above procedureLOOP 2400 Institutional Service LineX12Field nameMax lengthPrint location(837I) 2400/LX/01LINE # FOR CLAIM6 NUM(837I) 2400/SV2/01REVENUE CODE10 ALPHA-NUMUB04 – FL 42(837I) 2400/SV2/02:2 Set SV2/02 = HCPROCEDURE CODE ASSOCIATED WITH REV CODE10 ALPHA-NUMUB04 – FL 44(837I) 2400/SV2/06RATE8 NUM (ASSUME2 DECIMALS)UB04 – FL 44(837I) 2400/SV2/02:3MODIFIER 12 ALPHA-NUMUB04 – FL 44(837I) 2400/SV2/02:4MODIFIER 22 ALPHA-NUMUB04 – FL 44(837I) 2400/SV2/03TOTAL CHARGE8 NUM (ASSUME2 DECIMALS)UB04 – FL 47(837I) 2400/SV2/04TYPE OF UNITS2 ALPHA-NUM (DA/UN)(837I) 2400/SV2/05UNITS6 NUMUB04 – FL 46(837I) 2400/SV2/07NON-COVERED CHARGE8 NUM (ASSUME2 DECIMALS)UB04 – FL 48(837I) 2400/DTP/03 Set DTP/01 = 472 DTP/02 = D8INPATIENT FROM DATE/OUTPATIENT SERVICE DATE8 NUM (CCYYMMDD)UB04 – FL 6INPATIENT TO DATE8 NUM (CCYYMMDD)LOOP 2400/2410 Drug Service LineX12Field nameMax lengthPrint location(837P) 2400/LX/01LINE # FOR CLAIM6 NUM(837P) 2410/REF/02PRESCRIPTION #15 ALPHA-NUM1500 – Box 24(above the procedure)(837P)2400/SV1/01:7DRUG NAME(INCLUDING DAYS &QTY)55 ALPHA-NUM1500 – Box 24(above theprocedure – Daysand Quantityprint)(837P) 2400/DTP/03REFILL DATE8 NUM (CCYYMMDD) (837P) 2410/CTP/04DRUG QUANTITY (QUALIFIER = ‘PS’)10 NUM1500 – BOX 24line 2(837P) 2410/LIN/02NDC CODE FORMAT(“N4”) (Applies to RX1-4 and RX1-11 thru RX1-34)2 ALPHA-NUM(837P) 2410/LIN/03NDC CODE11 ALPHA-NUMLOOP 2430 Other INS COB Line Level AdjustmentX12Field nameMax lengthPrint location2430/SVD/01COB INSURANCE CO PAYER ID20 ALPHA-NUM2430/SVD/02AMOUNT PAID15 NUM (including2 decimals)2430/SVD/03-1 “HC” for HCPCSPROCEDURE TYPE2 ALPHA-NUM2430/SVD/03-2 Set SVD/03 = HCPROCEDURE20 ALPHA-NUM2430/SVD/03-3MODIFIER 12 ALPHA-NUM2430/SVD/03-4MODIFIER 22 ALPHA-NUM(837P) 2430/SVD/03-5MODIFIER 32 ALPHA-NUM(837P) 2430/SVD/03-6MODIFIER 42 ALPHA-NUM(837P) 2430/SVD/03-7DESCRIPTION80 ALPHA-NUM(837I) 2430/SVD/04REVENUE CODE10 ALPHA-NUM(837P) 2430/SVD/05PAID UNITS15 NUM(837P) 2430/SVD/06ASSIGNED LINE #6 NUM(837P) 2430/DTP/03DATE PAID8 NUM (CCYYMMDD)2430/CAS/01ADJUSTMENT GROUP CODE2 ALPHA-NUM2430/CAS/02ADJUSTMENT REASON CODEAllow up to six occurrences5 ALPHA-NUM2430/CAS/03ADJUSTMENT AMOUNTAllow up to six occurrences15 NUM(ASSUME 2 DECIMALS)2430/CAS/04ADJUSTMENT QUANTITYAllow up to six occurrences6 NUMAttachment D837 Primary Claims Tier 1 Payers Current Live Payers (Note: List is subject to change as payers are added or removed)Health Care Clearing House (HCCH) Revenue Transactions ProcessingPayer Name1199 National Benefit Fund1-888-OHIOCOMP (Ohio BWC)3P ADMINA & I BENEFIT PLAN ADMINISTRATORSA.G.I.A. Inc.AAG-American Administrative Group (Formerly Gallagher Benefit Admin)AARPAccess AdministratorsAcclaimACS Benefit Services, Inc.Administration Systems Research CorporationAdministrative Concepts, Inc.Administrative Services of Kansas, Inc.Administrative Services, Inc.Advantage Preferred PlusAdvantra FreedomAdventist Health System West - Roseville, CAAetnaAffinity Health PlanAFTRA Health FundAGAAgency Services IncAlaska Childrens Services, Inc.Alaska Electrical Health & Welfare FundALICAREAll Savers Insurance Co.Allegiance Benefit Plan Management, Inc.Alliance IPAAlliance PPO, LLCAlliant Health Plans of GeorgiaAllied Administrators (San Francisco, CA)Allied Benefit SystemsAltius (Utah)AMA Insurance AgencyAmeraPlanAmeriBen Solutions, Inc.AMERICAN BENEFIT ADMINISTRATIVE SERVICESAmerican Benefits Management (North Canton, OH)American Community Mutual InsuranceAmerican Family InsuranceAmerican GeneralAmerican Healthcare AllianceAmerican LIFECAREAmerican Medical Security, Inc.American National Ins. Co. (ANICO)American PioneerAmerican Postal Workers Union Health PlanAmerican Progressive Life and Health Insurance CompanyAmerican Republic InsuranceAmerican Worker Health PlanAmericas PPOAmeriChoice of New Jersey Personal Care Plus (Medicare)Amerigroup CorporationAmeriHealthAnchor Benefit Consulting, Inc.Ancillary Benefit Systems/ Arizona Foundation for Medical CareAntares Management SolutionsAnthem - Blue Cross Blue ShieldAPA Partners, Inc.Apex Benefit ServicesAPS Healthcare, Inc.Arcadian Management Services, IncArkansas Best Corporation - Choice BenefitsAssociates for Health Care, Inc. (AHC)Assurant HealthAssured Benefits AdministratorsAthens Area Health Plan SelectAtlanticare also known as Horizon HealthCare Admin (HHA)Atlantis Health PlanAtlas AdministratorsAultra Administrative GroupAutomated Benefit ServicesAvera Health PlansAvMed, Inc.Banner Health AZBass Administrators, Inc.BC AK (Premera)BC CA (Anthem)BC IDBC OKBC PA (Capital)BC PA (Independence)BC RIBC WA (Premera)BCBS ALBCBS ARBCBS AZBCBS CO (Anthem)BCBS CT (Anthem)BCBS DEBCBS FLBCBS GA (WellPoint)BCBS HI (HMSA)BCBS IABCBS IL (HCS)BCBS IN (Anthem)BCBS KSBCBS KY (Anthem)BCBS LABCBS MABCBS MD (CareFirst)BCBS ME (Anthem)BCBS MIBCBS MNBCBS MO (Anthem)BCBS MSBCBS MTBCBS National Capital (CareFirst)BCBS NCBCBS ND (Noridian)BCBS NEBCBS NH (Anthem)BCBS NJ (Horizon)BCBS NM (HCS)BCBS NV (Anthem)BCBS NY - Central NY (Excellus)BCBS NY - Empire (WellPoint)BCBS NY - Rochester Area (Excellus)BCBS NY - Utica Watertown (Excellus)BCBS OH (Anthem)BCBS OK (HCS)BCBS OR (Regence)BCBS SCBCBS SD (Wellmark)BCBS TNBCBS TX (HCS)BCBS UT (Regence)BCBS VA (Anthem)BCBS VTBCBS WI (Anthem)BCBS WV (Highmark)BCBS WYBeech StreetBehavioral Health SystemsBencomp National CorporationBenefit Administrative SystemsBenefit Management Services, Inc. (BCBS LA)Benefit Management Systems, IncBenefit Plan Administrators Co. (Eau Claire, WI)Benefit Plan Administrators, Inc. (Roanoke, VA)Benefit Plan Management, Inc.Benefit Planners, Inc.Benefit Source, Inc.Benefit Systems & Services, Inc. (BSSI)BenesightBERKSHIRE HEALTH PLANBluegrass Family HealthBoilermakers National Health & Welfare FundBoon-Chapman Benefit Administrators, Inc.BPA/Benefit Plan Administrators (North Dakota)BPS Inc.Bravo HealthBridgestone Claims ServicesBrockerage Concepts, Inc.BrodartBrown & Toland Medical GroupBS CABS ID (Regence)BS NY - Northeastern (HealthNow)BS NY - Western NY (HealthNow)BS PA - HighmarkBS WA (Regence)Butler BenefitCannon Cochran Management Services, Inc.Capital District Physicians Health PlanCapitol AdministratorsCare Improvement PlusCarelink Health PlanCarelink MedicaidCAREPLUSCariten HealthcareCarolina Care PlanCarolina Summit Healthcare, Inc.Carpenters Health and Welfare Trust Fund of St. LouisCatholic Healthcare WestCBCA AdministratorsCBSACCNCDO TechnologiesCedars-Sinai Medical Network ServicesCentral Benefits LifeCentral Reserve LifeCentral States Health & Welfare FundsCentury Health SolutionsCHA HealthCHAMPUS FOUNDATION HLCHAMPVA - HACChesapeake Life Insurance Company - Insurance CenterChildhealth Plus by Healthfirst (CHP)Christian Brothers ServicesCIGNACofinityCOLONIAL HEALTHCARECOLUMBIA MEDICARECommerce Benefits GroupCommonWealth Administrative GroupCommunity Care Managed Health Care Plans of OklahomaCommunity Health Electronic Claims/CHEC/webTPACommunity Health PlanComprehensive Benefits Administrator, Inc.ConnectiCare, IncConnecticut Carpenters Health FundConsociate GroupContinental General Insurance CompanyConversion Plan-APWUCooperative Benefit Administrators (CBA)Core Administrative ServicesCoreSourceCornerstone Benefit AdministratorsCorporate Benefits Service, Inc. (NC)Corporate Systems AdministrationCountry Life Insurance CompanyCovenant Administrators, Inc. (Atlanta, GA)Coventry Health & LifeCreative Medical SystemsCustom Benefit AdministratorsD.H. EVANS & ASSOC.Dart Management CorporationDefinity HealthDelta Health SystemsDeseret MutualDesert Family Practice AssociationDestiny HealthDirectors Guild of America - Producer Health PlanDiversified Administration CorporationDunn and Associates Benefits Administrators, Inc.EBC INCEBMS (Employee Benefit Management Services, Inc.)EDSEducators Mutual (EMIA)Emerald Health Network, Inc. (All PPO Business)Employee Benefit CorporationEmployee Benefit Management Corp (EBMC) aka Big Lots Assoc Benefit PlanEmployee Benefit Services (Ft. Mill, SC)Employee Benefit Services of Louisiana, Inc (EBS)Employee Plans, LLCEmployer Plan ServicesEmployers Direct HealthEmployers Insurance of WausauEmployers Mutual, Inc. (Stuart, Florida)Encircle PPOEncompassEquitable Plan Services (Oklahoma City, OK)Erin Group AdministratorsES Beveridge and AssociatesE-V Benefits Management, Inc (Columbus, OH)Evolutions Healthcare Systems (New Port Richey, FL)ExclusiCareFallon Community Health PlanFARA Benefit Services, Inc.FCE Benefit AdministratorsFederated Mutual InsuranceFirst Carolina CareFirst Choice HealthPlans of ConnecticutFirst Choice of Midwest (PPO)First Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma)First Health Services Corp.First Service Administrators, IncFirstCareFirstGuard Health Plan - KansasFiserv HealthFlorida Hospital Healthcare SystemsFMH Benefit Services, Inc.Formax, Inc.FOUNDATION BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMINFox-Everett, Inc.Fringe Benefit ManagementFringe Benefits CoordinatorsFrontPath Health CoalitionGEGA Group AdministratorsGeisinger Health PlanGENWORTH ADMINISTRATORS, INC., TEXASGHI - New York (Group Health Inc.)Gilsbar, Inc.Global Care Inc.GMS, Inc.Golden State Physicians Medical GroupGovernment Employees Hospital Association (GEHA)Great Lakes Health PlanGreat-West HealthcareGroup Administrators Ltd.Group and Pension AdministratorsGroup Health Co-opGroup Insurance Service Center, Inc.Guardian Life Insurance Company of AmericaH.E.R.E.I.U Welfare Pension FundsHAP/AHL/CuranetHarrington Benefit Services, Inc.Harvard Pilgrim Health CareHCH Administration (Illinois)HCHA Albq-Self FundedHDM Benefit SolutionsHealth Alliance Medical PlansHealth America Inc./Health Assurance/AdvantraHEALTH CARE SAVINGSHealth Cost SolutionsHealth Design Plus (Hudson, OH)Health NetHealth Network AmericaHEALTH NEW ENGLANDHealth Partners - Jackson, TNHealth Partners, PAHealth Plans Inc.HEALTHCARE COMPAREHEALTHCARE RESOURCESHealthcare Solutions GroupHealthcomp Inc.Healthfirst TPA (Tyler, TX)Healthlink HMOHealthlink PPOHealthNow - BCBS Northeastern NYHealthNow - Blue Cross Blue Shield of Western NYHealthPartners MNHealthPlan Services (Tampa only)HealthPlus of MichiganHealthSCOPE Benefits, Inc.HealthSmart Preferred Care, Inc.HealthStar, Inc.Heritage ConsultantsHFN, Inc.High Desert Primary CareHighmark Blue Cross & Blue Shield of PennsylvaniaHighmark Blue Cross Blue ShieldHIP - Health Insurance Plan of Greater New YorkHMA HawaiiHorizon NJ HealthHPS Paradigm, Inc.HumanaHumboldt-Del Norte Foundation for Medical CareHunt Insurance GroupIAAIMS Management ServicesINDECS CorporationIndependence Medical GroupIndependent HealthIndiana Health NetworkIndiana ProHealth NetworkIndiana Teamsters Health Benefits Fund (Indianapolis, IN)Informed, LLCINNOVATIVE HEALTHCARE SOLUTIONS, INC.Insurance Design AdministratorsInsurance Services of LubbockInsurers Administrative Corp.Integra GroupIntegra Group-CHAInterCare Health Plans Inc.Intergroup Services CorporationInternational Medical GroupInternational Medical Group (IMG)International Union of Operating Engineers Local 15, 15A, 15C & 15DJ. Smith Lanier & Co. AdministratorsJohn Alden Life Insurance Co.JOHN MORRELL COMPANY CO. - AHPBAJoplin ClaimsJP Farley CorporationKaiser Foundation Health PlanKanawha HealthCare Solutions, Inc.Kempton CompanyKern Health SystemsKey Benefit Administrators (Indianapolis, IN)Klais & CompanyKPS-Kitsap Physician ServicesLakeside Health ServicesLife Investors InsuranceLifeWise Healthplan of OregonLovelace Sandia Health PlanLumenos, Inc.Magellan Health ServicesMagnacareMail Handlers Benefit PlanManaged Care Services, LLCManaged Health NetworkManaged Physical NetworkMANATEE SERVICE CTRMARYLAND HEALTH PLANMaryland Physicians CareMasters, Mates and Pilots ProgramMBSMDNY HealthcareMedAdmin SolutionsMedBen (Newark, OH)MedComMedCost, Inc.MedicaMedical Benefit Administrators, Inc/dba MBA of MD, IncMedical Claims Service, Inc.Medical Mutual of OhioMedical Resource Network (MRN)Medicare of Texas (VA Only)MediversalMedSolutions, IncMega Life & Health Insurance Company - Insurance CenterMemphis Managed CareMercy Health PlansMeritain Health/North American AdministratorsMetcare Health Plans, Inc.MID ATLANTIC HEALTHMid Atlantic Psychiatric Services, Inc. (MAPSI)Midlands Choice, Inc.MidSouth Administrative GroupMid-West National Life Insurance Co. of TennesseeMidwest SecurityMississippi Public Entity Employee Benefit TrustMississippi Select Health CareMMSIMontefiore Contract Management OrganizationMonumental Life Insurance CompanyMultiplan Inc. for American FamilyMultiplan Wisconsin Preferred Provider NetworkMutual Assurance AdministratorsMVP Health Plan of NYNAA (North America Administrators, L.P.) (Nashville, TN)NALC/AffordableNational Benefit Administrators - New JerseyNational Benefit Administrators - North CarolinaNational Health Insurance CompanyNational Telecommunications Cooperative Association (NTCA)Nationwide Health PlansNCASNeighborhood Health Partnership of FloridaNeighborhood Health Plan (Boston, MA)NETWERKESNetwork HealthNew Era Life Insurance CompanyNGS American, IncNippon Life Insurance Company of AmericaNJ Carpenters Health FundNorth Broward Hospital DistrictNorth Texas Healthcare NetworkNorthern California Sheet Metal Workers Health Care PlanNorthern Nevada Trust FundNova Healthcare Administrators, Inc. (Grand Island, NY)Novasys Health NetworkNyhartOchsner Health PlanODS Health PlanOffice of Group Benefits- LouisianaOhio Health Choice, PPOOptima Health PlanOSF Health PlansOxford Health PlansP5 Health Plan Solutions of UtahPacific Life & Annuity CompanyPacifiCarePacificSource Health PlansPAIPARAGON BENEFITS, INCParamount HealthPCA HEALTH PLANSPEHP - UTAH PUBLIC EMPLOYEE HEALTH PLANPeoples Health NetworkPersonalCarePHP - Physicians Health Plan of Northern Indiana (Fort Wayne, IN)PHYSICIANS CARE NETWORKPhysicians Mutual Insurance CompanyPhysicians Plus Insurance CorporationPinnacle Claims Management, Inc.PIPELINE INDUSTRY BENEFIT FUNDPittman & AssociatesPoly America Medical & Dental Benefits PlanPOMCOPPOPlus LLCPrairie States Enterprises, Inc.Preferred Benefits AdministratorPreferred CarePreferred Care Partners (Miami, Florida)Preferred Community Choice/PCCSelect/CompMedPREFERRED HEALTH CAREPreferred Health Plan (Louisville, KY)Preferred Health ProfessionalsPreferred Health Systems Insurance CompanyPreferred Network Access, Inc.PreferredOne (MN)PREFFERED BENEFIT ADMINISTRATORSPrimary Health NetworkPrimary PhysicianCare, Inc.Priority HealthProfessional Benefit Administrators (Winter Park, FL)Professional Benefit Administrators, Inc. (Oak Brook, IL)Professional Claim AdministratorsProfessional Insurance Company (PIC) (Formerly GE Voluntary Benefits PIC)Professional Risk ManagementPRONETQual Choice of ArkansasQualCare, Inc.Quincy Health Care Management, Inc.RBMS, LLCRegency Employee BenefitsRegional Care, Inc.ResourceOne AdministratorsRMSCO, INC.Rocky Mountain Health Care Corp.S & S Healthcare StrategiesSagamore Health NetworkSAMBASecure Health Plans of Georgia, LLCSecurity Health PlanSelect Benefit Administrators (Des Moines, Iowa)Select Benefit Administrators of AmericaSelectCareSelf Insured Benefit Administrators (Clearwater, FL)Self-Funded Plans, Inc.Sentry Insurance a Mutual CompanyShasta Administrative ServicesSierra Health ServicesSignature Health AllianceSinclair Health PlanSloans Lake Preferred Health NetworksSmith AdministratorsSouth Carolina Department of Health & Human ServicesSOUTH CENTRAL PREFERRSouth Point Hotel & CasinoSouthCare/Healthcare PreferredSouthern Benefit ServicesSouthern Group AdministratorsSouthern Health Services, Inc.Southwest Administrators CaliforniaSpectrum Administrators Inc. - TPA Allentown, PA (IHS Gateway Payer)St. Barnabas System Health PlanSt. Johns Claims AdministrationStar HRGStarmarkState Farm Insurance CompaniesState of Texas Dental PlanStaywell Health PlanSterling Option 1Stoner and Associates (Cincinnati, OH)SummaCare Health PlanSummit America Insurance Services, Inc.Sun Life and Health Insurance Company (U.S.) (formerly GLHIC)Superior Administrators, Inc (Santa Ana, CA)SYNAPTEKTall Trees AdministratorsTBG Administrative ServicesTeachers Health TrustTeamsters Local Union #301TEXAS MEDICAREThe EPOCH GroupThe Health Plan (Massillon, Ohio and St. Clairsville, Ohio only)The Integrity Benefit Group, Inc.The Loomis Company - TPA Wyomissing, PA (IHS Gateway Payer)The Union Labor Life Insurance CompanyThree Rivers Health Plans, IncTML Intergovernmental Employee Benefit PoolTongass Timber TrustTower Life Insurance Co.TR Paul Inc.TrailBlazer Health EnterprisesTransAmerica Life Insurance CompanyTransChoice-Key Benefit AdministratorsTricare for LifeTricare NorthTricare SouthTricare WestTRIPLE STriSurant (formerly Health Administration Services-HAS)True Choice USATRUE CHOICE USATrusteed Plans Service CorporationTUFTS ASSOC HEALTHUBH-RIOSUFCWUHINUMWA Health & Retirement FundsUnicareUnified Group ServicesUniform Medical Plan/Harrington Benefit ServicesUNION PACIFIC RAILROAD EMPLOYES Health SystemsUnion Security Insurance CompanyUnited Agriculture Benefit TrustUNITED AMERICAN INSURANCE CO.United Healthcare of River ValleyUnited Medical ResourcesUnitedHealthcareUnivera - Health Care Plan/ChoiceCare BuffaloUnivera Healthcare WNYUniversal Health Care, IncUPMC Health PlanUS BenefitsUS Department of LaborUS Family Health Plan (USFHP)USAA (United States Automobile Association)USFHP - St. Vincent Catholic Medical Centers of New YorkVantage Health Plan, Inc.Vista Health PlanVytra HealthcareWashington Employers TrustWaterstone Benefit AdministratorsWatkins Associated Industries, Inc.WEA INS GROUPWellcareWellmarkWellPathWellPointWells Fargo Third Party Administrators, Inc. (Acordia)Western Health IncWestern Mutual InsuranceWestern Southern Financial Group (Cincinnati, OH)Weyco Inc.William C. EarhartWisconsin Auto and Truck DealersWisconsin Physicians Service Insurance CorporationWorld Insurance CompanyWriters Guild - Industry Health PlanYoung LifeAttachment E837 Primary Claims Tier 2 Payers Desired Payers(Note: List is subject to change as payers are added or removed)Health Care Clearing House (HCCH) Revenue Transactions ProcessingPayer NameAultcareBC PA - Northeastern (NEPA)BCBS PRBCBS RICONSECOIndependent Health FlexMercy Health PlansMichigan Regional Co CarpentersOlympic HealthReserve NationalValue Options, Inc.Attachment F837 COB Claims Tier 1 Payers(Note: List is subject to change as payers are added or removed)Health Care Clearing House (HCCH) Revenue Transactions ProcessingPayer NameAARPAdvantra FreedomAETNABC AK (Premera)BC IDBC WA (Premera)BCBS ALBCBS ARBCBS AZBCBS CO (Anthem)BCBS CT (Anthem)BCBS FLBCBS GA (WellPoint)BCBS IA (Wellmark)BCBS IL (HCS)BCBS IN (Anthem)BCBS KSBCBS KY (Anthem)BCBS MABCBS ME (Anthem)BCBS MIBCBS MO (Anthem)BCBS MSBCBS MTBCBS NCBCBS ND (aka Noridian)BCBS NEBCBS NH (Anthem)BCBS NJ (aka Horizon)BCBS NM (HCS)BCBS NV (Anthem)BCBS NY - Northeastern (HealthNow)BCBS NY - Western (HealthNow)BCBS OH (Anthem)BCBS OR (Regence)BCBS SCBCBS SD (Wellmark)BCBS TNBCBS TX (HCS)BCBS UT (Regence)BCBS VA (Anthem)BCBS WI (Anthem)BCBS WV (Highmark)BCBS WYBlue Grass Family Health PlanBS CABS ID (Regence)BS PA (Highmark)BS WA (Regence)Carelink-CommercialCariten Health CareCHCCIGNACoreSourceCoventry Health CareFirst HealthGHIGroup Health Plan (GHP/Advantra)Health America/Health Assurance/AdvantraMailhandlersMEDICAMUTUAL OF OMAHANALCPersonal CarePhysicians MutualPreferred Benefit AdministratorsPreferred HealthSouthern Health ServicesState FarmUNITED AMERICANUNITED HEALTH CAREWellPathAttachment G837 COB Claims Tier 2 Payers Desired Payers(Note: List is subject to change as payers are added or removed)Health Care Clearing House (HCCH) Revenue Transactions ProcessingPayer Name1199 National Benefit Fund3P ADMINA & I Benefit Plan AdministratorsA.G.I.A. Inc.AAG-American Administrative Group (Formerly Gallagher Benefit Admin)Access AdministratorsAcclaimAcordia/Wells FargoACS Benefit Services, Inc.Administrative Concepts, Inc.Administrative Services, Inc.AdvoCare Incorporated (aka ALPS CompCare or AultComp Managed Care Organization)Affinity Health PlanAFTRA Health FundAlaska Electrical Health & Welfare FundAlicare (aka Amalgamated Life)Allegiance Benefit Plan Management, Inc.Alliant Health Plans of GeorgiaAllied AdministratorsAllied Benefit SystemsAltiusAMA Insurance AgencyAmeraPlanAmeriBen Solutions, Inc.American Benefit Administrative Services, Inc.American Benefits ManagementAmerican Community Mutual InsuranceAmerican Family InsuranceAmerican GeneralAmerican Healthcare AllianceAmerican LIFECAREAmerican Medical Security, Inc.American National Ins. Co. (ANICO)American Pioneer South FloridaAmerican Postal Workers Union Health Plan (APWU)American Republic InsuranceAmerican Worker Health PlanAmeriChoice of New Jersey Personal Care Plus (Medicare)Amerigroup CorporationAmeriHealthAnchor Benefit Consulting, Inc.Ancillary Benefit Systems/ Arizona Foundation for Medical CareAntares Management SolutionsAPA Partners, Inc.Apex Benefit ServicesAPS Healthcare, Inc.ARAZ GroupArcadian Management Services, IncArkansas Best Corporation - Choice BenefitsAssociates for Health Care, Inc. (AHC)Assurant Health (aka Time Insurance Co)Assured Benefits AdministratorsAthens Area Health Plan SelectAtlanticare (aka Horizon HealthCare Admin (HHA))Atlantis Health PlanAtlas AdministratorsAutomated Benefit ServicesAutomated Group Administration, Inc.Avera Health PlansAvMed, Inc.Banner HealthBC CABC PA - CapitalBC PA - IndependenceBC PA - Northeastern (NEPA)BCBS Central NY, Rochester, Utica-Watertown, Universal Healthcare - ExcellusBCBS CT (Anthem)BCBS DEBCBS HI - Hawaii Medical Service Association (HMSA)BCBS IA (Wellmark)BCBS LABCBS MD (Care First)BCBS MNBCBS MO (Anthem)BCBS National Capital Area (Care First)BCBS NH (Anthem)BCBS NJ (Horizon)BCBS NY - Empire (WellPoint)BCBS OKBCBS OR (Regence)BCBS PRBCBS RIBCBS VA (Anthem)BCBS VTBCBS Western NY - Health NowBCBS WI (Anthem)Bencomp National CorporationBenefit Administrative SystemsBenefit Management ServiceBenefit Management Systems, IncBenefit Plan Administrators, Inc.Benefit Plan Management, Inc.Benefit Planners, Inc.Benefit Source, Inc.Benefit Systems & Services, Inc. (BSSI)BenesightBenesysBerkshire Health PartnersBluegrass Family HealthBoilermakers National Health & Welfare FundBoon-Chapman Benefit Administrators, Inc.BPA/Benefit Plan Administrators (North Dakota)Bravo Health (formerly known as ELDER HEALTH)Bridgestone Claims ServicesBrockerage Concepts, Inc.Brown & Toland Medical GroupBS NY (Northeastern) - Health NowBS PA HighmarkButler BenefitCannon Cochran Management Services, Inc.Capital District Physicians Health Plan (CDPHP)Capitol AdministratorsCarePlus Health Plans, Inc.Cariten HealthcareCarolina Care PlanCarolina Summit Healthcare, Inc.Carpenters Health and Welfare Trust Fund of St. LouisCatholic Healthcare WestCBCA Administrators (HRM)CCN Managed Care Inc. (aka First Health Network)CDO TechnologiesCedars-Sinai Medical Network ServicesCentral Benefits Life (aka Central Benefits Mutual)Central Reserve Life Insurance Co.Central States Health & Welfare Funds (aka Teamcare)Century Health SolutionsCHA HealthCHAMPVA - HACClaims Management ServicesCOLONIAL HEALTHCAREColumbia United ProvidersCommerce Benefits GroupCommonWealth Administrative GroupCommunity Care Managed Health Care Plans of OklahomaCommunity Health PlanComprehensive Benefits Administrator, Inc. (aka Employee Benefits Plan Administration, Inc. (E.B.P.A.))ConnectiCare, IncCONSECOConsociate GroupContinental General Insurance CompanyConversion Plan-APWUCooperative Benefit Administrators (CBA)Core Administrative ServicesCornerstone Benefit AdministratorsCorporate Benefit Services of America (aka Performax)Corporate Benefits Service, Inc.Country Life Insurance CompanyCovenant Administrators, Inc.Creative Medical SystemsCustom Benefit AdministratorsD.H. EVANS & ASSOC.Dart Management CorporationDefinity HealthDelta Health SystemsDeseret MutualDesert Family Practice Association (aka Desert Hospital)Destiny HealthDiversified Administration CorporationDME Region A (DMERC A) - NHICDunn and Associates Benefits Administrators, Inc.EBC, Inc. (aka EBC Mid-America)EBMS (Employee Benefit Management Services, Inc.)EDSEducators Mutual (EMIA)Emerald Health Network, Inc.Employee Benefit CorporationEmployee Benefit Management Corp (EBMC) aka Big Lots Assoc Benefit PlanEmployee Benefit ServicesEmployee Plans, LLCEmployer Plan ServicesEmployers Direct HealthEmployers Mutual, Inc.EncompassEncore Health NetworkEquitable Plan ServicesErin Group AdministratorsES Beveridge and AssociatesPayer NameEvolutions Healthcare SystemsFallon Community Health PlanFARA Benefit Services, Inc.FCE Benefit AdministratorsFederated Mutual InsuranceFirst Carolina CareFirst Choice of Midwest (PPO)First Health Services Corp.First Service Administrators, IncFirstCareFirstGuard Health PlanFiserv Health - Wausau Benefits/BenesightFlorida Hospital Healthcare SystemsFMH Benefit Services, Inc.Formax, Inc.Foundation Benefit Administrators/Contractor Employee Benefits AdminFox-Everett, Inc.Fringe Benefit ManagementFringe Benefits CoordinatorsFrontPath Health CoalitionGEGA Group AdministratorsGeisinger Health PlanGenworth Life and Health Insurance Company (GLHIC) (Formerly GEGLAC)GHI - New York (Group Health Inc.)Gilsbar, Inc.Global Care Inc.GMS, Inc.Golden Rule Insurance CompanyGovernment Employees Hospital Association (GEHA)Great Lakes Health PlanGreat-West HealthcareGroup Administrators Ltd.Group and Pension AdministratorsGroup Health CooperativeGuardian Life Insurance Company of AmericaHAP/AHL/CuranetHarrington Benefit Services, Inc.Harvard Pilgrim Health CareHCH AdministrationHCHA Albq-Self FundedHDM Benefit SolutionsHealth & Welfare Trust (Cement Masons & Plasterers/Alaska United Food & Commercial Workers)Health Alliance Medical PlansHealth Care Savings, Inc.Health Cost SolutionsPayer NameHealth Design PlusHealth NetHealth Network AmericaHEALTH NEW ENGLANDHealth PartnersHealthcare PartnersHealthcare ResourcesHealthcare Solutions GroupHealthcomp Inc.Healthfirst Family Health Plus (FHP)Healthfirst TPAHealthlinkHealthPlan Services (Tampa only)HealthPlus of MichiganHealthSCOPE Benefits, Inc.HealthSmart Preferred Care, Inc.HealthStar, Inc.Heritage ConsultantsHFN, Inc.High Desert Primary CareHIP - Health Insurance Plan of Greater New YorkHMA HawaiiHPS Paradigm, Inc.HumanaHumboldt-Del Norte Foundation for Medical CareIMS Management ServicesINDECS CorporationIndependent HealthIndiana Health NetworkIndiana ProHealth NetworkInformed, LLCInsurance Administrators of America, Inc.Insurance Design AdministratorsInsurance Services of LubbockInsurers Administrative Corp.Integra GroupIntegrity Benefit Group, Inc.InterCare Health Plans Inc.Intergroup Services CorporationInternational Medical Group (IMG)International Union of Operating Engineers Local 15, 15A, 15C & 15DJ. Smith Lanier & Co. AdministratorsJohn Alden Life Insurance Co.Joplin ClaimsJP Farley CorporationKaiser Health Plan IncPayer NameKanawha HealthCare Solutions, IncKempton CompanyKern Health SystemsKey Benefit AdministratorsKeystone Health Plan EastKlais & CompanyLakeside Health ServicesLife Investors InsuranceLifeWise Healthplan of OregonLocal 135 Health Benefits FundLumenos, Inc.Magellan Health ServicesMagnacareMAMSI Life and Health Insurance Co. (MLH) (aka Mid Atlantic Psychiatric Services, Inc. (MAPSI) or Optimum Choice, Inc. (OCI) or OneNet PPO, LLC)Managed Care Services, LLCManaged Care Systems (Delano Regional Medical Group)Managed Health NetworkManaged Physical NetworkManatee Service CenterMaryland Health Insurance PlanMaryland Physicians CareMcareMDNY HealthcareMedAdmin SolutionsMedComMedcost Benefit Services (MBS)MedCost, Inc.Medical Benefit Administrators, Inc/dba MBA of MD, IncMedical Benefits Mutual Life Insurance Co.Medical Claims Service, Inc.Medical Mutual of OhioMedical Resource Network (MRN)Medicare of Texas (VA Only)MediversalMedSolutions, IncMega Life & Health Insurance Company - Insurance CenterMemphis Managed CareMercy Health PlansMeritain Health / Agency ServicesMetcare Health Plans, Inc.Midlands Choice, Inc.Mid-West National Life Insurance Co.Midwest SecurityMississippi Public Entity Employee Benefit Trust (MPEEBT)Mississippi Select Health Care/Select Administrative Services (SAS)Payer NameMMOMMSIMontefiore Contract Management OrganizationMonumental Life Insurance CompanyMultiplan Inc. for American FamilyMultiplan Wisconsin Preferred Provider NetworkMutual Assurance AdministratorsMVP Health Plan of NYNational Benefit AdministratorsNational Health Insurance CompanyNational Telecommunications Cooperative Association (NTCA)Nationwide Health PlansNCASNeighborhood Health Partnership of FloridaNETWERKESNetwork Health Plan of Wisconsin, Inc.New Era Life Insurance CompanyNGS American (Trust Mark)Nippon Life Insurance Company of AmericaNJ Carpenters Health FundNorth American Administrators, Inc. (NAA)North American Benefits NetworkNorth Broward Hospital DistrictNorth Texas Healthcare NetworkNorthern Nevada Trust FundNova Healthcare Administrators, Inc.Novasys Health Network (aka Community Care Plus)NyhartOchsner Health PlanOffice of Group Benefits - LAOhio Health Choice, PPOOlympic HealthOregon Dental Services (ODS) Health PlanOSF Health PlansOxford Health PlansP5 Health Plan Solutions of UtahPacific Life & Annuity Company (aka PM Group)PacifiCarePacificSource Health PlansParagon Benefits, Inc.PCA HEALTH PLANSPEHP (Utah Public Employee Health Plan)Peoples Health NetworkPHP - Physicians Health Plan of Northern IndianaPhysicians Care NetworkPhysicians Plus Insurance CorporationPayer NamePIPELINE INDUSTRY BENEFIT FUNDPittman & AssociatesPlanned Administrators, Inc.Poly America Medical & Dental Benefits PlanPOMCOPPOM, LLC (aka Cofinity)PPOPlus LLCPrairie States Enterprises, Inc.Preferred Benefits AdministratorPreferred Care PartnersPreferred CarePreferred Community Choice/PCCSelect/CompMedPreferred Health CarePreferred Health PlanPreferred Health ProfessionalsPreferred Health SystemsPreferredOne (MN)Premier Benefits, Inc.Primary Health NetworkPrimary PhysicianCare, Inc.Principal Life Insurance Co.Priority HealthProfessional Benefit Administrators, Inc.Professional Claims ManagementProfessional Insurance Company (PIC) (Formerly GE Voluntary Benefits PIC)Professional Risk ManagementProvidence Health PlansQualCare, Inc.Quincy Health Care Management, Inc.RBMS, LLCRegency Employee BenefitsRegional Care, Inc.Reserve NationalResourceOne AdministratorsRMSCO, INCRocky Mountain Health PlanS & S Healthcare StrategiesSagamore Health NetworkSeabury & SmithSecurity Health PlanSelect Benefit Administrators of AmericaSelect CareSelf Insured Benefit AdministratorsSelf Insured PlansSelf-Funded Plans, Inc.Sentara Health ManagementPayer NameSentry Insurance a Mutual CompanyShasta Administrative ServicesSheet Metal Workers Health Care Plan (Benesys)Sierra Health ServicesSignature Health AllianceSinclair Health PlanSloans Lake Preferred Health NetworksSmith AdministratorsSouth Carolina Department of Health & Human ServicesSouth Central PreferredSouth Point Hotel & CasinoSouthCare/Healthcare PreferredSouthern Benefit ServicesSouthern Group AdministratorsSouthwest AdministratorsSpecial Agents Mutual Benefit Association (SAMBA)Spectrum Administrators Inc.St. Barnabas System Health PlanSt. Johns Claims AdministrationStar HRGState of Texas Dental PlanStaywell Health Plan (aka Wellcare)Sterling Option 1Stoner and AssociatesStudent InsuranceSummaCare Health PlanSummit America Insurance Services, Inc.Tall Trees AdministratorsTBG Administrative ServicesTeachers Health TrustTeamsters Local Union #301The EPOCH GroupThe Health Plan (Massillon, Ohio and St. Clairsville, Ohio only)The Loomis Company - TPAThe Union Labor Life Insurance CompanyTHIN-GREENTREE ADMINThree Rivers Health Plans, IncTML Intergovernmental Employee Benefit PoolTodays Options (American Progressive Life & Health Ins Co and Pyramid Life Insurance Co)Tongass Timber TrustTower Life Insurance Co.TrailBlazer Health Enterprises (THE)TransAmerica Life Insurance CompanyTricare (Palmetto Govt Benefits Admin)Tricare for LifeTriSurant (formerly Health Administration Services-HAS)Payer NameTrue Choice USATrusteed Plans Service CorporationTrustmark Insurance CompanyTufts Health PlanUBH - United Behavioral Health (former MetraHealth - UNET)UFCWUMWA Health & Retirement FundsUnicareUnified Group ServicesUniform Medical Plan/Harrington Benefit ServicesUNION PACIFIC RAILROAD EMPLOYES Health SystemsUnion Security Insurance CompanyUnited Agriculture Benefit TrustUnited Healthcare of River Valley (formerly John Deere Health Care Inc.)United Medical ResourcesUniveraUniversal Health Care, IncUPMC Health PlanUS BenefitsUS Department of LaborUS Family Health Plan (USFHP)USAA (United States Automobile Association)USFHP - St. Vincent Catholic Medical Centers of New YorkVantage Health Plan, Inc.Vista Health PlanVytra HealthcareWashington Employers TrustWaterstone Benefit AdministratorsWatkins Associated Industries, Inc.WEA INS GROUPwebTPA/Community Health Electronic Claims/CHECWellcareWellmarkWestern Growers Insurance CompanyWestern Health IncWestern Mutual InsuranceWestern Southern Financial GroupWeyco Inc.Wisconsin Physicians Service Insurance CorporationWorld Insurance CompanyWriters Guild - Industry Health PlanAttachment H 835 Tier 1 PayersCurrent Live Payers(Note: List is subject to change as payers are added or removed)Health Care Clearing House (HCCH) Revenue Transactions ProcessingPayer NameAARPAcordia NationalAegon USAAETNAAmerican Republic Insurance Co (ARIC)AmeriHealthAsuris Northwest HealthAtrium Health PlanAvera Health PlansAvMed, Inc.Bankers Life and CasualtyBC AK (Premera)BC CA (Anthem)BC IDBC PA - CapitalBC PA - IndependenceBC PA - NortheastBC WA (Premera)BCBS ALBCBS ARBCBS AZBCBS CO (Anthem)BCBS CT (Anthem)BCBS DEBCBS FLBCBS GA (WellPoint)BCBS HI (aka HMSA)BCBS IA (Wellmark)BCBS IL (HCS)BCBS IN (Anthem)BCBS KS - Kansas CityBCBS KY (Anthem)BCBS LABCBS MABCBS MD (CareFirst)BCBS ME (Anthem)BCBS MIBCBS MNBCBS MO (Anthem)BCBS MSBCBS MTBCBS National Capital (CareFirst)BCBS NCBCBS ND (aka Noridian)BCBS NEBCBS NH (Anthem)BCBS NJ (aka Horizon)BCBS NM (HCS)BCBS NV (Anthem)BCBS NY - EmpireBCBS NY - Western (HealthNow)BCBS OH (Anthem)BCBS OK (HCS)BCBS OR (Regence)BCBS RIBCBS SCBCBS SD (Wellmark)BCBS TNBCBS TX (HCS)BCBS UT (Regence)BCBS VA (Anthem)BCBS WI (Anthem)BCBS WV (Highmark)BCBS WYBoilermakers National H&W FundBPB USA INCBrown & Toland Medical GroupBS CABS ID (Regence)BS PA - HighmarkBS WA (Regence)Cariten HealthcareCBA Inc.CHA HealthCIGNACMC Steel GroupColonial Penn Life Insurance GroupCombined Insurance Co of AmericaConnectiCare inc.CONSECOCoreSourceCoventry Health CareDarigold IncDiamondjacks CasinoExclusiCareFederated Mutual Insurance CoFirst HealthFMH Benefit Services IncGovernment Employees Hospital Association (GEHA)Geisinger Health PlansGeorgia Dept of Community HealthGreat West LifeGroup HealthHarvard Pilgrim HealthcareHealth AllianceHealth Insurance Co AlabamaHealth Management AssociatesHealth NetHealth PartnersHealthScope BenefitsHealthy Alliance Insurance CoHIP of Greater New YorkHMO Missouri IncHMO of LouisianaHumanaIBA Health and Life Insurance CoING Life Insurance and Annuity CoJefferson National Life Insurance CoJohn Alden Insurance CoKaiser PermanenteKanawha Insurance CoKnights of ColumbusLifewiseLincoln Heritage LifeMail HandlersMaine Partners Health PlanMatthew Thorton Health Plan of NHMedica Health PlanMedical Mutual of OhioMega Life and HealthMercy Health PlansMESSAMid Atlantic Medical Service Inc.MN Indemnity (MII) Life Inc.Morris AssocaitesMutual of OmahaNational Association of Letter CarriersNationwide Health PlansNew York LifeNewpark Resources Inc.NGS American Inc.Nippon Life Insurance Co of AmericaOxford Health Plans LLCPacifiCarePacificSource Health PlansPHP Management Systems IncPhysicians Mutual Insurance CoPhysicians Health PlanPOMCOPreferredOne Administrative ServicesPremier BluePrincipal Life Insurance CoPriority HealthRenal Care GroupReserve NationalRoyal Neighbors of America GMHIPSecure Horizons DirectSensus Metering Systems Inc.State Farm Insurance CompaniesSterling Life Insurance CompanyStonebridge Life Insurance CoTexas Gulf Coast HMO IncThe Everett ClinicTime Insurance CoTricare North/South (Palmetto Government Benefits Administrator)Trustmark LifeTufts Benefit AdministratorsU S ConcreteUnicare (WellPoint)United American InsuranceUnited of OmahaUnited WorldUnitedHealthcareUniversal Fidelity Life Insurance CoUPMC Health PlanUS Behavioral Health PlanValue Options IncVirginia Mason Medical CenterWashington National Insurance CoWausauWellcareWorld National Insurance CoAttachment I 835 Tier 2 Payers Desired PayersHealth Care Clearing House (HCCH) Revenue Transactions ProcessingNote: List is subject to change as payers are added or removedPayer Name1199 National Benefit Fund3P ADMINA & I Benefit Plan AdministratorsA.G.I.A. Inc.AAG-American Administrative Group (Formerly Gallagher Benefit Admin)Access AdministratorsAcclaimACS Benefit Services, Inc.Administrative Concepts, Inc.Administrative Services, Inc.Advantra FreedomAdvoCare Incorporated (aka ALPS CompCare or AultComp Managed Care Organization)Affinity Health PlanAFTRA Health FundAlaska Electrical Health & Welfare FundAlicare (aka Amalgamated Life)Allegiance Benefit Plan Management, Inc.Alliant Health Plans of GeorgiaAllied AdministratorsAllied Benefit SystemsAltiusAMA Insurance AgencyAmeraPlanAmeriBen Solutions, Inc.American Benefit Administrative Services, Inc.American Benefits ManagementAmerican Community Mutual InsuranceAmerican Family InsuranceAmerican GeneralAmerican Healthcare AllianceAmerican International Group, Inc. (AIG) (aka Evercare or Medica)American LIFECAREAmerican Medical Security, Inc.American National Ins. Co. (ANICO)American Pioneer South FloridaAmerican Postal Workers Union Health Plan (APWU)American Worker Health PlanAmeriChoice of New Jersey Personal Care Plus (Medicare)Amerigroup CorporationAmeriHealthAnchor Benefit Consulting, Inc.Ancillary Benefit Systems/ Arizona Foundation for Medical CareAntares Management SolutionsAPA Partners, Inc.Apex Benefit ServicesAPS Healthcare, Inc.ARAZ GroupArcadian Management Services, IncArkansas Best Corporation - Choice BenefitsAssociates for Health Care, Inc. (AHC)Assurant Health (aka Time Insurance Co)Assured Benefits AdministratorsAthens Area Health Plan SelectAtlanticare (aka Horizon HealthCare Admin (HHA))Atlantis Health PlanAtlas AdministratorsAultcareAutomated Benefit ServicesAutomated Group Administration, Inc.Avera Health PlansBanner HealthBC IDBC OKBC PA - Northeastern (NEPA)BC UT (Regence)BCBS Central NY, Rochester, Utica-Watertown, Universal Healthcare - ExcellusBCBS ME (Anthem)BCBS NH (Anthem)BCBS RIBCBS WV - Mountain StateBencomp National CorporationBenefit Administrative SystemsBenefit Management ServiceBenefit Management Systems, IncBenefit Plan Administrators, Inc.Benefit Plan Management, Inc.Benefit Planners, Inc.Benefit Source, Inc.Benefit Systems & Services, Inc. (BSSI)BenesightBenesysBerkshire Health PartnersBluegrass Family HealthBoilermakers National Health & Welfare FundBoon-Chapman Benefit Administrators, Inc.BPA/Benefit Plan Administrators (North Dakota)Bravo Health (formerly known as ELDER HEALTH)Bridgestone Claims ServicesBrockerage Concepts, Inc.Brown & Toland Medical GroupButler BenefitCannon Cochran Management Services, Inc.Capital District Physicians Health PlanCapitol AdministratorsCarelink Health PlanCarePlus Health Plans, Inc.Carolina Care PlanCarolina Summit Healthcare, Inc.Carpenters Health and Welfare Trust Fund of St. LouisCatholic Healthcare WestCBCA Administrators (HRM)CCN Managed Care Inc. (aka First Health Network)CDO TechnologiesCedars-Sinai Medical Network ServicesCentral Benefits Life (aka Central Benefits Mutual)Central Reserve Life Insurance Co.Central States Health & Welfare Funds (aka Teamcare)Century Health SolutionsCHAMPVA - HACClaims Management ServicesCOLONIAL HEALTHCAREColumbia United ProvidersCommerce Benefits GroupCommonWealth Administrative GroupCommunity Care Managed Health Care Plans of OklahomaCommunity Health PlanComprehensive Benefits Administrator, Inc. (aka Employee Benefits Plan Administration, Inc. (E.B.P.A.))ConnectiCare, IncConsociate GroupContinental General Insurance CompanyConversion Plan-APWUCooperative Benefit Administrators (CBA)Core Administrative ServicesCoreSourceCornerstone Benefit AdministratorsCorporate Benefit Services of America (aka Performax)Corporate Benefits Service, Inc.Country Life Insurance CompanyCovenant Administrators, Inc.Creative Medical SystemsCustom Benefit AdministratorsD.H. EVANS & ASSOC.Dart Management CorporationDefinity HealthDelta Health SystemsDeseret MutualDesert Family Practice Association (aka Desert Hospital)Destiny HealthDiversified Administration CorporationDME Region A (DMERC A) - NHICDunn and Associates Benefits Administrators, Inc.EBC, Inc. (aka EBC Mid-America)EBMS (Employee Benefit Management Services, Inc.)EDSEducators Mutual (EMIA)Emerald Health Network, Inc.Employee Benefit CorporationEmployee Benefit Management Corp (EBMC) aka Big Lots Assoc Benefit PlanEmployee Benefit ServicesEmployee Plans, LLCEmployer Plan ServicesEmployers Direct HealthEmployers Mutual, Inc.EncompassEncore Health NetworkEquitable Plan ServicesErin Group AdministratorsES Beveridge and AssociatesEvolutions Healthcare SystemsFallon Community Health PlanFARA Benefit Services, Inc.FCE Benefit AdministratorsFederated Mutual InsuranceFirst Carolina CareFirst Choice of Midwest (PPO)First Health NetworkFirst Health Services Corp.First Service Administrators, IncFirstCareFirstGuard Health PlanFlorida Hospital Healthcare SystemsFMH Benefit Services, Inc.Formax, Inc.Foundation Benefit Administrators/Contractor Employee Benefits AdminFox-Everett, Inc.Fringe Benefit ManagementFringe Benefits CoordinatorsFrontPath Health CoalitionGEGA Group AdministratorsGenworth Life and Health Insurance Company (GLHIC) (Formerly GEGLAC)GHI - New York (Group Health Inc.)GHP (Group Health Plan)Gilsbar, Inc.Global Care Inc.GMS, Inc.Golden Rule Insurance CompanyGreat Lakes Health PlanGroup Administrators Ltd.Group and Pension AdministratorsGroup Health CooperativeGuardian Life Insurance Company of AmericaHAP/AHL/CuranetHarrington Benefit Services, Inc.Harvard PilgrimHarvard Pilgrim Health CareHCH AdministrationHCHA Albq-Self FundedHDM Benefit SolutionsHealth & Welfare Trust (Cement Masons & Plasterers/Alaska United Food & Commercial Workers)Health Alliance Medical PlansHealth America Inc./Health Assurance/AdvantraHealth Care Savings, Inc.Health Cost SolutionsHealth Design PlusHealth Network AmericaHEALTH NEW ENGLANDHealthcare PartnersHealthcare ResourcesHealthcare Solutions GroupHealthcomp Inc.Healthfirst Family Health Plus (FHP)Healthfirst TPAHealthlinkHealthPlan Services (Tampa only)HealthPlus of MichiganHealthSCOPE Benefits, Inc.HealthSmart Preferred Care, Inc.HealthStar, Inc.Heritage ConsultantsHFN, Inc.High Desert Primary CareHIP - Health Insurance Plan of Greater New YorkHMA HawaiiHPS Paradigm, Inc.Humboldt-Del Norte Foundation for Medical CareIMS Management ServicesINDECS CorporationIndependent Health FlexIndependent HealthIndiana Health NetworkIndiana ProHealth NetworkInformed, LLCInsurance Administrators of America, Inc.Insurance Design AdministratorsInsurance Services of LubbockInsurers Administrative Corp.Integra GroupIntegrity Benefit Group, Inc.InterCare Health Plans Inc.Intergroup Services CorporationInternational Medical Group (IMG)International Union of Operating Engineers Local 15, 15A, 15C & 15DJ. Smith Lanier & Co. AdministratorsJohn Alden Life Insurance Co.Joplin ClaimsJP Farley CorporationKaiser Health Plan IncKanawha HealthCare Solutions, IncKempton CompanyKern Health SystemsKey Benefit AdministratorsKeystone Health Plan EastKlais & CompanyLakeside Health ServicesLife Investors InsuranceLifeWise Healthplan of OregonLocal 135 Health Benefits FundLumenos, Inc.Magellan Health ServicesMagnacareManaged Care Services, LLCManaged Care Systems (Delano Regional Medical Group)Managed Health NetworkManaged Physical NetworkManatee Service CenterMaryland Health Insurance PlanMaryland Physicians CareMcareMDNY HealthcareMedAdmin SolutionsMedComMedcost Benefit Services (MBS)MedCost, Inc.Medical Benefit Administrators, Inc/dba MBA of MD, IncMedical Benefits Mutual Life Insurance Co.Medical Claims Service, Inc.Medical Resource Network (MRN)Medicare of Texas (VA Only)MediversalMedSolutions, IncMemphis Managed CareMeritain Health / Agency ServicesMetcare Health Plans, Inc.Michigan Regional Co CarpentersMidlands Choice, Inc.Mid-West National Life Insurance Co.Midwest SecurityMississippi Public Entity Employee Benefit Trust (MPEEBT)Mississippi Select Health Care/Select Administrative Services (SAS)MMSIMontefiore Contract Management OrganizationMonumental Life Insurance CompanyMultiplan Inc. for American FamilyMultiplan Wisconsin Preferred Provider NetworkMutual Assurance AdministratorsMVP Health Plan of NYNational Benefit AdministratorsNational Health Insurance CompanyNational Telecommunications Cooperative Association (NTCA)NCASNeighborhood Health Partnership of FloridaNETWERKESNetwork Health Plan of Wisconsin, Inc.New Era Life Insurance CompanyNGS American, IncNippon Life Insurance Company of AmericaNJ Carpenters Health FundNorth American Administrators, Inc. (NAA)North American Benefits NetworkNorth Broward Hospital DistrictNorth Texas Healthcare NetworkNorthern Nevada Trust FundNova Healthcare Administrators, Inc.Novasys Health Network (aka Community Care Plus)NyhartOchsner Health PlanOffice of Group Benefits - LAOhio Health Choice, PPOOregon Dental Services (ODS) Health PlanOSF Health PlansP5 Health Plan Solutions of UtahPacific Life & Annuity Company (aka PM Group)Paragon Benefits, Inc.PCA HEALTH PLANSPEHP (Utah Public Employee Health Plan)Peoples Health NetworkPersonalCarePHP - Physicians Health Plan of Northern IndianaPhysicians Care NetworkPhysicians Mutual Insurance CompanyPhysicians Plus Insurance CorporationPIPELINE INDUSTRY BENEFIT FUNDPittman & AssociatesPlanned Administrators, Inc.Poly America Medical & Dental Benefits PlanPOMCOPPOM, LLC (aka Cofinity)PPOPlus LLCPrairie States Enterprises, Inc.Preferred Benefits AdministratorPreferred Care PartnersPreferred CarePreferred Community Choice/PCCSelect/CompMedPreferred Health CarePreferred Health PlanPreferred Health ProfessionalsPreferred Health Systems Insurance CompanyPreferredOne (MN)Premier Benefits, Inc.Primary Health NetworkPrimary PhysicianCare, Inc.Professional Benefit Administrators, Inc.Professional Claims ManagementProfessional Insurance Company (PIC) (Formerly GE Voluntary Benefits PIC)Professional Risk ManagementQualCare, Inc.Quincy Health Care Management, Inc.RBMS, LLCRegency Employee BenefitsRegional Care, Inc.ResourceOne AdministratorsRMSCO, INCRocky Mountain Health PlanS & S Healthcare StrategiesSagamore Health NetworkSeabury & SmithSecurity Health PlanSelect Benefit Administrators of AmericaSelect CareSelf Insured Benefit AdministratorsSelf Insured PlansSelf-Funded Plans, Inc.Sentara Health ManagementSentry Insurance a Mutual CompanyShasta Administrative ServicesSheet Metal Workers Health Care Plan (Benesys)Sierra Health ServicesSignature Health AllianceSinclair Health PlanSloans Lake Preferred Health NetworksSmith AdministratorsSouth Carolina Department of Health & Human ServicesSouth Central PreferredSouth Point Hotel & CasinoSouthCare/Healthcare PreferredSouthern Benefit ServicesSouthern Group AdministratorsSouthern Health Services, Inc.Southwest AdministratorsSpecial Agents Mutual Benefit Association (SAMBA)Spectrum Administrators Inc.St. Barnabas System Health PlanSt. Johns Claims AdministrationStar HRGState of Texas Dental PlanStaywell Health Plan (aka Wellcare)Sterling Option 1Stoner and AssociatesStudent InsuranceSummaCare Health PlanSummit America Insurance Services, Inc.Tall Trees AdministratorsTBG Administrative ServicesTeachers Health TrustTeamsters Local Union #301The EPOCH GroupThe Health Plan (Massillon, Ohio and St. Clairsville, Ohio only)The Loomis Company - TPAThe Union Labor Life Insurance CompanyTHIN-GREENTREE ADMINThree Rivers Health Plans, IncTML Intergovernmental Employee Benefit PoolTodays Options (American Progressive Life & Health Ins Co and Pyramid Life Insurance Co)Tongass Timber TrustTower Life Insurance Co.TrailBlazer Health Enterprises (THE)TransAmerica Life Insurance CompanyTricare for LifeTriSurant (formerly Health Administration Services-HAS)True Choice USATrusteed Plans Service CorporationUBH - United Behavioral Health (former MetraHealth - UNET)UFCWUMWA Health & Retirement FundsUnified Group ServicesUniform Medical Plan/Harrington Benefit ServicesUNION PACIFIC RAILROAD EMPLOYES Health SystemsUnion Security Insurance CompanyUnited Agriculture Benefit TrustUnited Healthcare of River Valley (formerly John Deere Health Care Inc.)United Medical ResourcesUniveraUniversal Health Care, IncUS BenefitsUS Department of LaborUS Family Health Plan (USFHP)USAA (United States Automobile Association)USFHP - St. Vincent Catholic Medical Centers of New YorkVantage Health Plan, Inc.Vista Health PlanVytra HealthcareWashington Employers TrustWaterstone Benefit AdministratorsWatkins Associated Industries, Inc.WEA INS GROUPwebTPA/Community Health Electronic Claims/CHECWellmarkWellPathWestern Growers Insurance CompanyWestern Health IncWestern Mutual InsuranceWestern Southern Financial GroupWeyco Inc.Wisconsin Physicians Service Insurance CorporationWorld Insurance CompanyWriters Guild - Industry Health PlanYoung LifeAttachment J 270/271 Tier 1 Payers Current Live PayersHealth Care Clearing House (HCCH) Revenue Transactions ProcessingNote: List is subject to change as payers are added or removedPayer NameADVANTRA (TX, NM, AZ)AETNA SENIOR SUPPLEMENTALAFLAC - DENTALAFTRA HEALTH FUNDALLIED BENEFIT SYSTEMSALTIUS HEALTH PLANSAMERICAN FAMILYAMERICAN NATIONAL INSURANCEAMERICHOICE OF NJ (COMMERCIAL)AMERIGROUP CORPORATIONAMERITAS LIFE INS COASSOC DE MAESTROS PUERTO RICOAVMEDBCBS OF ALABAMABCBS OF ALASKA (PREMERA)BCBS OF ARIZONABCBS OF ARKANSASBCBS OF KANSASBCBS OF KANSAS CITYBCBS OF LOUISIANABCBS OF MASSACHUSETTSBCBS OF MICHIGANBCBS OF MISSISSIPPIBCBS OF NEBRASKABCBS OF NORTH DAKOTABCBS OF OREGON (REGENCE)BCBS OF PENNSYLVANIA (HIGHMARK)BCBS OF RHODE ISLANDBCBS OF SOUTH DAKOTABCBS OF VERMONTBCBS OF WYOMINGBEST LIFE & HEALTHBLUE CROSS OF IDAHOBLUE CROSS OF PENNSYLVANIA (INDEPENDENCE)BLUE CROSS OF WASHINGTON (PREMERA)BLUE SHIELD OF WASHINGTON (REGENCE)BLUEGRASS FAMILY HEALTHC AND O EMP HOSP ASSOCCENTRAL STATES FUNDCHC OF FLORIDACHC OF ILLINOISCHC OF KANSASCIGNACOLORADO ACCESSCOMMUNITY CARE OF OKLAHOMACOOPERATIVE BENEFIT ADMIN (CBA)CORESOURCE (FMH)CORESOURCE (LITTLE ROCK)CORESOURCE (MD PA IL NC IN)CORESOURCE (OH)COVENTRY GROUP HEALTH PLAN (GHP)COVENTRY HEALTH AMERICA/HAPACOVENTRY HEALTH AND LIFE (OKLAHOMA)COVENTRY HEALTH AND LIFE (TENN)COVENTRY HEALTH AND LIFE-NEVADACOVENTRY HEALTH CARE CARELINKCOVENTRY HEALTH CARE FEDERALCOVENTRY HEALTH CARE OF DELAWARECOVENTRY HEALTH CARE OF GEORGIACOVENTRY HEALTH CARE OF IOWACOVENTRY HEALTH CARE OF LOUISIANACOVENTRY HEALTH CARE OF NEBRASKACOVENTRY HEALTHCARE NATIONAL NETWKCOVENTRY MISSOURICOVENTRY OF THE CAROLINAS -WELLPATHCOVENTRY SOUTHERN HEALTH SVCS (SHS)COVENTRYONEEBMSESSENCE HEALTHCAREFEDERATED INSURANCE COMPANYFIRST AMERITAS OF NEW YORKFIRST RELIANCE STANDARD LIFE INS COGREAT WEST HEALTHCAREHARVARD PILGRIM HEALTH CAREHEALTH ALLIANCE MEDICAL PLANS (HAP-MI)HEALTH FIRST OF NEW JERSEYHEALTH NET (AZ, CA, OR, NORTHEAST)HEALTH PARTNERS OF PHILADELPHIAHEALTHCOMP ADMINISTRATORSHEALTHFIRST OF NEW YORKHEALTHPLUS OF MICHIGANINTERNATIONAL MEDICAL CARD INCJOHN ALDEN LIFE INS CO (JALIC)KAISER FDN HEALTHPLAN- COLORADOKAISER FDN HEALTHPLAN- HAWAIIKAISER FDN HEALTHPLAN- MID-ATLANTICKAISER FDN HEALTHPLAN- NORTHWESTKAISER PERMANENTE OF GEORGIAKAISER PERMANENTE OF N CALIFORNIAKAISER PERMANENTE OF S CALIFORNIALOYAL AMERICAN MEDICARE SUPPMEDBEN (NEWARK OH)MEDICAMEDICAL CARD SYSTEMMEDICO INSURANCE COMPANYMEGALIFE (OKLAHOMA CITY)MERITAIN HEALTH-AGENCY SERVICESMHNET BEHAVIORAL HEALTHMMSI (MAYO)MOLINA HEALTHCARE OF CALIFORNIAMOLINA HEALTHCARE OF FLORIDAMOLINA HEALTHCARE OF ILLINOISMOLINA HEALTHCARE OF MICHIGANMOLINA HEALTHCARE OF NEW MEXICOMOLINA HEALTHCARE OF OHIOMOLINA HEALTHCARE OF SOUTH CAROLINAMOLINA HEALTHCARE OF TEXASMOLINA HEALTHCARE OF UTAHMOLINA HEALTHCARE OF WASHINGTONMOLINA HEALTHCARE OF WISCONSINMUTUAL OF OMAHAMVP HEALTH CARENETWORK HEALTH PLANOPTUM HEALTH BEHAVIORAL (OHB)OXFORD HEALTH PLANS (UHC)PANAM LIFE PUERTO RICO (PALIC)PHCS SAVILITY PAYERSPHYSICIANS MUTUAL INSURANCE COPITTMAN AND ASSOCIATESPLANNED ADMINISTRATORS INCPREFERRED ONEPRINCIPAL FIN GRP - NIPPON LIFEPROVIDENCE HEALTH PLANRELIANCE STANDARD LIFE INS COROCKY MOUNTAIN HEALTH PLANSIGNIFICA BENEFIT SERVICESSTANDARD INS CO OF NEW YORKSTAR - HRGSTUDENT INSURANCETEXANPLUS NORTH TEXAS AREATEXANPLUS SOUTHEAST TEXAS AREATIME INSURANCE COMPANY (FIC)TRICARE FOR LIFETRICARE OVERSEASTRUSTMARK INSURANCEUMR (WAUSAU)UNION PACIFIC RAILROAD EMP HLTH SYSUNION SECURITY INSURANCE CO (FBIC)UNITED AMERICAN INSURANCE COMPANYUNITED HEALTH PLAN RIVER VALLEYUNIVERSITY OF MISSOURIEUSAA-MEDICARE SUPPLEMENTALVIVA HEALTH INCWEB-TPAWELLS FARGO THIRD PARTY(CHIP PEIA)WPS HEALTH INSURANCEAttachment K 270/271 Tier 2 Payers Desired PayersHealth Care Clearing House (HCCH) Revenue Transactions ProcessingNote: List is subject to change as payers are added or removedPayer Name Access MedicareAdvantage by Bridgeway Health SolutionsAdvantage by Buckeye Community Health PlanAdvantage by Managed Health ServicesAdvantage by Superior HealthPlan ServicesAmerican Income Life Insurance CompanyAmerican Network Insurance (REHAB)-Medicare SupplementalAmerican Retirement Life Insurance Company Medicare SupplementArise Health Plan-Medicare Select PolicyCarePoint Medicare AdvantageCigna Behavioral HealthCMFG Life Insurance CoCommonwealth Care Alliance incConsolidated Associate Railroad EmployeesConstellation HealthErickson AdvantageFirst United AmericanGlobe Life & Accident Insurance CompanyHealth New England (HNE)Kelseycare AdvantageKentucky Health CooperativeLiberty National Life Insurance CompanyMartins Point General Health AdvantageThe Mega Life and Health Insurance Company (a HealthMarkets Company)MercyCare Health PlansMid-West National Life Insurance Company of TN (a HealthMarkets Company)National Health Plans of North CarolinaNetwork Health Incorporated (Medicare advantage)OPTIMUM BEHAVIORALOptimum Healthcare Inc.Penn Treaty Network America Insurance (REHAB)-Medicare SupplementalPiedmont Wellstar Health PlansPrimetime HealthplanProvident American Life & Health Insurance Company - Medicare SupplementSPJST - Medicare SupplementThe Ullico Family of CompaniesUnited Teacher Associates Insurance Company - Medicare SupplementVNS CHOICE MedicareW.O. Comstock and AssociatesWashington National (formerly Conseco Services)Attachment L File ReportsHealth Care Clearing House (HCCH) Revenue Transactions ProcessingFile ReportsGeneral report informationTest/Production flagCreate date – Date clearinghouse created the report. File status flag - Accepted or rejectedFile and claim tracking informationClearinghouse Trace Number – A value that can be used to locate the file within the clearinghouse system.VA file tracking information - equal to transaction set control number found in ST segment of the submitted file.Error information - if rejectedError messageData locations – field name, X12 field IDAttachment M HCCH ReportsHealth Care Clearing House (HCCH) Revenue Transactions ProcessingHCCH Reports Claim level messageMessage severity 1 = rejected 2 = accepted Message status codeMessages text – If text is not supplied then HCCH must supply a status code to message crosswalk.Detail line messageLine item number which received the message, Message severity 1 = rejected 2 = accepted Message status codeMessages text – If text is not supplied then HCCH must supply a status code to message crosswalk.Error information - if rejectedData locations – field name, X12 field ID Data in error.Attachment N Payer ReportsHealth Care Clearing House (HCCH) Revenue Transactions ProcessingPayer ReportsGeneral report informationTest/Production flagCreate date – Date clearinghouse created the report. Payer create date – Date Payer reported on claim.Report number – Type of report if more than one.Report source – Report generated from clearinghouse or Payer system. Number of claims in file.Total amount charged. Number of rejected claims Rejected claim chargesClaim informationClaim status code – accepted or rejected Patient name – first, last, middle.Patient ID numberSubscriber name – first, last, middle Subscriber ID numberPayer name and ID number.Claim type (Professional, Institutional, Dental) Insurance group nameFrom and to date of service Payer amount paid.Split claim indicator. If the claim has been divided into multiple claims by the Payer.File and claim tracking informationClearinghouse trace number – A value that can be used to locate a claim within the clearinghouse system.Payer trace number – A value that can be used to locate claim within the Payer system. Patient control number – Equal to loop 2300 CLM 02 on the inbound file.Claim level messageMessage severity 1 = rejected 2 = accepted Message status codeMessages text – If text is not supplied then HCCH must supply a status code to message crosswalk.Detail line messageLine item number which received the message, Message severity 1 = rejected 2 = accepted Message status codeMessages text – If text is not supplied then HCCH must supply a status code to message crosswalk.Error information - if rejectedData locations – field name, X12 field ID Data in error.Attachment O Payer ReportsHealth Care Clearing House (HCCH) Revenue Transactions ProcessingTransaction Volume Report Report Fields:VHA Submitter / Receiver Name VHA Submitter / Receiver Identifier PayerTransaction Transaction QuantityTransaction Total Dollar Amount (if appropriate)Attachment P Payer ReportsHealth Care Clearing House (HCCH) Revenue Transactions ProcessingERA Quantity Report FieldsMonth Payer Name Payer ID ERA CountVendor Name Receiver Name Receiver TIN Provider Name Provider TINAttachment QQuality Assurance Surveillance Plan (QASP)Health Care Clearing House (HCCH) Revenue Transactions ProcessingContract No: Contract Description: The objective of this Contract is to establish a Contract with a Contractor to support and leverage Health Insurance Portability and Accountability (HIPPA) mandated transactions by increasing connectivity and decreasing paper processing for Revenue Transaction Processing.Contractor’s name: (Hereafter Referred to as Contractor).PURPOSE: Each Contractor is required to submit a QASP thirty (30) calendar days after the Contract award date that outlines how the Contractor plans to provide continued uninterrupted quality of service. This QASP provides a systematic method to evaluate performance for the stated Contract and explains the following:What shall be monitored?How monitoring shall take place?Who shall conduct the monitoring?How monitoring efforts and results shall be documented?This QASP does not detail how the Contractor accomplishes the work. Rather, the QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the Contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.This QASP is a “living document” and the Government shall review and revise it on a regular basis. However, the Government shall coordinate changes with the Contractor. Copies of the original QASP and revisions shall be provided to the Contractor and Government officials implementing surveillance ERNMENT ROLES AND RESPONSIBILITIES: The following personnel shall oversee and coordinate surveillance activities.Contracting Officer (CO): The CO shall ensure performance of all necessary actions for effective Contracting, ensure compliance with the Contract terms, and shall safeguard the interests of the United States (U.S) in the Contractual relationship. The CO shall also assure that the Contractor receives impartial, fair, and equitable treatment under this Contract. The CO is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.Assigned CO: Organization or Agency: Work: E-m HYPERLINK "mailto:erica.blake@" ail: Contracting Officer’s Technical Representative (COR): The COR is responsible for technical administration of the Contract and shall assure proper Government surveillance of the Contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any Contractual commitments or to authorize any Contractual changes on the Government’s behalf.Assigned COR: Amanda Bishop 90 K Street NEWashington, DC 20006Work: (202) 382-2510E-m HYPERLINK "mailto:amanda.bishop@" ail: amanda.bishop@Other Key Government Personnel: Upon award, Government shall enter name, if applicable and shall include Performance Monitors, Clinical Quality experts, etc. who act on behalf of the COR to monitor performance>CONTRACTOR REPRESENTATIVES: The following employees of the Contractor serve as the Contractor’s PM for this Contract.Program Manager (PM): Ruth-Ann PhelpsWork: (202) 382-2510E-m HYPERLINK "mailto:ruth.ann.phelps@" ail: ruth.ann.phelps@Other Contractor Personnel: Work: E-m HYPERLINK "mailto:JMurphy@" ail: Title: PERFORMANCE STANDARDS: Performance standards define desired services. The Government performs surveillance to determine if the Contractor exceeds, meets or does not meet these standards.The Performance Requirements Summary Matrix below includes performance standards. The Government shall use these standards to determine Contractor performance and shall compare Contractor performance to the Acceptable Quality Level (AQL).Performance Standards:ObjectivesMeasuresStandardsEach task shall be priced independently and billed according to described tiers and within the described standard.PWS 11Review and acceptance by the GovernmentDeliverables provided IAW the Government approved standard/frequency standard. Documentation shall be comprehensive, accurate, and written in a format and text that is understandable to a wide range of users.Each sub-task shall increase connectivity and decrease of paper processing for Revenue Transaction Processing and completed within the described standard.PWS 12Review and acceptance by the GovernmentDeliverables provided IAW the Government approved standard/frequency standard. Documentation shall be comprehensive, accurate, and written in a format and text that is understandable to a wide range of users and within the described monthly accuracy standard.Deliverables Specific to This Order: Each deliverable shall be priced independently and billed as follows:DeliverableStandard/FrequencyMedium/FormatSubmit ToLess than 1,500,000 batch transactions processed each month.PWS 11.1Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 1,500,000 but lessthan 2,500,000 batch transactions processed each monthPWS 11.2Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 2,500,000 batch transactions processed each monthPWS 11.3Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamLess than 1,500,000 real time transactions processed each month.PWS 11.4Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 1,500,000 but lessthan 2,500,000 real time transactions processed each monthPWS 11.5Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMore than 2,500,000 real time transactions processed each monthPWS 11.6Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamDeliverable Sub-Tasks Specific to This Order: The below performance metrics are associated with this deliverable:DeliverableStandard/FrequencyMedium/FormatSubmit ToSupport Current & Future VHA Transaction VolumesPWS 12.1Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamEstablish Reconciliation & Production Failure ProtocolsPWS 12.2Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamCoordination of System ChangesPWS 12.3Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamSupport National Provider Identifier (NPI) and Health Plan Identifier (HPID)PWS 12.5Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamOperational SupportPWS 12. 6Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamHealth Care Transaction ServicesPWS 12.7Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamAccess to PayersPWS 12.8Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamAdditional Access to Additional PayersPWS 12.9Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamSubmit VAClaims toMedicarePWS 12.10Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractorshall provide aMonthly StatusReportElectronically inMicrosoft 2007 orhigherCORe-Business ProjectTeamImplement Medicare- equivalent Remittance Advice (MRA)PWS 12. 11Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamPrint Facsimile Medicare EOB’sPWS 12.12Ninety eight percent (98%) monthly accuracyThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamProvide Paper Claims to Non- Electronic CarriersPWS 12.13Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMonitor ClaimsPWS 12.14Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamFacilitate Enrollment and RegistrationPWS 12.15Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamSupport Pharmacy ClaimsPWS 12.16Ninety nine point nine percent (99.9%) monthly accuracy based on VA/VHA requirementsThe Contractor shall provide a Monthly Status ReportElectronically in Microsoft 2007 or higherCORe-Business Project TeamMETHODS OF QA SURVEILLANCE: Various methods exist to monitor performance. The COR and PO shall use the surveillance methods listed below in the administration of this QASP for the above deliverables.Direct Observation: Can be performed periodically or through 100% surveillance.Periodic Inspection: Evaluates outcomes on a periodic basis. Inspections shall be scheduled daily, weekly, monthly, quarterly, annually or unscheduled, as required based in part of results of Quality Assurance (QA) surveillance results.User Survey: Combines elements of validated user complaints and random sampling. Random surveys shall be conducted to solicit user satisfaction, generate inspections, and sampling.Validated User/Customer Complaints: The COR and PO shall identify deficiencies, investigate and validate complaints.Periodic Sampling: This is a variation of random sampling. A sample is only taken when a problem/deficiency is suspected. Sample results are applicable only for the specific workinspected. Sampling is not entirely random and cannot be applied to total activity performance.Random Sampling: Designed to evaluate performance by randomly selecting and inspecting a sample of uploads.Progress or Status Meetings: Held with the Contractor to elicit and provide feedback.Analysis of Contractor’s Monthly Progress Reports: Submitted electronically to the COR and PO.RATINGS: Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be utilized:Positive Outcome: Performance meets or exceeds standards.Neutral outcome: Performance meets or exceeds standards and/or shall not meet performance standards, but shall be within three percent (3%) of the performance target for the non-highest priority standard for no more than two (2) consecutive months for no more than two (2) standards.Negative outcomes: Performance does not meet standards and/or shall not meet performance standards.DOCUMENTING PERFORMANCE:Acceptable Performance: The Government shall document positive performance. Any report shall become a part of the supporting documentation for any Contractual action.Unacceptable Performance: When unacceptable performance occurs, a written notice shall be issued to the Contractor, outlining the performance measure(s) that is not met. The Contractor shall provide a written corrective action plan to the COR within ten (10) business days. The COR shall document the discussion and place it in the COR file.The COR shall prepare a Contract Discrepancy Report (CDR), and present it to the Contractor's PM. The Contractor shall acknowledge receipt of the CDR in writing. The CDR shall specify if the Contractor is required to prepare a corrective action plan to document how the Contractor shall correct the unacceptable performance and avoid a recurrence. The CDR shall state how long after receipt the Contractor has to present this corrective action plan to the COR. The Government shall review the Contractor's corrective action plan to determine acceptability.All CDR’s shall become a part of the supporting documentation for any Contractual action deemed necessary by the CO.8. FREQUENCY OF MEASUREMENT: During Contract performance, the COR shall periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed. Various methods cited in para 5 shall be utilized.9. FREQUENCY OF PERFORMANCE ASSESSMENT MEETINGS: The COR shall meetwith the Contractor annually to assess performance and shall provide a written assessment. Feedback shall be provided quarterly.<After award, both the Contractor’s PM and the COR shall sign this document>Signature – Contractor Program ManagerSignature – Contracting Officer’s RepresentativeA.5 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011) This solicitation includes FAR 52.219-4 Notice of Price Evaluation Preference for HubZone Small Business Concerns. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.A.6 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011) This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.A.7 52.203-3 GRATUITIES (APR 1984) (a) The right of the Contractor to proceed may be terminated by written notice if, after notice and hearing, the agency head or a designee determines that the Contractor, its agent, or another representative— (1) Offered or gave a gratuity (e.g., an entertainment or gift) to an officer, official, or employee of the Government; and (2) Intended, by the gratuity, to obtain a contract or favorable treatment under a contract. (b) The facts supporting this determination may be reviewed by any court having lawful jurisdiction. (c) If this contract is terminated under paragraph (a) above, the Government is entitled— (1) To pursue the same remedies as in a breach of the contract; and (2) In addition to any other damages provided by law, to exemplary damages of not less than 3 nor more than 10 times the cost incurred by the Contractor in giving gratuities to the person concerned, as determined by the agency head or a designee. (This subparagraph (c)(2) is applicable only if this contract uses money appropriated to the Department of Defense.) (d) The rights and remedies of the Government provided in this clause shall not be exclusive and are in addition to any other rights and remedies provided by law or under this contract.(End of Clause)A.8 52.203-12 LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (OCT 2010) (a) Definitions. As used in this clause— "Agency" means executive agency as defined in Federal Acquisition Regulation (FAR) 2.101. "Covered Federal action" means any of the following actions: (1) Awarding any Federal contract. (2) Making any Federal grant. (3) Making any Federal loan. (4) Entering into any cooperative agreement. (5) Extending, continuing, renewing, amending, or modifying any Federal contract, grant, loan, or cooperative agreement. "Indian tribe" and "tribal organization" have the meaning provided in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b) and include Alaskan Natives. "Influencing or attempting to influence" means making, with the intent to influence, any communication to or appearance before an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with any covered Federal action. "Local government" means a unit of government in a State and, if chartered, established, or otherwise recognized by a State for the performance of a governmental duty, including a local public authority, a special district, an intrastate district, a council of governments, a sponsor group representative organization, and any other instrumentality of a local government. "Officer or employee of an agency" includes the following individuals who are employed by an agency: (1) An individual who is appointed to a position in the Government under Title 5, United States Code, including a position under a temporary appointment. (2) A member of the uniformed services, as defined in subsection 101(3), Title 37, United States Code. (3) A special Government employee, as defined in section 202, Title 18, United States Code. (4) An individual who is a member of a Federal advisory committee, as defined by the Federal Advisory Committee Act, Title 5, United States Code, appendix 2. "Person" means an individual, corporation, company, association, authority, firm, partnership, society, State, and local government, regardless of whether such entity is operated for profit, or not for profit. This term excludes an Indian tribe, tribal organization, or any other Indian organization eligible to receive Federal contracts, grants, cooperative agreements, or loans from an agency, but only with respect to expenditures by such tribe or organization that are made for purposes specified in paragraph (b) of this clause and are permitted by other Federal law. "Reasonable compensation" means, with respect to a regularly employed officer or employee of any person, compensation that is consistent with the normal compensation for such officer or employee for work that is not furnished to, not funded by, or not furnished in cooperation with the Federal Government. "Reasonable payment" means, with respect to professional and other technical services, a payment in an amount that is consistent with the amount normally paid for such services in the private sector. "Recipient" includes the Contractor and all subcontractors. This term excludes an Indian tribe, tribal organization, or any other Indian organization eligible to receive Federal contracts, grants, cooperative agreements, or loans from an agency, but only with respect to expenditures by such tribe or organization that are made for purposes specified in paragraph (b) of this clause and are permitted by other Federal law. "Regularly employed" means, with respect to an officer or employee of a person requesting or receiving a Federal contract, an officer or employee who is employed by such person for at least 130 working days within 1 year immediately preceding the date of the submission that initiates agency consideration of such person for receipt of such contract. An officer or employee who is employed by such person for less than 130 working days within 1 year immediately preceding the date of the submission that initiates agency consideration of such person shall be considered to be regularly employed as soon as he or she is employed by such person for 130 working days. "State" means a State of the United States, the District of Columbia, or an outlying area of the United States, an agency or instrumentality of a State, and multi-State, regional, or interstate entity having governmental duties and powers. (b) Prohibition. 31 U.S.C. 1352 prohibits a recipient of a Federal contract, grant, loan, or cooperative agreement from using appropriated funds to pay any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with any covered Federal actions. In accordance with 31 U.S.C. 1352, the Contractor shall not use appropriated funds to pay any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the award of this contractor the extension, continuation, renewal, amendment, or modification of this contract. (1) The term appropriated funds does not include profit or fee from a covered Federal action. (2) To the extent the Contractor can demonstrate that the Contractor has sufficient monies, other than Federal appropriated funds, the Government will assume that these other monies were spent for any influencing activities that would be unallowable if paid for with Federal appropriated funds. (c) Exceptions. The prohibition in paragraph (b) of this clause does not apply under the following conditions: (1) Agency and legislative liaison by Contractor employees. (i) Payment of reasonable compensation made to an officer or employee of the Contractor if the payment is for agency and legislative liaison activities not directly related to this contract. For purposes of this paragraph, providing any information specifically requested by an agency or Congress is permitted at any time. (ii) Participating with an agency in discussions that are not related to a specific solicitation for any covered Federal action, but that concern— (A) The qualities and characteristics (including individual demonstrations) of the person's products or services, conditions or terms of sale, and service capabilities; or (B) The application or adaptation of the person's products or services for an agency's use. (iii) Providing prior to formal solicitation of any covered Federal action any information not specifically requested but necessary for an agency to make an informed decision about initiation of a covered Federal action; (iv) Participating in technical discussions regarding the preparation of an unsolicited proposal prior to its official submission; and (v) Making capability presentations prior to formal solicitation of any covered Federal action by persons seeking awards from an agency pursuant to the provisions of the Small Business Act, as amended by Pub.L. 95-507, and subsequent amendments. (2) Professional and technical services. (i) A payment of reasonable compensation made to an officer or employee of a person requesting or receiving a covered Federal action or an extension, continuation, renewal, amendment, or modification of a covered Federal action, if payment is for professional or technical services rendered directly in the preparation, submission, or negotiation of any bid, proposal, or application for that Federal action or for meeting requirements imposed by or pursuant to law as a condition for receiving that Federal action. (ii) Any reasonable payment to a person, other than an officer or employee of a person requesting or receiving a covered Federal action or an extension, continuation, renewal, amendment, or modification of a covered Federal action if the payment is for professional or technical services rendered directly in the preparation, submission, or negotiation of any bid, proposal, or application for that Federal action or for meeting requirements imposed by or pursuant to law as a condition for receiving that Federal action. Persons other than officers or employees of a person requesting or receiving a covered Federal action include consultants and trade associations. (iii) As used in paragraph (c)(2) of this clause, "professional and technical services" are limited to advice and analysis directly applying any professional or technical discipline (for examples, see FAR 3.803(a)(2)(iii)). (iv) Requirements imposed by or pursuant to law as a condition for receiving a covered Federal award include those required by law or regulation and any other requirements in the actual award documents. (3) Only those communications and services expressly authorized by paragraphs (c)(1) and (2) of this clause are permitted. (d) Disclosure. (1) If the Contractor did not submit OMB Standard Form LLL, Disclosure of Lobbying Activities, with its offer, but registrants under the Lobbying Disclosure Act of 1995 have subsequently made a lobbying contact on behalf of the Contractor with respect to this contract, the Contractor shall complete and submit OMB Standard Form LLL to provide the name of the lobbying registrants, including the individuals performing the services. (2) If the Contractor did submit OMB Standard Form LLL disclosure pursuant to paragraph (d) of the provision at FAR 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions, and a change occurs that affects Block 10 of the OMB Standard Form LLL (name and address of lobbying registrant or individuals performing services), the Contractor shall, at the end of the calendar quarter in which the change occurs, submit to the Contracting Officer within 30 days an updated disclosure using OMB Standard Form LLL. (e) Penalties. (1) Any person who makes an expenditure prohibited under paragraph (b) of this clause or who fails to file or amend the disclosure to be filed or amended by paragraph (d) of this clause shall be subject to civil penalties as provided for by 31 U.S.C.1352. An imposition of a civil penalty does not prevent the Government from seeking any other remedy that may be applicable. (2) Contractors may rely without liability on the representation made by their subcontractors in the certification and disclosure form. (f) Cost allowability. Nothing in this clause makes allowable or reasonable any costs which would otherwise be unallowable or unreasonable. Conversely, costs made specifically unallowable by the requirements in this clause will not be made allowable under any other provision. (g) Subcontracts. (1) The Contractor shall obtain a declaration, including the certification and disclosure in paragraphs (c) and (d) of the provision at FAR 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions, from each person requesting or receiving a subcontract exceeding $150,000 under this contract. The Contractor or subcontractor that awards the subcontract shall retain the declaration. (2) A copy of each subcontractor disclosure form (but not certifications) shall be forwarded from tier to tier until received by the prime Contractor. The prime Contractor shall, at the end of the calendar quarter in which the disclosure form is submitted by the subcontractor, submit to the Contracting Officer within 30 days a copy of all disclosures. Each subcontractor certification shall be retained in the subcontract file of the awarding Contractor. (3) The Contractor shall include the substance of this clause, including this paragraph (g), in any subcontract exceeding $150,000.FAR NumberTitle52.212-1INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMSFAR NumberTitle52.212-4CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMSA.9 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2017) (a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (1) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)). (2) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (NOV 2015). (3) 52.233-3, Protest After Award (Aug 1996) (31 U.S.C. 3553). (4) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Public Laws 108-77 and 108-78 (19 U.S.C. 3805 note)). (b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [X] (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402). [X] (2) 52.203-13, Contractor Code of Business Ethics and Conduct (OCT 2015) (41 U.S.C. 3509). [] (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (JUN 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.) [X] (4) 52.204–10, Reporting Executive Compensation and First-Tier Subcontract Awards (OCT 2016) (Pub. L. 109–282) (31 U.S.C. 6101 note). [] (5) [Reserved] [X] (6) 52.204–14, Service Contract Reporting Requirements (OCT 2016) (Pub. L. 111–117, section 743 of Div. C). [] (7) 52.204–15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts (OCT 2016) (Pub. L. 111–117, section 743 of Div. C). [X] (8) 52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (OCT 2015) (31 U.S.C. 6101 note). [X] (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Jul 2013) (41 U.S.C. 2313). [] (10) [Reserved] [] (11)(i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (NOV 2011) (15 U.S.C. 657a). [] (ii) Alternate I (NOV 2011) of 52.219-3. [X] (12)(i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (OCT 2014) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a). [] (ii) Alternate I (JAN 2011) of 52.219-4. [] (13) [Reserved] [] (14)(i) 52.219-6, Notice of Total Small Business Set-Aside (NOV 2011) (15 U.S.C. 644). [] (ii) Alternate I (NOV 2011). [] (iii) Alternate II (NOV 2011). [] (15)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644). [] (ii) Alternate I (Oct 1995) of 52.219-7. [] (iii) Alternate II (Mar 2004) of 52.219-7. [X] (16) 52.219-8, Utilization of Small Business Concerns (NOV 2016) (15 U.S.C. 637(d)(2) and (3)). [] (17)(i) 52.219-9, Small Business Subcontracting Plan (JAN 2017) (15 U.S.C. 637(d)(4)). [] (ii) Alternate I (NOV 2016) of 52.219-9. [] (iii) Alternate II (NOV 2016) of 52.219-9. [] (iv) Alternate III (NOV 2016) of 52.219-9. [] (v) Alternate IV (NOV 2016) of 52.219-9. [] (18) 52.219-13, Notice of Set-Aside of Orders (NOV 2011) (15 U.S.C. 644(r)). [] (19) 52.219-14, Limitations on Subcontracting (JAN 2017) (15 U.S.C. 637(a)(14)). [] (20) 52.219-16, Liquidated Damages—Subcontracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)). [] (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (NOV 2011) (15 U.S.C. 657f). [X] (22) 52.219-28, Post Award Small Business Program Representation (Jul 2013) (15 U.S.C 632(a)(2)). [] (23) 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women-Owned Small Business Concerns (DEC 2015) (15 U.S.C. 637(m)). [] (24) 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (DEC 2015) (15 U.S.C. 637(m)). [X] (25) 52.222-3, Convict Labor (June 2003) (E.O. 11755). [] (26) 52.222–19, Child Labor—Cooperation with Authorities and Remedies (OCT 2016) (E.O. 13126). [X] (27) 52.222-21, Prohibition of Segregated Facilities (APR 2015). [X] (28) 52.222–26, Equal Opportunity (SEP 2016) (E.O. 11246). [X] (29) 52.222-35, Equal Opportunity for Veterans (OCT 2015) (38 U.S.C. 4212). [X] (30) 52.222-36, Equal Opportunity for Workers with Disabilities (JUL 2014) (29 U.S.C. 793). [X] (31) 52.222-37, Employment Reports on Veterans (FEB 2016) (38 U.S.C. 4212). [X] (32) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496). [X] (33)(i) 52.222-50, Combating Trafficking in Persons (MAR 2015) (22 U.S.C. chapter 78 and E.O. 13627). [] (ii) Alternate I (MAR 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627). [X] (34) 52.222-54, Employment Eligibility Verification (OCT 2015). (E. O. 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.) [] (35) 52.222-59, Compliance with Labor Laws (Executive Order 13673) (OCT 2016). (Applies at $50 million for solicitations and resultant contracts issued from October 25, 2016 through April 24, 2017; applies at $500,000 for solicitations and resultant contracts issued after April 24, 2017). Note to paragraph (b)(35): By a court order issued on October 24, 2016, 52.222-59 is enjoined indefinitely as of the date of the order. The enjoined paragraph will become effective immediately if the court terminates the injunction. At that time, DoD, GSA, and NASA will publish a document in the Federal Register advising the public of the termination of the injunction. [X] (36) 52.222-60, Paycheck Transparency (Executive Order 13673) (OCT 2016). [] (37)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated Items (May 2008) (42 U.S.C.6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (38) 52.223-11, Ozone-Depleting Substances and High Global Warming Potential Hydrofluorocarbons (JUN 2016) (E.O. 13693). [] (39) 52.223-12, Maintenance, Service, Repair, or Disposal of Refrigeration Equipment and Air Conditioners (JUN 2016) (E.O. 13693). [] (ii) Alternate I (MAY 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (40)(i) 52.223-13, Acquisition of EPEAT?-Registered Imaging Equipment (JUN 2014) (E.O.s 13423 and 13514). [] (ii) Alternate I (OCT 2015) of 52.223-13. [] (41)(i) 52.223-14, Acquisition of EPEAT?-Registered Televisions (JUN 2014) (E.O.s 13423 and 13514). [] (ii) Alternate I (JUN 2014) of 52.223-14. [] (42) 52.223-15, Energy Efficiency in Energy-Consuming Products (DEC 2007)(42 U.S.C. 8259b). [] (43)(i) 52.223-16, Acquisition of EPEAT?-Registered Personal Computer Products (OCT 2015) (E.O.s 13423 and 13514). [] (ii) Alternate I (JUN 2014) of 52.223-16. [X] (44) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (AUG 2011) [] (45) 52.223-20, Aerosols (JUN 2016) (E.O. 13693). [] (46) 52.223-21, Foams (JUN 2016) (E.O. 13693). [] (47) (i) 52.224-3, Privacy Training (JAN 2017) (5 U.S.C. 552a). [] (ii) Alternate I (JAN 2017) of 52.224-3. [] (48) 52.225-1, Buy American—Supplies (MAY 2014) (41 U.S.C. chapter 83). [] (49)(i) 52.225-3, Buy American—Free Trade Agreements—Israeli Trade Act (MAY 2014) (41 U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 note, Pub. L. 103-182, 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41, 112-42, and 112-43. [] (ii) Alternate I (MAY 2014) of 52.225-3. [] (iii) Alternate II (MAY 2014) of 52.225-3. [] (iv) Alternate III (MAY 2014) of 52.225-3. [X] (50) 52.225–5, Trade Agreements (OCT 2016) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note). [X] (51) 52.225-13, Restrictions on Certain Foreign Purchases (JUN 2008) (E.O.'s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury). [] (52) 52.225–26, Contractors Performing Private Security Functions Outside the United States (OCT 2016) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note). [] (53) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150). [] (54) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) (42 U.S.C. 5150). [] (55) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 4505, 10 U.S.C. 2307(f)). [] (56) 52.232-30, Installment Payments for Commercial Items (JAN 2017) (41 U.S.C. 4505, 10 U.S.C. 2307(f)). [] (57) 52.232-33, Payment by Electronic Funds Transfer—System for Award Management (Jul 2013) (31 U.S.C. 3332). [X] (58) 52.232-34, Payment by Electronic Funds Transfer—Other than System for Award Management (Jul 2013) (31 U.S.C. 3332). [] (59) 52.232-36, Payment by Third Party (MAY 2014) (31 U.S.C. 3332). [] (60) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a). [] (61) 52.242-5, Payments to Small Business Subcontractors (JAN 2017)(15 U.S.C. 637(d)(12)). [] (62)(i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). [] (ii) Alternate I (Apr 2003) of 52.247-64. (c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [] (1) 52.222-17, Nondisplacement of Qualified Workers (MAY 2014) (E.O. 13495). [] (2) 52.222-41, Service Contract Labor Standards (MAY 2014) (41 U.S.C. chapter 67). [] (3) 52.222-42, Statement of Equivalent Rates for Federal Hires (MAY 2014) (29 U.S.C. 206 and 41 U.S.C. chapter 67). [] (4) 52.222-43, Fair Labor Standards Act and Service Contract Labor Standards—Price Adjustment (Multiple Year and Option Contracts) (MAY 2014) (29 U.S.C. 206 and 41 U.S.C. chapter 67). [] (5) 52.222-44, Fair Labor Standards Act and Service Contract Labor Standards—Price Adjustment (MAY 2014) (29 U.S.C 206 and 41 U.S.C. chapter 67). [] (6) 52.222-51, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment—Requirements (MAY 2014) (41 U.S.C. chapter 67). [] (7) 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services—Requirements (MAY 2014) (41 U.S.C. chapter 67). [] (8) 52.222-55, Minimum Wages Under Executive Order 13658 (DEC 2015). [] (9) 52.222-62, Paid Sick Leave Under Executive Order 13706 (JAN 2017) (E.O. 13706). [] (10) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations (MAY 2014) (42 U.S.C. 1792). [] (11) 52.237-11, Accepting and Dispensing of $1 Coin (SEP 2008) (31 U.S.C. 5112(p)(1)). (d) Comptroller General Examination of Record. The Contractor shall comply with the provisions of this paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records—Negotiation. (1) The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor's directly pertinent records involving transactions related to this contract. (2) The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction, until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved. (3) As used in this clause, records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant to a provision of law. (e)(1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c), and (d) of this clause, the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1) in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be as required by the clause— (i) 52.203-13, Contractor Code of Business Ethics and Conduct (OCT 2015) (41 U.S.C. 3509). (ii) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)). (iii) 52.219-8, Utilization of Small Business Concerns (NOV 2016) (15 U.S.C. 637(d)(2) and (3)), in all subcontracts that offer further subcontracting opportunities. (iv) 52.222-17, Nondisplacement of Qualified Workers (MAY 2014) (E.O. 13495). Flow down required in accordance with paragraph (l) of FAR clause 52.222-17. (v) 52.222-21, Prohibition of Segregated Facilities (APR 2015). (vi) 52.222–26, Equal Opportunity (SEP 2016) (E.O. 11246). (vii) 52.222-35, Equal Opportunity for Veterans (OCT 2015) (38 U.S.C. 4212). (viii) 52.222-36, Equal Opportunity for Workers with Disabilities (JUL 2014) (29 U.S.C. 793). (ix) 52.222-37, Employment Reports on Veterans (FEB 2016) (38 U.S.C. 4212). (x) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496). Flow down required in accordance with paragraph (f) of FAR clause 52.222-40. (xi) 52.222-41, Service Contract Labor Standards (MAY 2014) (41 U.S.C. chapter 67). (xii)(A) 52.222-50, Combating Trafficking in Persons (MAR 2015) (22 U.S.C. chapter 78 and E.O. 13627). (B) Alternate I (MAR 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627). (xiii) 52.222-51, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment—Requirements (MAY 2014) (41 U.S.C. chapter 67). (xiv) 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services—Requirements (MAY 2014) (41 U.S.C. chapter 67). (xv) 52.222-54, Employment Eligibility Verification (OCT 2015) (E. O. 12989). (xvi) 52.222-55, Minimum Wages Under Executive Order 13658 (DEC 2015). (xvii) 52.222-59, Compliance with Labor Laws (Executive Order 13673) (OCT 2016) (Applies at $50 million for solicitations and resultant contracts issued from October 25, 2016 through April 24, 2017; applies at $500,000 for solicitations and resultant contracts issued after April 24, 2017). Note to paragraph (e)(1)(xvii): By a court order issued on October 24, 2016, 52.222-59 is enjoined indefinitely as of the date of the order. The enjoined paragraph will become effective immediately if the court terminates the injunction. At that time, DoD, GSA, and NASA will publish a document in the Federal Register advising the public of the termination of the injunction. (xviii) 52.222-60, Paycheck Transparency (Executive Order 13673) (OCT 2016)). (xix) 52.222-62 Paid Sick Leave Under Executive Order 13706 (JAN 2017) (E.O. 13706). (xx)(A) 52.224-3, Privacy Training (JAN 2017) (5 U.S.C. 552a). (B) Alternate I (JAN 2017) of 52.224-3. (xxi) 52.225–26, Contractors Performing Private Security Functions Outside the United States (OCT 2016) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note). (xxii) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations (MAY 2014) (42 U.S.C. 1792). Flow down required in accordance with paragraph (e) of FAR clause 52.226-6. (xxiii) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of FAR clause 52.247-64. (2) While not required, the Contractor may include in its subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligations.(End of Clause)A.10 52.216-18 ORDERING (OCT 1995) (a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from JULY 16, 2017 through JULY 15, 2020. (b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control. (c) If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.(End of Clause)A.11 52.216-19 ORDER LIMITATIONS (OCT 1995) (a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $1,000, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract. (b) Maximum order. The Contractor is not obligated to honor— (1) Any order for a single item in excess of $6,999,000; (2) Any order for a combination of items in excess of $6,999,000; or (3) A series of orders from the same ordering office within 365 calendar days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section. (c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section. (d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 30 calendar days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.(End of Clause)A.12 52.216-22 INDEFINITE QUANTITY (OCT 1995) (a) This is an indefinite-quantity contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies and services specified in the Schedule are estimates only and are not purchased by this contract. (b) Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. The Contractor shall furnish to the Government, when and if ordered, the supplies or services specified in the Schedule up to and including the quantity designated in the Schedule as the "maximum." The Government shall order at least the quantity of supplies or services designated in the Schedule as the "minimum." (c) Except for any limitations on quantities in the Order Limitations clause or in the Schedule, there is no limit on the number of orders that may be issued. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations. (d) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after July 15, 2020.(End of Clause)A.13 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 calendar days..(End of Clause)The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. This includes options under FAR 52.217-8, Option to Extend Services, which applies to this solicitation. Evaluation of options under FAR 52.217-8 will be accomplished by adding six months of the Offeror's price for the last potential period of performance under this contract to the Offeror's total price.? In this case, the Offeror's total price for the purpose of evaluation will include the base period, all option periods, and an additional six months of the last option period. Offerors must price only the base and option periods specified in the contract line item numbers (CLINs), and shall not submit a price for the potential six-month extension of services under FAR 52.217-8. The Government reserves the right to exercise the option under FAR 52.217-8 before the end of any of the contractor's performance periods. Evaluation of options shall not obligate the Government to exercise the option(s)."A.14 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) (a) The Government may extend the term of this contract by written notice to the Contractor within 30 calendar days.; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 calendar days before the contract expires. The preliminary notice does not commit the Government to an extension. (b) If the Government exercises this option, the extended contract shall be considered to include this option clause. (c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 36 months.(End of Clause)FAR NumberTitleDate52.224-1PRIVACY ACT NOTIFICATIONAPR 198452.224-2PRIVACY ACTAPR 1984A.15 52.227-1 AUTHORIZATION AND CONSENT (DEC 2007) (a) The Government authorizes and consents to all use and manufacture, in performing this contract or any subcontract at any tier, of any invention described in and covered by a United States patent— (1) Embodied in the structure or composition of any article the delivery of which is accepted by the Government under this contract; or (2) Used in machinery, tools, or methods whose use necessarily results from compliance by the Contractor or a subcontractor with (i) specifications or written provisions forming a part of this contract or (ii) specific written instructions given by the Contracting Officer directing the manner of performance. The entire liability to the Government for infringement of a United States patent shall be determined solely by the provisions of the indemnity clause, if any, included in this contract or any subcontract hereunder (including any lower-tier subcontract), and the Government assumes liability for all other infringement to the extent of the authorization and consent hereinabove granted. (b) The Contractor shall include the substance of this clause, including this paragraph (b), in all subcontracts that are expected to exceed the simplified acquisition threshold. However, omission of this clause from any subcontract, including those at or below the simplified acquisition threshold, does not affect this authorization and consent.(End of Clause)A.16 52.227-14 RIGHTS IN DATA—GENERAL (MAY 2014) ALTERNATE V (DEC 2007) (a) Definitions. As used in this clause— "Computer database" or "database" means a collection of recorded information in a form capable of, and for the purpose of, being stored in, processed, and operated on by a computer. The term does not include computer software. "Computer software"— (1) Means (i) Computer programs that comprise a series of instructions, rules, routines, or statements, regardless of the media in which recorded, that allow or cause a computer to perform a specific operation or series of operations; and (ii) Recorded information comprising source code listings, design details, algorithms, processes, flow charts, formulas, and related material that would enable the computer program to be produced, created, or compiled. (2) Does not include computer databases or computer software documentation. "Computer software documentation" means owner's manuals, user's manuals, installation instructions, operating instructions, and other similar items, regardless of storage medium, that explain the capabilities of the computer software or provide instructions for using the software. "Data" means recorded information, regardless of form or the media on which it may be recorded. The term includes technical data and computer software. The term does not include information incidental to contract administration, such as financial, administrative, cost or pricing, or management information. "Form, fit, and function data" means data relating to items, components, or processes that are sufficient to enable physical and functional interchangeability, and data identifying source, size, configuration, mating and attachment characteristics, functional characteristics, and performance requirements. For computer software it means data identifying source, functional characteristics, and performance requirements but specifically excludes the source code, algorithms, processes, formulas, and flow charts of the software. "Limited rights" means the rights of the Government in limited rights data as set forth in the Limited Rights Notice of paragraph (g)(3) if included in this clause. "Limited rights data" means data, other than computer software, that embody trade secrets or are commercial or financial and confidential or privileged, to the extent that such data pertain to items, components, or processes developed at private expense, including minor modifications. "Restricted computer software" means computer software developed at private expense and that is a trade secret, is commercial or financial and confidential or privileged, or is copyrighted computer software, including minor modifications of the computer software. "Restricted rights", as used in this clause, means the rights of the Government in restricted computer software, as set forth in a Restricted Rights Notice of paragraph (g) if included in this clause, or as otherwise may be provided in a collateral agreement incorporated in and made part of this contract, including minor modifications of such computer software. "Technical data", means recorded information (regardless of the form or method of the recording) of a scientific or technical nature (including computer databases and computer software documentation). This term does not include computer software or financial, administrative, cost or pricing, or management data or other information incidental to contract administration. The term includes recorded information of a scientific or technical nature that is included in computer databases. (See 41 U.S.C. 116). "Unlimited rights" means the rights of the Government to use, disclose, reproduce, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, in any manner and for any purpose, and to have or permit others to do so. (b) Allocation of rights. (1) Except as provided in paragraph (c) of this clause, the Government shall have unlimited rights in— (i) Data first produced in the performance of this contract; (ii) Form, fit, and function data delivered under this contract; (iii) Data delivered under this contract (except for restricted computer software) that constitute manuals or instructional and training material for installation, operation, or routine maintenance and repair of items, components, or processes delivered or furnished for use under this contract; and (iv) All other data delivered under this contract unless provided otherwise for limited rights data or restricted computer software in accordance with paragraph (g) of this clause. (2) The Contractor shall have the right to— (i) Assert copyright in data first produced in the performance of this contract to the extent provided in paragraph (c)(1) of this clause; (ii) Use, release to others, reproduce, distribute, or publish any data first produced or specifically used by the Contractor in the performance of this contract, unless provided otherwise in paragraph (d) of this clause; (iii) Substantiate the use of, add, or correct limited rights, restricted rights, or copyright notices and to take other appropriate action, in accordance with paragraphs (e) and (f) of this clause; and (iv) Protect from unauthorized disclosure and use those data that are limited rights data or restricted computer software to the extent provided in paragraph (g) of this clause. (c) Copyright— (1) Data first produced in the performance of this contract. (i) Unless provided otherwise in paragraph (d) of this clause, the Contractor may, without prior approval of the Contracting Officer, assert copyright in scientific and technical articles based on or containing data first produced in the performance of this contract and published in academic, technical or professional journals, symposia proceedings, or similar works. The prior, express written permission of the Contracting Officer is required to assert copyright in all other data first produced in the performance of this contract. (ii) When authorized to assert copyright to the data, the Contractor shall affix the applicable copyright notices of 17 U.S.C. 401 or 402, and an acknowledgment of Government sponsorship (including contract number). (iii) For data other than computer software, the Contractor grants to the Government, and others acting on its behalf, a paid- up, nonexclusive, irrevocable, worldwide license in such copyrighted data to reproduce, prepare derivative works, distribute copies to the public, and perform publicly and display publicly by or on behalf of the Government. For computer software, the Contractor grants to the Government, and others acting on its behalf, a paid- up, nonexclusive, irrevocable, worldwide license in such copyrighted computer software to reproduce, prepare derivative works, and perform publicly and display publicly (but not to distribute copies to the public) by or on behalf of the Government. (2) Data not first produced in the performance of this contract. The Contractor shall not, without the prior written permission of the Contracting Officer, incorporate in data delivered under this contract any data not first produced in the performance of this contract unless the Contractor— (i) Identifies the data; and (ii) Grants to the Government, or acquires on its behalf, a license of the same scope as set forth in paragraph (c)(1) of this clause or, if such data are restricted computer software, the Government shall acquire a copyright license as set forth in paragraph (g)(4) of this clause (if included in this contract) or as otherwise provided in a collateral agreement incorporated in or made part of this contract. (3) Removal of copyright notices. The Government will not remove any authorized copyright notices placed on data pursuant to this paragraph (c), and will include such notices on all reproductions of the data. (d) Release, publication, and use of data. The Contractor shall have the right to use, release to others, reproduce, distribute, or publish any data first produced or specifically used by the Contractor in the performance of this contract, except— (1) As prohibited by Federal law or regulation (e.g., export control or national security laws or regulations); (2) As expressly set forth in this contract; or (3) If the Contractor receives or is given access to data necessary for the performance of this contract that contain restrictive markings, the Contractor shall treat the data in accordance with such markings unless specifically authorized otherwise in writing by the Contracting Officer. (e) Unauthorized marking of data. (1) Notwithstanding any other provisions of this contract concerning inspection or acceptance, if any data delivered under this contract are marked with the notices specified in paragraph (g)(3) or (g) (4) if included in this clause, and use of the notices is not authorized by this clause, or if the data bears any other restrictive or limiting markings not authorized by this contract, the Contracting Officer may at any time either return the data to the Contractor, or cancel or ignore the markings. However, pursuant to 41 U.S.C. 4703, the following procedures shall apply prior to canceling or ignoring the markings. (i) The Contracting Officer will make written inquiry to the Contractor affording the Contractor 60 days from receipt of the inquiry to provide written justification to substantiate the propriety of the markings; (ii) If the Contractor fails to respond or fails to provide written justification to substantiate the propriety of the markings within the 60-day period (or a longer time approved in writing by the Contracting Officer for good cause shown), the Government shall have the right to cancel or ignore the markings at any time after said period and the data will no longer be made subject to any disclosure prohibitions. (iii) If the Contractor provides written justification to substantiate the propriety of the markings within the period set in paragraph (e)(1)(i) of this clause, the Contracting Officer will consider such written justification and determine whether or not the markings are to be cancelled or ignored. If the Contracting Officer determines that the markings are authorized, the Contractor will be so notified in writing. If the Contracting Officer determines, with concurrence of the head of the contracting activity, that the markings are not authorized, the Contracting Officer will furnish the Contractor a written determination, which determination will become the final agency decision regarding the appropriateness of the markings unless the Contractor files suit in a court of competent jurisdiction within 90 days of receipt of the Contracting Officer's decision. The Government will continue to abide by the markings under this paragraph (e)(1)(iii) until final resolution of the matter either by the Contracting Officer's determination becoming final (in which instance the Government will thereafter have the right to cancel or ignore the markings at any time and the data will no longer be made subject to any disclosure prohibitions), or by final disposition of the matter by court decision if suit is filed. (2) The time limits in the procedures set forth in paragraph (e)(1) of this clause may be modified in accordance with agency regulations implementing the Freedom of Information Act (5 U.S.C. 552) if necessary to respond to a request thereunder. (3) Except to the extent the Government's action occurs as the result of final disposition of the matter by a court of competent jurisdiction, the Contractor is not precluded by paragraph (e) of the clause from bringing a claim, in accordance with the Disputes clause of this contract, that may arise as the result of the Government removing or ignoring authorized markings on data delivered under this contract. (f) Omitted or incorrect markings. (1) Data delivered to the Government without any restrictive markings shall be deemed to have been furnished with unlimited rights. The Government is not liable for the disclosure, use, or reproduction of such data. (2) If the unmarked data has not been disclosed without restriction outside the Government, the Contractor may request, within 6 months (or a longer time approved by the Contracting Officer in writing for good cause shown) after delivery of the data, permission to have authorized notices placed on the data at the Contractor's expense. The Contracting Officer may agree to do so if the Contractor— (i) Identifies the data to which the omitted notice is to be applied; (ii) Demonstrates that the omission of the notice was inadvertent; (iii) Establishes that the proposed notice is authorized; and (iv) Acknowledges that the Government has no liability for the disclosure, use, or reproduction of any data made prior to the addition of the notice or resulting from the omission of the notice. (3) If data has been marked with an incorrect notice, the Contracting Officer may— (i) Permit correction of the notice at the Contractor's expense if the Contractor identifies the data and demonstrates that the correct notice is authorized; or (ii) Correct any incorrect notices. (g) Protection of limited rights data and restricted computer software. (1) The Contractor may withhold from delivery qualifying limited rights data or restricted computer software that are not data identified in paragraphs (b)(1)(i), (ii), and (iii) of this clause. As a condition to this withholding, the Contractor shall— (i) Identify the data being withheld; and (ii) Furnish form, fit, and function data instead. (2) Limited rights data that are formatted as a computer database for delivery to the Government shall be treated as limited rights data and not restricted computer software. (3) [Reserved] (h) Subcontracting. The Contractor shall obtain from its subcontractors all data and rights therein necessary to fulfill the Contractor's obligations to the Government under this contract. If a subcontractor refuses to accept terms affording the Government those rights, the Contractor shall promptly notify the Contracting Officer of the refusal and shall not proceed with the subcontract award without authorization in writing from the Contracting Officer. (i) Relationship to patents or other rights. Nothing contained in this clause shall imply a license to the Government under any patent or be construed as affecting the scope of any license or other right otherwise granted to the Government. (j) The Contractor agrees, except as may be otherwise specified in this contract for specific data deliverables listed as not subject to this paragraph, that the Contracting Officer may, up to three years after acceptance of all deliverables under this contract, inspect at the Contractor's facility any data withheld pursuant to paragraph (g)(1) of this clause, for purposes of verifying the Contractor's assertion of limited rights or restricted rights status of the data or for evaluating work performance. When the Contractor whose data are to be inspected demonstrates to the Contracting Officer that there would be a possible conflict of interest if a particular representative made the inspection, the Contracting Officer shall designate an alternate inspector.(End of Clause)A.17 52.227-17 RIGHTS IN DATA—SPECIAL WORKS (DEC 2007) (a) Definitions. As used in this clause— "Data" means recorded information, regardless of form or the media on which it may be recorded. The term includes technical data and computer software. The term does not include information incidental to contract administration, such as financial, administrative, cost or pricing, or management information. "Unlimited rights" means the rights of the Government to use, disclose, reproduce, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, in any manner and for any purpose, and to have or permit others to do so. (b) Allocation of Rights. (1) The Government shall have— (i) Unlimited rights in all data delivered under this contract, and in all data first produced in the performance of this contract, except as provided in paragraph (c) of this clause. (ii) The right to limit assertion of copyright in data first produced in the performance of this contract, and to obtain assignment of copyright in that data, in accordance with paragraph (c)(1) of this clause. (iii) The right to limit the release and use of certain data in accordance with paragraph (d) of this clause. (2) The Contractor shall have, to the extent permission is granted in accordance with paragraph (c)(1) of this clause, the right to assert claim to copyright subsisting in data first produced in the performance of this contract. (c) Copyright— (1) Data first produced in the performance of this contract. (i) The Contractor shall not assert or authorize others to assert any claim to copyright subsisting in any data first produced in the performance of this contract without prior written permission of the Contracting Officer. When copyright is asserted, the Contractor shall affix the appropriate copyright notice of 17 U.S.C. 401 or 402 and acknowledgment of Government sponsorship (including contract number) to the data when delivered to the Government, as well as when the data are published or deposited for registration as a published work in the U.S. Copyright Office. The Contractor grants to the Government, and others acting on its behalf, a paid-up, nonexclusive, irrevocable, worldwide license for all delivered data to reproduce, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of the Government. (ii) If the Government desires to obtain copyright in data first produced in the performance of this contract and permission has not been granted as set forth in paragraph (c)(1)(i) of this clause, the Contracting Officer shall direct the Contractor to assign (with or without registration), or obtain the assignment of, the copyright to the Government or its designated assignee. (2) Data not first produced in the performance of this contract. The Contractor shall not, without prior written permission of the Contracting Officer, incorporate in data delivered under this contract any data not first produced in the performance of this contract and that contain the copyright notice of 17 U.S.C. 401 or 402, unless the Contractor identifies such data and grants to the Government, or acquires on its behalf, a license of the same scope as set forth in paragraph (c)(1) of this clause. (d) Release and use restrictions. Except as otherwise specifically provided for in this contract, the Contractor shall not use, release, reproduce, distribute, or publish any data first produced in the performance of this contract, nor authorize others to do so, without written permission of the Contracting Officer. (e) Indemnity. The Contractor shall indemnify the Government and its officers, agents, and employees acting for the Government against any liability, including costs and expenses, incurred as the result of the violation of trade secrets, copyrights, or right of privacy or publicity, arising out of the creation, delivery, publication, or use of any data furnished under this contract; or any libelous or other unlawful matter contained in such data. The provisions of this paragraph do not apply unless the Government provides notice to the Contractor as soon as practicable of any claim or suit, affords the Contractor an opportunity under applicable laws, rules, or regulations to participate in the defense of the claim or suit, and obtains the Contractor's consent to the settlement of any claim or suit other than as required by final decree of a court of competent jurisdiction; and these provisions do not apply to material furnished to the Contractor by the Government and incorporated in data to which this clause applies. (End of Clause)A.18 52.203-99 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS (DEVIATION) (FEB 2015) (a) The Contractor shall not require employees or contractors seeking to report fraud, waste, or abuse to sign or comply with internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or subcontractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information. (b) The contractor shall notify employees that the prohibitions and restrictions of any internal confidentiality agreements covered by this clause are no longer in effect. (c) The prohibition in paragraph (a) of this clause does not contravene requirements applicable to Standard Form 312, Form 4414, or any other form issued by a Federal department or agency governing the nondisclosure of classified information. (d)(1) In accordance with section 743 of Division E, Title VII, of the Consolidated and Further Continuing Resolution Appropriations Act, 2015 (Pub. L. 113-235), use of funds appropriated (or otherwise made available) under that or any other Act may be prohibited, if the Government determines that the Contractor is not in compliance with the provisions of this clause. (2) The Government may seek any available remedies in the event the contractor fails to comply with the provisions of this clause.(End of Clause)FAR NumberTitleDate52.228-5INSURANCE—WORK ON A GOVERNMENT INSTALLATIONJAN 199752.232-40PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS SUBCONTRACTORSDEC 2013A.19 52.233-3 PROTEST AFTER AWARD (AUG 1996) (a) Upon receipt of a notice of protest (as defined in FAR 33.101) or a determination that a protest is likely (see FAR 33.102(d)), the Contracting Officer may, by written order to the Contractor, direct the Contractor to stop performance of the work called for by this contract. The order shall be specifically identified as a stop-work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage. Upon receipt of the final decision in the protest, the Contracting Officer shall either— (1) Cancel the stop-work order; or (2) Terminate the work covered by the order as provided in the Default, or the Termination for Convenience of the Government, clause of this contract. (b) If a stop-work order issued under this clause is canceled either before or after a final decision in the protest, the Contractor shall resume work. The Contracting Officer shall make an equitable adjustment in the delivery schedule or contract price, or both, and the contract shall be modified, in writing, accordingly, if— (1) The stop-work order results in an increase in the time required for, or in the Contractor's cost properly allocable to, the performance of any part of this contract; and (2) The Contractor asserts its right to an adjustment within 30 days after the end of the period of work stoppage; provided, that if the Contracting Officer decides the facts justify the action, the Contracting Officer may receive and act upon a proposal submitted at any time before final payment under this contract. (c) If a stop-work order is not canceled and the work covered by the order is terminated for the convenience of the Government, the Contracting Officer shall allow reasonable costs resulting from the stop-work order in arriving at the termination settlement. (d) If a stop-work order is not canceled and the work covered by the order is terminated for default, the Contracting Officer shall allow, by equitable adjustment or otherwise, reasonable costs resulting from the stop-work order. (e) The Government's rights to terminate this contract at any time are not affected by action taken under this clause. (f) If, as the result of the Contractor's intentional or negligent misstatement, misrepresentation, or miscertification, a protest related to this contract is sustained, and the Government pays costs, as provided in FAR 33.102(b)(2) or 33.104(h)(1), the Government may require the Contractor to reimburse the Government the amount of such costs. In addition to any other remedy available, and pursuant to the requirements of Subpart 32.6, the Government may collect this debt by offsetting the amount against any payment due the Contractor under any contract between the Contractor and the Government.(End of Clause)A.20 52.237-3 CONTINUITY OF SERVICES (JAN 1991) (a) The Contractor recognizes that the services under this contract are vital to the Government and must be continued without interruption and that, upon contract expiration, a successor, either the Government or another contractor, may continue them. The Contractor agrees to (1) furnish phase-in training and (2) exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor. (b) The Contractor shall, upon the Contracting Officer's written notice, (1) furnish phase-in, phase-out services for up to 90 days after this contract expires and (2) negotiate in good faith a plan with a successor to determine the nature and extent of phase-in, phase-out services required. The plan shall specify a training program and a date for transferring responsibilities for each division of work described in the plan, and shall be subject to the Contracting Officer's approval. The Contractor shall provide sufficient experienced personnel during the phase-in, phase-out period to ensure that the services called for by this contract are maintained at the required level of proficiency. (c) The Contractor shall allow as many personnel as practicable to remain on the job to help the successor maintain the continuity and consistency of the services required by this contract. The Contractor also shall disclose necessary personnel records and allow the successor to conduct on-site interviews with these employees. If selected employees are agreeable to the change, the Contractor shall release them at a mutually agreeable date and negotiate transfer of their earned fringe benefits to the successor. (d) The Contractor shall be reimbursed for all reasonable phase-in, phase-out costs (i.e., costs incurred within the agreed period after contract expiration that result from phase-in, phase-out operations) and a fee (profit) not to exceed a pro rata portion of the fee (profit) under this contract.(End of Clause)A.21 52.223-6 DRUG-FREE WORKPLACE (MAY 2001) (a) Definitions. As used in this clause, "Controlled substances" means a controlled substance in schedules I through V of section 202 of the Controlled Substances Act (21 U.S.C. 812) and as further defined in regulation at 21 CFR 1308.11-1308.15. "Conviction" means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes. "Criminal drug statute" means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, possession or use of any controlled substance. "Drug-free workplace" means the site(s) for the performance of work done by the Contractor in connection with a specific contract where employees of the Contractor are prohibited from engaging in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance. "Employee" means an employee of a Contractor directly engaged in the performance of work under a Government contract. "Directly engaged" is defined to include all direct cost employees and any other Contractor employee who has other than a minimal impact or involvement in contract performance. "Individual" means an offeror/contractor that has no more than one employee including the offeror/contractor. (b) The Contractor, if other than an individual, shall—within 30 days after award (unless a longer period is agreed to in writing for contracts of 30 days or more performance duration); or as soon as possible for contracts of less than 30 days performance duration— (1) Publish a statement notifying its employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violations of such prohibition; (2) Establish an ongoing drug-free awareness program to inform such employees about— (i) The dangers of drug abuse in the workplace; (ii) The contractor's policy of maintaining a drug-free workplace; (iii) Any available drug counseling, rehabilitation, and employee assistance programs; and (iv) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. (3) Provide all employees engaged in performance of the contract with a copy of the statement required by subparagraph (b)(1) of this clause; (4) Notify such employees in writing in the statement required by subparagraph (b)(1) of this clause, that as a condition of continued employment on this contract, the employee will— (i) Abide by the terms of the statement; and (ii) Notify the employer in writing of the employee's conviction under a criminal drug statute for a violation occurring in the workplace no later than 5 days after such conviction; (5) Notify the Contracting Officer in writing within 10 calendar days after receiving notice under subdivision (a)(4)(ii) of this clause, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee; (6) Within 30 days after receiving notice under subparagraph (b)(4)(ii) of this provision of a conviction, take one of the following actions with respect to any employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination; or (ii) Require such employee to satisfactorily participate in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and (7) Make a good faith effort to maintain a drug-free workplace through implementation of subparagraphs (b)(1) through (b)(6) of this clause. (c) The Contractor, if an individual, agrees by award of the contract or acceptance of a purchase order, not to engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance while performing this contract. (d) In addition to other remedies available to the Government, the Contractor's failure to comply with the requirements of paragraph (b) and (c) of this clause may, pursuant to FAR 23.506, render the contractor subject to suspension of contract payments, termination of the contract for default, and suspension or debarment.(End of Clause)A.22 52.239-1 PRIVACY OR SECURITY SAFEGUARDS (AUG 1996) (a) The Contractor shall not publish or disclose in any manner, without the Contracting Officer's written consent, the details of any safeguards either designed or developed by the Contractor under this contract or otherwise provided by the Government. (b) To the extent required to carry out a program of inspection to safeguard against threats and hazards to the security, integrity, and confidentiality of Government data, the Contractor shall afford the Government access to the Contractor's facilities, installations, technical capabilities, operations, documentation, records, and databases. (c) If new or unanticipated threats or hazards are discovered by either the Government or the Contractor, or if existing safeguards have ceased to function, the discoverer shall immediately bring the situation to the attention of the other party.(End of Clause)FAR NumberTitleDate52.203-17CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER RIGHTSAPR 2014A.23 52.246-4 INSPECTION OF SERVICES—FIXED-PRICE (AUG 1996) (a) Definitions. "Services," as used in this clause, includes services performed, workmanship, and material furnished or utilized in the performance of services. (b) The Contractor shall provide and maintain an inspection system acceptable to the Government covering the services under this contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to the Government during contract performance and for as long afterwards as the contract requires. (c) The Government has the right to inspect and test all services called for by the contract, to the extent practicable at all times and places during the term of the contract. The Government shall perform inspections and tests in a manner that will not unduly delay the work. (d) If the Government performs inspections or tests on the premises of the Contractor or a subcontractor, the Contractor shall furnish, and shall require subcontractors to furnish, at no increase in contract price, all reasonable facilities and assistance for the safe and convenient performance of these duties. (e) If any of the services do not conform with contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. When the defects in services cannot be corrected by reperformance, the Government may (1) require the Contractor to take necessary action to ensure that future performance conforms to contract requirements and (2) reduce the contract price to reflect the reduced value of the services performed. (f) If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with contract requirements, the Government may (1) by contract or otherwise, perform the services and charge to the Contractor any cost incurred by the Government that is directly related to the performance of such service or (2) terminate the contract for default.(End of Clause)FAR NumberTitleDate52.204-9PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNELJAN 2011A.24 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): 52.233-2 SERVICE OF PROTEST (SEP 2006) Protests, as defined in section 33.101 of the Federal Acquisition Regulation, that are filed directly with an agency, and copies of any protests that are filed with the Government Accountability Office (GAO), shall be served on the Contracting Officer (addressed as follows) by obtaining written and dated acknowledgment of receipt from: LINDA D. ELEY Hand-Carried Address: Same as mail Mailing Address: PCAC - ST. LOUIS ATTN: LINDA D. ELEY 11152 S. TOWNE SQUARE ST. LOUIS MO 63123 (b) The copy of any protest shall be received in the office designated above within one day of filing a protest with the GAO.(End of Provision)A.26 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) The bidder or offeror agrees that if a contract is awarded to him/her, as a result of this solicitation, he/she will not advertise the award of the contract in his/her commercial advertising in such a manner as to state or imply that the Department of Veterans Affairs endorses a product, project or commercial line of endeavor.(End of Clause)A.27 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992) (a) Except as provided in paragraph (c) below, the Contractor shall display prominently, in common work areas within business segments performing work under VA contracts, Department of Veterans Affairs Hotline posters prepared by the VA Office of Inspector General. (b) Department of Veterans Affairs Hotline posters may be obtained from the VA Office of Inspector General (53E), P.O. Box 34647, Washington, DC 20043-4647. (c) The Contractor need not comply with paragraph (a) above if the Contractor has established a mechanism, such as a hotline, by which employees may report suspected instances of improper conduct, and instructions that encourage employees to make such reports.(End of Clause)A.28 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009) The offeror agrees, if awarded a contract, to use the service-disabled veteran-owned small businesses or veteran-owned small businesses proposed as subcontractors in accordance with 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, or to substitute one or more service-disabled veteran-owned small businesses or veteran-owned small businesses for subcontract work of the same or similar value.(End of Clause)A.29 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM REQUIREMENTS (DEC 2009) (a) This clause does not apply to small business concerns. (b) If the offeror is required to submit an individual subcontracting plan, the minimum goals for award of subcontracts to service-disabled veteran-owned small business concerns and veteran-owned small business concerns shall be at least commensurate with the Department's annual service-disabled veteran-owned small business and veteran-owned small business prime contracting goals for the total dollars planned to be subcontracted. (c) For a commercial plan, the minimum goals for award of subcontracts to service-disabled veteran-owned small business concerns and veteran-owned small businesses shall be at least commensurate with the Department's annual service-disabled veteran-owned small business and veteran-owned small business prime contracting goals for the total value of projected subcontracts to support the sales for the commercial plan. (d) To be credited toward goal achievements, businesses must be verified as eligible in the Vendor Information Pages database. The contractor shall annually submit a listing of service-disabled veteran-owned small businesses and veteran-owned small businesses for which credit toward goal achievement is to be applied for the review of personnel in the Office of Small and Disadvantaged Business Utilization. (e) The contractor may appeal any businesses determined not eligible for crediting toward goal achievements by following the procedures contained in 819.407.(End of Clause)A.30 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012) (a) Definitions. As used in this clause— (1) Contract financing payment has the meaning given in FAR 32.001. (2) Designated agency office has the meaning given in 5 CFR 1315.2(m). (3) Electronic form means an automated system transmitting information electronically according to the Accepted electronic data transmission methods and formats identified in paragraph (c) of this clause. Facsimile, email, and scanned documents are not acceptable electronic forms for submission of payment requests. (4) Invoice payment has the meaning given in FAR 32.001. (5) Payment request means any request for contract financing payment or invoice payment submitted by the contractor under this contract. (b) Electronic payment requests. Except as provided in paragraph (e) of this clause, the contractor shall submit payment requests in electronic form. Purchases paid with a Government-wide commercial purchase card are considered to be an electronic transaction for purposes of this rule, and therefore no additional electronic invoice submission is required. (c) Data transmission. A contractor must ensure that the data transmission method and format are through one of the following: (1) VA’s Electronic Invoice Presentment and Payment System. (See Web site at .) (2) Any system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) and chartered by the American National Standards Institute (ANSI). The X12 EDI Web site () includes additional information on EDI 810 and 811 formats. (d) Invoice requirements. Invoices shall comply with FAR 32.905. (e) Exceptions. If, based on one of the circumstances below, the contracting officer directs that payment requests be made by mail, the contractor shall submit payment requests by mail through the United States Postal Service to the designated agency office. Submission of payment requests by mail may be required for: (1) Awards made to foreign vendors for work performed outside the United States; (2) Classified contracts or purchases when electronic submission and processing of payment requests could compromise the safeguarding of classified or privacy information; (3) Contracts awarded by contracting officers in the conduct of emergency operations, such as responses to national emergencies; (4) Solicitations or contracts in which the designated agency office is a VA entity other than the VA Financial Services Center in Austin, Texas; or (5) Solicitations or contracts in which the VA designated agency office does not have electronic invoicing capability as described above.(End of Clause)A.31 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) The contractor shall obtain all necessary licenses and/or permits required to perform this work. He/she shall take all reasonable precautions necessary to protect persons and property from injury or damage during the performance of this contract. He/she shall be responsible for any injury to himself/herself, his/her employees, as well as for any damage to personal or public property that occurs during the performance of this contract that is caused by his/her employees fault or negligence, and shall maintain personal liability and property damage insurance having coverage for a limit as required by the laws of the State of MISSOURI. Further, it is agreed that any negligence of the Government, its officers, agents, servants and employees, shall not be the responsibility of the contractor hereunder with the regard to any claims, loss, damage, injury, and liability resulting there from.(End of Clause)A.32 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (SEPT 2007) (a) Definitions. As used in this provision—"Lobbying contact" has the meaning provided at 2 U.S.C. 1602(8). The terms "agency," "influencing or attempting to influence," "officer or employee of an agency," "person," "reasonable compensation," and "regularly employed" are defined in the FAR clause of this solicitation entitled "Limitation on Payments to Influence Certain Federal Transactions" (52.203-12). (b) Prohibition. The prohibition and exceptions contained in the FAR clause of this solicitation entitled "Limitation on Payments to Influence Certain Federal Transactions" (52.203-12) are hereby incorporated by reference in this provision. (c) Certification. The offeror, by signing its offer, hereby certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on its behalf in connection with the awarding of this contract. (d) Disclosure. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made. (e) Penalty. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by 31 U.S.C. 1352. Any person who makes an expenditure prohibited under this provision or who fails to file or amend the disclosure required to be filed or amended by this provision, shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.(End of Provision)A.33 52.209-5 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (DEVIATION)(MAR 2012) (a) In accordance with Division H, sections 8124 and 8125 of P.L. 112-74 and sections 738 and 739 of P.L. 112-55 none of the funds made available by either Act may be used to enter into a contract with any corporation that— (1) Has an unpaid federal tax liability, unless the agency has considered suspension or debarment of the corporation and the Suspension and Debarment Official has made a determination that this action is not necessary to protect the interests of the Government. (2) Has a felony criminal violation under any Federal or State law within the preceding 24 months, unless the agency has considered suspension or debarment of the corporation and Suspension and Debarment Official has made a determination that this action is not necessary to protect the interests of the Government. (b) The Offeror represents that— (1) The offeror does [ ] does not [ ] have any unpaid Federal tax liability that has been assessed and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability. (2) The offeror, its officers or agents acting on its behalf have [ ] have not [ ] been convicted of a felony criminal violation under a Federal or State law within the preceding 24 months.(End of Provision)A.34 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013) (a) Definitions. As used in this provision— "Administrative proceeding" means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables. "Federal contracts and grants with total value greater than $10,000,000" means— (1) The total value of all current, active contracts and grants, including all priced options; and (2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules). "Principal" means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions). (b) The offeror [ ] has [ ] does not have current active Federal contracts and grants with total value greater than $10,000,000. (c) If the offeror checked "has" in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information: (1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions: (i) In a criminal proceeding, a conviction. (ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more. (iii) In an administrative proceeding, a finding of fault and liability that results in— (A) The payment of a monetary fine or penalty of $5,000 or more; or (B) The payment of a reimbursement, restitution, or damages in excess of $100,000. (iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision. (2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence. (d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management database via HYPERLINK "" (see 52.204-7).(End of Provision)A.35 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014) (a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:Technical CapabilityPast PerformanceSmall Business Economic Size FactorsPrice Technical and past performance are more important than Small Business Economic Size Factors, when combined, all three factors are more important than price. (b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s). (c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.(End of Provision)INSTRUCTIONS GOVERNING THE SUBMISSION OF OFFERSPRE-PROPOSAL DISCUSSIONS: The pre-Proposal period is the period of time between the issuance of the Solicitation and due date for Proposals. This time period allows for an exchange of information between the Veteran’s Administration and all potential Offeror’s. All questions regarding this Solicitation shall be sent in writing directly to the Contracting Officer by e-mail to HYPERLINK "mailto:linda.eley@" linda.eley@. All submitted questions shall reference Solicitation No VA777-17-R-0103 in block five (5) of the Standard Form (SF) 1449 and the title referenced in the Performance Work Statement. The last day to submit questions shall be three (3) calendar days after the Solicitation release date. Answers to these questions shall be provided shortly thereafter in one (1) Amendment publically posted to FBO.The Contractor shall provide the following three (3) separate Proposal Volume submissions as three (3) separate attachments electronically by e-mail to the Contracting Officer.Volume 1 shall be titled “Volume 1 - Technical Capability consisting of:Evaluation Factor 1 – Technical Capability2. Volume 2 (two) shall be titled “Volume 2 – Past Performance Factor and Small Business Socioeconomic Size Factors” a. Evaluation Factor 3 – Past PerformanceEvaluation Factor 4 – Small Business Socioeconomic Size Factors3. Volume 3 (three) shall be titled “Volume 3 – Price” consisting of:Evaluation Factor 5 – PricingProvide a pricing narrative (basis of estimate) with one (1) copy of the Pricing Offer in an Excel Spreadsheet format4. The following information shall be submitted separately of the Volumes listed above:One scanned original copy of SF 1449 signature page (completing blocks 17a, 17b, 30a, 30b, and 30c) with original signature.One (1) copy of administrative information listed under section B-1 of the Solicitation submitted electronically to include all Section E provisions requiring completion.All representations and certifications listed in Section E of this Solicitation.Business Associate Agreement (Attachment 1 (Optional, but will be required prior to performance)Electronic copies of Offeror’s Proposal – Volume 1, Volume 2, and Volume 3 with the additional documents in their entirety shall be sent to the Contracting Officer at HYPERLINK "mailto:linda.eley@" linda.eley@ by e-mail on or before the due date and time as listed in Block eight (8) of the SF 1449. ADDITIONAL INFORMATION: Any Proposal submitted to the Contracting Officer ( HYPERLINK "mailto:linda.eley@" linda.eley@) after the due date and time listed in block eight (8) of the SF 1449 shall be considered nonresponsive to the Solicitation and rejected. It is the Offeror’s responsibility to insure that their Proposal is submitted in its entirety. Partial Proposals shall be considered non-responsive to the Solicitation and shall be rejected. The Offeror’s Proposal shall be written in plain language in twelve (12) font (the VA prohibits the use of elaborate technical Proposals). The Offeror shall clearly separate each Evaluation Factor submitted with their offer. The Offeror shall submit narrative responses tailored specifically to the tasks and to each evaluation factor. Note: Ensure all sub deliverables within each task are fully explained in each overall task narrative response. The Offeror shall not submit the company’s general marketing literature or brochures. Such materials are not considered responsive to the specific evaluation criteria and shall not be evaluated by the board. The Offeror’s technical section shall not exceed thirty (30) total pages in length. The Offeror’s past performance and Veteran-owned and Service Disabled Veteran-owned status shall not exceed ten (10) total pages in length. Note: The Offeror shall be registered in VETBIZ and be CVE certified to claim veteran’s preference at HYPERLINK "" . The Offeror’s pricing section has no page limit, however please attempt to keep its length under five (5) total pages in length, if possible. The Proposals shall be evaluated strictly in accordance with their written content. The Government reserves the right to award without discussions based upon the initial evaluation of Proposals. Proposals which merely restate the requirement or state that the requirement shall be met, without providing supporting rationale, are not sufficient to meet minimum requirements. This includes options under FAR 52.217-8, Option to Extend Services, which applies to this solicitation. Evaluation of options under FAR 52.217-8 will be accomplished by adding six months of the Offeror's price for the last potential period of performance under this contract to the Offeror's total price.? In this case, the Offeror's total price for the purpose of evaluation will include the base period, all option periods, and an additional six months of the last option period. Offerors must price only the base and option periods specified in the contract line item numbers (CLINs), and shall not submit a price for the potential six-month extension of services under FAR 52.217-8. The Government reserves the right to exercise the option under FAR 52.217-8 before the end of any of the contractor's performance periods. Evaluation of options shall not obligate the Government to exercise the option(s)."The Offeror’s shall address each evaluation factor in detail. The Offeror shall include all supporting details necessary for the Government to determine the Offeror’s technical qualifications and ability to perform the required services, as well as the adequacy and advantages of the Proposal.ADDENDUM TO 52.212-2 EVALUATION-COMMERCIAL ITEMS (JAN 1999)EVALUATION FACTORSThe Government will award one Contract resulting from this Solicitation to the responsible Offeror’s IAW FAR 13.106-1(2) whose offer conformning to the Solicitation will be most advantageous to the Government, price and other factors considered. This is Best Value Tradeoff procurement, using an integrated assessment approach. Factors are listed in descending order of importance. Technical and past performance factors are approximately equal in importance and significantly more important than Small Business Size Factors and Price. Price will become more important as technical, past performance and small business socio-economic size become more equal. Technical CapabilityPast PerformanceSmall Business Socioeconomic Size FactorsPriceOptions: The Government shall evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of Options shall not obligate the Government to exercise the option(s). Offeror Proposals shall be evaluated using the evaluation factors described below and must address, at a minimum, all elements listed in the Solicitation’s instructions to Offeror’s. The below ratings shall be used to reflect the assessment of each Evaluation Factor. Strength is an attribute of the offeror’s proposal which is likely to lead or contribute to successful Contract performance. A significant strength is an attribute of the Offeror’s Proposal which is very substantially likely to lead or contribute to successful Contract performance. Weakness is an attribute of the Offeror’s Proposal which is likely to increase the probability of unsuccessful Contract performance. A significant weakness is an attribute of the Offeror’s Proposal which is likely to substantially increase the probability of unsuccessful Contract performance.Deficiency is a material failure of a Proposal to meet a Government requirement or a combination of significant weaknesses in a Proposal that increases the risk of unsuccessful Contract performance to an unacceptable level.Extension of services will be evaluated at the time of award.Proposals must demonstrate a clear understanding of the standards and requirements outlined in the solicitation. The technical approach must meet or exceed contract requirements which will be evaluated in respect to providing the VA with a high level of confidence in successful performance. Contractors are cautioned that “parroting” of the Performance Work Statement with a statement of intent to perform does not reveal the Contractors’ understanding of the requirement or their capability for addressing it. Contractors were also cautioned that while the Government will strive for maximum objectivity, the technical evaluation process, by its nature, is subjective; therefore, professional judgment is implicit throughout the process.The technical proposal shall not exceed thirty (30) pages, past performance shall not exceed ten (10) pages and length for a not to exceed amount of forty (40) pages, 8 ?” x 11” standard paper, times new roman or similar font not less than 12 pitch, with 1” margins all around, double spaced. Graphs and tables must be easily readable and legible. The pricing schedule, SF1449, cover sheets, and index will not count in the technical proposal page count. Offerors are encouraged to limit their technical responses to meeting the evaluation criteria as expressed in the evaluation criteria. Offerors are encouraged to submit only requested information, CPARS, brochures, line cards and other branded information is not required. Technical proposal shall not have company logo imbedded on the pages, but may have identifying information on the first page, and RFP and numbering on subsequent pages.EVALUATION CRITERIA/WEIGHTING: ColorRatingDefinitionBlue ExceptionalIf a Proposal shows the Offeror clearly exceeds specified performance or capability in a beneficial way to the VA and has no significant weaknesses. High probability of success, it should be rated as "exceptional" and given a Color rating of Blue.Green AcceptableIf a Proposal shows that the Offeror meets evaluation standards and weaknesses are readily corrected. Good probability of success. Exceeds the minimum standard requirements for a given rating factor, it should be rated as "Acceptable" with a Color rating of Green.Yellow MarginalIf a Proposal shows that the Offeror fails to meet evaluation standards; however, any significant deficiencies are correctable. Low probability of satisfying requirements, it should be rated as "Marginal" with a Color rating of Yellow.Red UnacceptableIf a Proposal shows that the Offeror fails to meet the minimum requirements of the RFQ and the deficiency is not correctable without a major revision of the Proposal, it should be rated as "Unacceptable" with a Color rating of RED.Evaluation Factors are listed below.EVALUATION FACTOR - 1: TECHNICAL CAPABILITY The Offeror’s Proposal shall be evaluated for its detailed discussion and Offeror’s approach to proposed solutions and demonstrated ability to perform the type of work described by the PWS, and the qualifications of the Offeror’s technical expertise management approach as follows:Understanding the Requirement: Technical Proposal shall clearly demonstrate an understanding of the requirements, the context and the scope of the project.Methodology: Technical Proposal shall clearly demonstrate their approach to how the contractor will complete each task. (i.e. Technical Proposal shall be complete and specific to each of the tasks).Connectivity to Payers: The Offeror’s Proposal shall be evaluated on information that demonstrates ability to connect to current payers and demonstrate connections to those payers who are currently not reached.Accreditation(s): Shall be a fully “Accredited Healthcare Network” (HNAP-EHN and ePAP-EHN accredited) by the Electronic Healthcare Network Accreditation Commission (EHNAC) () at the time of proposal submission and maintain accreditation for the duration of the Contract.EVALUATION FACTOR - 2: PAST PERFORMANCEThe Offeror shall demonstrate successful past performance by providing recent and relevant past performance information on 3 (three) Contracts, for work completed within the past 3 (three) years, concerning previous history and completion of similar scale (size and scope) projects within the same time and cost estimates. Include the following information for each Contract and Sub-Contract listed:Name of the Contracting AgencyContract NumberContract TitleBrief Description of Contract/Sub-Contract and Relevance of this RequirementTotal Contract ValueContract TypePeriod of PerformanceContacting Officer and Telephone NumberProgram Manager or Project Officer, and Telephone NumberThe Government may also consider information obtained through other sources. Past performance information shall be utilized to determine the quality of the contractor’s past performance as it relates to the probability of success of the required effort.The Government shall evaluate Small Business (SB) participation. To receive credit, a firm must be registered in the SAM as a SB. A SB shall be evaluated as having a “Green/Acceptable” technical value for the purposes of arriving at the best value decision using price/technical tradeoffs.EVALUATION FACTOR 3 – SMALL BUSINESS SOCIOECONOMIC SIZE FACTORS852.215-70? Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors.SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (DEC 2009)(a) In an effort to achieve socioeconomic small business goals, depending on the evaluation factors included in the solicitation, VA shall evaluate offerors based on their service-disabled veteran-owned or veteran-owned small business status and their proposed use of eligible service disabled veteran-owned small businesses and veteran-owned small businesses as subcontractors.(b) Eligible service-disabled veteran-owned offerors will receive full credit, and offerors qualifying as veteran-owned small businesses will receive partial credit for the Service-Disabled Veteran-Owned and Veteran-owned Small Business Status evaluation factor.? To receive credit, an offeror must be registered and verified in Vendor Information Pages (VIP) database.? ( HYPERLINK "" \o "Visit the VetBiz website" ).(c) Non-veteran offerors proposing to use service-disabled veteran-owned small businesses or veteran-owned small businesses as subcontractors will receive some consideration under this evaluation factor.? Offerors must state in their proposals the names of the SDVOSBs and VOSBs with whom they intend to subcontract and provide a brief description of the proposed subcontracts and the approximate dollar values of the proposed subcontracts.? In addition, the proposed subcontractors must be registered and verified in the VIP database ( HYPERLINK "" \o "Visit the VetBiz website" ).The VA provides small, Veteran-Owned or Service-Disabled Veteran owned firms evaluation preference; therefore, if a small, Veteran-Owned or Service-Disabled owned firm is approximately technically equal to an other than SB, it shall be evaluated as having a higher technical value for the purposes of arriving at the best value decision using price/technical tradeoffs.Preference will be given for business status and assigned a corresponding rating in descending order. Note this is not a set-aside;A prime contractor that is Service-Disabled Veteran-Owned SB (SDVOSB) or a Veteran-Owned SB (VOSB) will receive a Blue/Exceptional rating; A prime contractor that is any category of SB will receive a Green/Acceptable rating;A prime contractor that is a large business that teams with any category of SB will receive a Yellow/Marginal rating; and A prime contractor that is a large business not teaming with a SB will receive a White/Neutral rating.The VA provides SDVOSB or VOSB firms evaluation preference; therefore, if a SDVOSB or VOSB owned firm is approximately technically equal to an other than SB, it shall be evaluated as having a “Blue/Exceptional” technical value for the purposes of arriving at the best value decision using price / technical tradeoffs. To receive credit, a firm must be registered in Offeror Information Pages ( HYPERLINK "" ).EVALUATION CRITERIA/WEIGHTING: ColorRatingDefinitionBlue ExceptionalA prime Contractor that is SDVOSB or a VOSB will receive a Blue/Exceptional rating. Green AcceptableA prime Contractor that is any category of SB will receive a Green/Acceptable rating.Yellow MarginalA prime Contractor that is a large business that teams with any category of SB will receive a Yellow/Marginal rating.White NeutralA prime Contractor that is a large business not teaming with a SB will receive a White/Neutral rating.The Government will evaluate SB participation. To receive credit, a firm must be registered in the SAM as a SB. A SB shall be evaluated as having a “Green/Acceptable” technical value for the purposes of arriving at the best value decision using price/technical tradeoffs.The Government will evaluate large business partnered with SB, participation. To receive credit, the SB partnering firms must be registered in the SAM as a SB. A large business teaming with a SB shall be evaluated as having a “Yellow/Marginal” technical value for the purposes of arriving at the best value decision using price/technical tradeoffs. Large businesses will also submit a subcontracting plan.EVALUATION FACTOR – 4: PRICEPricing: Pricing for this IDIQ shall be FFP and presented in accordance with the Offeror’s Proposal, including any discount being offered. Price shall be presented separately from the Technical Proposal and Past Performance. Offers: Offers which are unrealistic in terms of technical commitment or unrealistically low in price shall be deemed to show an inherent lack of technical competence or failure to comprehend the complexity and risk of the requirements. This may be grounds for the rejection of the quotation. The Government may reject any quotation that is unreasonable or materially unbalanced as to prices. An unbalanced quotation is one that incorporates prices significantly less than cost for some items and/or prices that are significantly overstated for other items.The Government shall utilize a “Best Value Trade-Off Method,” where the price shall not be point-scored; however, its importance shall increase should an Offeror’s proposal be close in their technical merit and point scores. (End of Addendum to 52.212-1)A.36 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (JAN 2017) The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site located at HYPERLINK "" . If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) of this provision. (a) Definitions. As used in this provision— Administrative merits determination means certain notices or findings of labor law violations issued by an enforcement agency following an investigation. An administrative merits determination may be final or be subject to appeal or further review. To determine whether a particular notice or finding is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance. Arbitral award or decision means an arbitrator or arbitral panel determination that a labor law violation occurred, or that enjoined or restrained a violation of labor law. It includes an award or decision that is not final or is subject to being confirmed, modified, or vacated by a court, and includes an award or decision resulting from private or confidential proceedings. To determine whether a particular award or decision is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance. Civil judgment means— (1) In paragraph (h) of this provision: A judgment or finding of a civil offense by any court of competent jurisdiction. (2) In paragraph (s) of this provision: Any judgment or order entered by any Federal or State court in which the court determined that a labor law violation occurred, or enjoined or restrained a violation of labor law. It includes a judgment or order that is not final or is subject to appeal. To determine whether a particular judgment or order is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance. DOL Guidance means the Department of Labor (DOL) Guidance entitled: “Guidance for Executive Order 13673, ‘Fair Pay and Safe Workplaces’ “. The DOL Guidance, dated August 25, 2016, can be obtained from HYPERLINK "\\\\DSI-KB2\\KBA_Work\\KBs\\Dev7\\GENTRAC\\Segments\\\\fairpayandsafeworkplaces" fairpayandsafeworkplaces. Economically disadvantaged women-owned small business (EDWOSB) concern means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program. Enforcement agency means any agency granted authority to enforce the Federal labor laws. It includes the enforcement components of DOL (Wage and Hour Division, Office of Federal Contract Compliance Programs, and Occupational Safety and Health Administration), the Equal Employment Opportunity Commission, the Occupational Safety and Health Review Commission, and the National Labor Relations Board. It also means a State agency designated to administer an OSHA-approved State Plan, but only to the extent that the State agency is acting in its capacity as administrator of such plan. It does not include other Federal agencies which, in their capacity as contracting agencies, conduct investigations of potential labor law violations. The enforcement agencies associated with each labor law under E.O. 13673 are— (1) Department of Labor Wage and Hour Division (WHD) for— (i) The Fair Labor Standards Act; (ii) The Migrant and Seasonal Agricultural Worker Protection Act; (iii) 40 U.S.C. chapter 31, subchapter IV, formerly known as the Davis-Bacon Act; (iv) 41 U.S.C. chapter 67, formerly known as the Service Contract Act; (v) The Family and Medical Leave Act; and (vi) E.O. 13658 of February 12, 2014 (Establishing a Minimum Wage for Contractors); (2) Department of Labor Occupational Safety and Health Administration (OSHA) for— (i) The Occupational Safety and Health Act of 1970; and (ii) OSHA-approved State Plans; (3) Department of Labor Office of Federal Contract Compliance Programs (OFCCP) for— (i) Section 503 of the Rehabilitation Act of 1973; (ii) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era Veterans' Readjustment Assistance Act of 1974; and (iii) E.O. 11246 of September 24, 1965 (Equal Employment Opportunity); (4) National Labor Relations Board (NLRB) for the National Labor Relations Act; and (5) Equal Employment Opportunity Commission (EEOC) for— (i) Title VII of the Civil Rights Act of 1964; (ii) The Americans with Disabilities Act of 1990; (iii) The Age Discrimination in Employment Act of 1967; and (iv) Section 6(d) of the Fair Labor Standards Act (Equal Pay Act). Forced or indentured child labor means all work or service— (1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or (2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties. Highest-level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner. Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: Ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees. Inverted domestic corporation means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). Labor compliance agreement means an agreement entered into between a contractor or subcontractor and an enforcement agency to address appropriate remedial measures, compliance assistance, steps to resolve issues to increase compliance with the labor laws, or other related matters. Labor laws means the following labor laws and E.O.s: (1) The Fair Labor Standards Act. (2) The Occupational Safety and Health Act (OSHA) of 1970. (3) The Migrant and Seasonal Agricultural Worker Protection Act. (4) The National Labor Relations Act. (5) 40 U.S.C. chapter 31, subchapter IV, formerly known as the Davis-Bacon Act. (6) 41 U.S.C. chapter 67, formerly known as the Service Contract Act. (7) E.O. 11246 of September 24, 1965 (Equal Employment Opportunity). (8) Section 503 of the Rehabilitation Act of 1973. (9) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era Veterans' Readjustment Assistance Act of 1974. (10) The Family and Medical Leave Act. (11) Title VII of the Civil Rights Act of 1964. (12) The Americans with Disabilities Act of 1990. (13) The Age Discrimination in Employment Act of 1967. (14) E.O. 13658 of February 12, 2014 (Establishing a Minimum Wage for Contractors). (15) Equivalent State laws as defined in the DOL Guidance. (The only equivalent State laws implemented in the FAR are OSHA-approved State Plans, which can be found at HYPERLINK "\\\\DSI-KB2\\KBA_Work\\KBs\\Dev7\\GENTRAC\\Segments\\\\dcsp\\osp\\approved_state_plans.html" dcsp/osp/approved_state_plans.html). Labor law decision means an administrative merits determination, arbitral award or decision, or civil judgment, which resulted from a violation of one or more of the laws listed in the definition of “labor laws”. Manufactured end product means any end product in product and service codes (PSCs) 1000-9999, except— (1) PSC 5510, Lumber and Related Basic Wood Materials; (2) Product or Service Group (PSG) 87, Agricultural Supplies; (3) PSG 88, Live Animals; (4) PSG 89, Subsistence; (5) PSC 9410, Crude Grades of Plant Materials; (6) PSC 9430, Miscellaneous Crude Animal Products, Inedible; (7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products; (8) PSC 9610, Ores; (9) PSC 9620, Minerals, Natural and Synthetic; and (10) PSC 9630, Additive Metal Materials. Place of manufacture means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture. Predecessor means an entity that is replaced by a successor and includes any predecessors of the predecessor. Restricted business operations means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate— (1) Are conducted under contract directly and exclusively with the regional government of southern Sudan; (2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization; (3) Consist of providing goods or services to marginalized populations of Sudan; (4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization; (5) Consist of providing goods or services that are used only to promote health or education; or (6) Have been voluntarily suspended. “Sensitive technology”— (1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically— (i) To restrict the free flow of unbiased information in Iran; or (ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and (2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)). Service-disabled veteran-owned small business concern— (1) Means a small business concern— (i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and (ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran. (2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16). Small business concern means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation. Small disadvantaged business concern, consistent with 13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that— (1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by— (i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and (ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and (2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition. Subsidiary means an entity in which more than 50 percent of the entity is owned— (1) Directly by a parent corporation; or (2) Through another subsidiary of a parent corporation. Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances. Veteran-owned small business concern means a small business concern— (1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and (2) The management and daily business operations of which are controlled by one or more veterans. Women-owned business concern means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women. Women-owned small business concern means a small business concern— (1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and (2) Whose management and daily business operations are controlled by one or more women. Women-owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States. Note to paragraph (a): By a court order issued on October 24, 2016, the following definitions in this paragraph (a) are enjoined indefinitely as of the date of the order: “Administrative merits determination”, “Arbitral award or decision”, paragraph (2) of “Civil judgment”, “DOL Guidance”, “Enforcement agency”, “Labor compliance agreement”, “Labor laws”, and “Labor law decision”. The enjoined definitions will become effective immediately if the court terminates the injunction. At that time, DoD, GSA, and NASA will publish a document in the Federal Register advising the public of the termination of the injunction. (b)(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted on the SAM website. (2) The offeror has completed the annual representations and certifications electronically via the SAM website access through HYPERLINK "" . After reviewing the SAM database information, the offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications—Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs . (c) Offerors must complete the following representations when the resulting contract will be performed in the United States or its outlying areas. Check all that apply. (1) Small business concern. The offeror represents as part of its offer that it [ ] is, [ ] is not a small business concern. (2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a veteran-owned small business concern. (3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a service-disabled veteran-owned small business concern. (4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ] is, [ ] is not a small disadvantaged business concern as defined in 13 CFR 124.1002. (5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ] is, [ ] is not a women-owned small business concern. (6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that— (i) It [ ] is, [ ] is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: ___________.] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation. (7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that— (i) It [ ] is, [ ] is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: ___________.] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold. (8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ] is a women-owned business concern. (9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price: ___________________________________________ (10) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that— (i) It [ ] is, [ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material change in ownership and control, principal office, or HUBZone employee percentage has occurred since it was certified by the Small Business Administration in accordance with 13 CFR Part 126; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for the HUBZone small business concern or concerns that are participating in the joint venture. [The offeror shall enter the name or names of the HUBZone small business concern or concerns that are participating in the joint venture:____________.] Each HUBZone small business concern participating in the joint venture shall submit a separate signed copy of the HUBZone representation. (d) Representations required to implement provisions of Executive Order 11246— (1) Previous contracts and compliance. The offeror represents that— (i) It [ ] has, [ ] has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and (ii) It [ ] has, [ ] has not filed all required compliance reports. (2) Affirmative Action Compliance. The offeror represents that— (i) It [ ] has developed and has on file, [ ] has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 CFR parts 60-1 and 60-2), or (ii) It [ ] has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. (e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352). (Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made. (f) Buy American Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American—Supplies, is included in this solicitation.) (1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.” The terms “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American—Supplies.” (2) Foreign End Products: Line Item No Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (3) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. (g)(1) Buy American—Free Trade Agreements—Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American—Free Trade Agreements—Israeli Trade Act, is included in this solicitation.) (i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms “Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product,” “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” “Free Trade Agreement country,” “Free Trade Agreement country end product,” “Israeli end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act.” (ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act”: Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) of this provision) as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act.” The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.” Other Foreign End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (iv) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. (2) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act”: Canadian End Products: Line Item No. __________________________________________ __________________________________________ __________________________________________[List as necessary] (3) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act”: Canadian or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (4) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act”: Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.) (i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled “Trade Agreements”. (ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end products. Other End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (iii) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American statute. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation. (h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals— (1) [ ] Are, [ ] are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; (2) [ ] Have, [ ] have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property; (3) [ ] Are, [ ] are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and (4) [ ] Have, [ ] have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied. (i) Taxes are considered delinquent if both of the following criteria apply: (A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted. (B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded. (ii) Examples. (A) The taxpayer has received a statutory notice of deficiency, under I.R.C. Sec. 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. Sec. 6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (C) The taxpayer has entered into an installment agreement pursuant to I.R.C. Sec. 6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment. (D) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code). (i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). (1) Listed end products.Listed End ProductListed Countries of Origin (2) Certification. [If the Contracting Officer has identified end products and countries of origin in paragraph (i)(1) of this provision, then the offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the appropriate block.] [ ] (i) The offeror will not supply any end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. [ ] (ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. The offeror certifies that it has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture any such end product furnished under this contract. On the basis of those efforts, the offeror certifies that it is not aware of any such use of child labor. (j) Place of manufacture. (Does not apply unless the solicitation is predominantly for the acquisition of manufactured end products.) For statistical purposes only, the offeror shall indicate whether the place of manufacture of the end products it expects to provide in response to this solicitation is predominantly— (1) __ In the United States (Check this box if the total anticipated price of offered end products manufactured in the United States exceeds the total anticipated price of offered end products manufactured outside the United States); or (2) __ Outside the United States. (k) Certificates regarding exemptions from the application of the Service Contract Labor Standards. (Certification by the offeror as to its compliance with respect to the contract also constitutes its certification as to compliance by its subcontractor if it subcontracts out the exempt services.) [] (1) Maintenance, calibration, or repair of certain equipment as described in FAR 22.1003-4(c)(1). The offeror [ ] does [ ] does not certify that— (i) The items of equipment to be serviced under this contract are used regularly for other than Governmental purposes and are sold or traded by the offeror (or subcontractor in the case of an exempt subcontract) in substantial quantities to the general public in the course of normal business operations; (ii) The services will be furnished at prices which are, or are based on, established catalog or market prices (see FAR 22.1003- 4(c)(2)(ii)) for the maintenance, calibration, or repair of such equipment; and (iii) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract will be the same as that used for these employees and equivalent employees servicing the same equipment of commercial customers. [] (2) Certain services as described in FAR 22.1003- 4(d)(1). The offeror [ ] does [ ] does not certify that— (i) The services under the contract are offered and sold regularly to non-Governmental customers, and are provided by the offeror (or subcontractor in the case of an exempt subcontract) to the general public in substantial quantities in the course of normal business operations; (ii) The contract services will be furnished at prices that are, or are based on, established catalog or market prices (see FAR 22.1003-4(d)(2)(iii)); (iii) Each service employee who will perform the services under the contract will spend only a small portion of his or her time (a monthly average of less than 20 percent of the available hours on an annualized basis, or less than 20 percent of available hours during the contract period if the contract period is less than a month) servicing the Government contract; and (iv) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract is the same as that used for these employees and equivalent employees servicing commercial customers. (3) If paragraph (k)(1) or (k)(2) of this clause applies— (i) If the offeror does not certify to the conditions in paragraph (k)(1) or (k)(2) and the Contracting Officer did not attach a Service Contract Labor Standards wage determination to the solicitation, the offeror shall notify the Contracting Officer as soon as possible; and (ii) The Contracting Officer may not make an award to the offeror if the offeror fails to execute the certification in paragraph (k)(1) or (k)(2) of this clause or to contact the Contracting Officer as required in paragraph (k)(3)(i) of this clause. (l) Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701). (Not applicable if the offeror is required to provide this information to the SAM database to be eligible for award.) (1) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the Internal Revenue Service (IRS). (2) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN. (3) Taxpayer Identification Number (TIN). [ ] TIN: _____________________. [ ] TIN has been applied for. [ ] TIN is not required because: [ ] Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; [ ] Offeror is an agency or instrumentality of a foreign government; [ ] Offeror is an agency or instrumentality of the Federal Government. (4) Type of organization. [ ] Sole proprietorship; [ ] Partnership; [ ] Corporate entity (not tax-exempt); [ ] Corporate entity (tax-exempt); [ ] Government entity (Federal, State, or local); [ ] Foreign government; [ ] International organization per 26 CFR 1.6049-4; [ ] Other _________________________. (5) Common parent. [ ] Offeror is not owned or controlled by a common parent; [ ] Name and TIN of common parent: Name _____________________. TIN _____________________. (m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies that the offeror does not conduct any restricted business operations in Sudan. (n) Prohibition on Contracting with Inverted Domestic Corporations. (1) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at 9.108-2(b) applies or the requirement is waived in accordance with the procedures at 9.108-4. (2) Representation. The Offeror represents that— (i) It [ ] is, [ ] is not an inverted domestic corporation; and (ii) It [ ] is, [ ] is not a subsidiary of an inverted domestic corporation. (o) Prohibition on contracting with entities engaging in certain activities or transactions relating to Iran. (1) The offeror shall email questions concerning sensitive technology to the Department of State at HYPERLINK "mailto:CISADA106@" CISADA106@. (2) Representation and certifications. Unless a waiver is granted or an exception applies as provided in paragraph (o)(3) of this provision, by submission of its offer, the offeror— (i) Represents, to the best of its knowledge and belief, that the offeror does not export any sensitive technology to the government of Iran or any entities or individuals owned or controlled by, or acting on behalf or at the direction of, the government of Iran; (ii) Certifies that the offeror, or any person owned or controlled by the offeror, does not engage in any activities for which sanctions may be imposed under section 5 of the Iran Sanctions Act; and (iii) Certifies that the offeror, and any person owned or controlled by the offeror, does not knowingly engage in any transaction that exceeds $3,500 with Iran’s Revolutionary Guard Corps or any of its officials, agents, or affiliates, the property and interests in property of which are blocked pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.) (see OFAC’s Specially Designated Nationals and Blocked Persons List at HYPERLINK "" ). (3) The representation and certification requirements of paragraph (o)(2) of this provision do not apply if— (i) This solicitation includes a trade agreements certification (e.g., 52.212–3(g) or a comparable agency provision); and (ii) The offeror has certified that all the offered products to be supplied are designated country end products. (p) Ownership or Control of Offeror. (Applies in all solicitations when there is a requirement to be registered in SAM or a requirement to have a unique entity identifier in the solicitation). (1) The Offeror represents that it [ ] has or [ ] does not have an immediate owner. If the Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (2) and if applicable, paragraph (3) of this provision for each participant in the joint venture. (2) If the Offeror indicates “has” in paragraph (p)(1) of this provision, enter the following information: Immediate owner CAGE code: ____. Immediate owner legal name: ____. (Do not use a “doing business as” name) Is the immediate owner owned or controlled by another entity: [ ] Yes or [ ] No. (3) If the Offeror indicates “yes” in paragraph (p)(2) of this provision, indicating that the immediate owner is owned or controlled by another entity, then enter the following information: Highest-level owner CAGE code: ____. Highest-level owner legal name: ____. (Do not use a “doing business as” name) (q) Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law. (1) As required by sections 744 and 745 of Division E of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235), and similar provisions, if contained in subsequent appropriations acts, The Government will not enter into a contract with any corporation that— (i) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or (ii) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government. (2) The Offeror represents that— (i) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and (ii) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months. (r) Predecessor of Offeror. (Applies in all solicitations that include the provision at 52.204-16, Commercial and Government Entity Code Reporting.) (1) The Offeror represents that it [ ] is or [ ] is not a successor to a predecessor that held a Federal contract or grant within the last three years. (2) If the Offeror has indicated “is” in paragraph (r)(1) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order): Predecessor CAGE code: ____ (or mark “Unknown”). Predecessor legal name: ____. (Do not use a “doing business as” name). (s) Representation regarding compliance with labor laws (Executive Order 13673). If the offeror is a joint venture that is not itself a separate legal entity, each concern participating in the joint venture shall separately comply with the requirements of this provision. (1)(i) For solicitations issued on or after October 25, 2016 through April 24, 2017: The Offeror [ ] does [ ] does not anticipate submitting an offer with an estimated contract value of greater than $50 million. (ii) For solicitations issued after April 24, 2017: The Offeror [ ] does [ ] does not anticipate submitting an offer with an estimated contract value of greater than $500,000. (2) If the Offeror checked “does” in paragraph (s)(1)(i) or (ii) of this provision, the Offeror represents to the best of the Offeror's knowledge and belief [Offeror to check appropriate block]: [ ](i) There has been no administrative merits determination, arbitral award or decision, or civil judgment for any labor law violation(s) rendered against the offeror (see definitions in paragraph (a) of this section) during the period beginning on October 25, 2015 to the date of the offer, or for three years preceding the date of the offer, whichever period is shorter; or [ ](ii) There has been an administrative merits determination, arbitral award or decision, or civil judgment for any labor law violation(s) rendered against the Offeror during the period beginning on October 25, 2015 to the date of the offer, or for three years preceding the date of the offer, whichever period is shorter. (3)(i) If the box at paragraph (s)(2)(ii) of this provision is checked and the Contracting Officer has initiated a responsibility determination and has requested additional information, the Offeror shall provide-- (A) The following information for each disclosed labor law decision in the System for Award Management (SAM) at , unless the information is already current, accurate, and complete in SAM. This information will be publicly available in the Federal Awardee Performance and Integrity Information System (FAPIIS): (1) The labor law violated. (2) The case number, inspection number, charge number, docket number, or other unique identification number. (3) The date rendered. (4) The name of the court, arbitrator(s), agency, board, or commission that rendered the determination or decision; (B) The administrative merits determination, arbitral award or decision, or civil judgment document, to the Contracting Officer, if the Contracting Officer requires it; (C) In SAM, such additional information as the Offeror deems necessary to demonstrate its responsibility, including mitigating factors and remedial measures such as offeror actions taken to address the violations, labor compliance agreements, and other steps taken to achieve compliance with labor laws. Offerors may provide explanatory text and upload documents. This information will not be made public unless the contractor determines that it wants the information to be made public; and (D) The information in paragraphs (s)(3)(i)(A) and (s)(3)(i)(C) of this provision to the Contracting Officer, if the Offeror meets an exception to SAM registration (see FAR 4.1102(a)). (ii)(A) The Contracting Officer will consider all information provided under (s)(3)(i) of this provision as part of making a responsibility determination. (B) A representation that any labor law decision(s) were rendered against the Offeror will not necessarily result in withholding of an award under this solicitation. Failure of the Offeror to furnish a representation or provide such additional information as requested by the Contracting Officer may render the Offeror nonresponsible. (C) The representation in paragraph (s)(2) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous representation, in addition to other remedies available to the Government, the Contracting Officer may terminate the contract resulting from this solicitation in accordance with the procedures set forth in FAR 12.403. (4) The Offeror shall provide immediate written notice to the Contracting Officer if at any time prior to contract award the Offeror learns that its representation at paragraph (s)(2) of this provision is no longer accurate. (5) The representation in paragraph (s)(2) of this provision will be public information in the Federal Awardee Performance and Integrity Information System (FAPIIS). Note to paragraph (s): By a court order issued on October 24, 2016, this paragraph (s) is enjoined indefinitely as of the date of the order. The enjoined paragraph will become effective immediately if the court terminates the injunction. At that time, DoD, GSA, and NASA will publish a document in the Federal Register advising the public of the termination of the injunction. (t) Public Disclosure of Greenhouse Gas Emissions and Reduction Goals. Applies in all solicitations that require offerors to register in SAM (52.212-1(k)). (1) This representation shall be completed if the Offeror received $7.5 million or more in contract awards in the prior Federal fiscal year. The representation is optional if the Offeror received less than $7.5 million in Federal contract awards in the prior Federal fiscal year. (2) Representation. [Offeror to check applicable block(s) in paragraph (t)(2)(i) and (ii)]. (i) The Offeror (itself or through its immediate owner or highest-level owner) [ ] does, [ ] does not publicly disclose greenhouse gas emissions, i.e., makes available on a publicly accessible Web site the results of a greenhouse gas inventory, performed in accordance with an accounting standard with publicly available and consistently applied criteria, such as the Greenhouse Gas Protocol Corporate Standard. (ii) The Offeror (itself or through its immediate owner or highest-level owner) [ ] does, [ ] does not publicly disclose a quantitative greenhouse gas emissions reduction goal, i.e., make available on a publicly accessible Web site a target to reduce absolute emissions or emissions intensity by a specific quantity or percentage. (iii) A publicly accessible Web site includes the Offeror’s own Web site or a recognized, third-party greenhouse gas emissions reporting program. (3) If the Offeror checked “does” in paragraphs (t)(2)(i) or (t)(2)(ii) of this provision, respectively, the Offeror shall provide the publicly accessible Web site(s) where greenhouse gas emissions and/or reduction goals are reported:_____. (u)(1) In accordance with section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions), Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with an entity that requires employees or subcontractors of such entity seeking to report waste, fraud, or abuse to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or subcontractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information. (2) The prohibition in paragraph (u)(1) of this provision does not contravene requirements applicable to Standard Form 312 (Classified Information Nondisclosure Agreement), Form 4414 (Sensitive Compartmented Information Nondisclosure Agreement), or any other form issued by a Federal department or agency governing the nondisclosure of classified information. (3) Representation. By submission of its offer, the Offeror represents that it will not require its employees or subcontractors to sign or comply with internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or subcontractors from lawfully reporting waste, fraud, or abuse related to the performance of a Government contract to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information (e.g., agency Office of the Inspector General).(End of Provision)FAR NumberTitleDate52.204-16COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTINGJUL 2016A.37 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION) (a) In an effort to achieve socioeconomic small business goals, depending on the evaluation factors included in the solicitation, VA shall evaluate offerors based on their service-disabled veteran-owned or veteran-owned small business status and their proposed use of eligible service-disabled veteran-owned small businesses and veteran-owned small businesses as subcontractors. (b) Eligible service-disabled veteran-owned offerors will receive full credit, and offerors qualifying as veteran-owned small businesses will receive partial credit for the Service-Disabled Veteran-Owned and Veteran-owned Small Business Status evaluation factor. To receive credit, an offeror must be registered and verified in Vendor Information Pages (VIP) database ( HYPERLINK "" ). (c) Non-veteran offerors proposing to use service-disabled veteran-owned small businesses or veteran-owned small businesses as subcontractors will receive some consideration under this evaluation factor. Offerors must state in their proposals the names of the SDVOSBs and VOSBs with whom they intend to subcontract and provide a brief description of the proposed subcontracts and the approximate dollar values of the proposed subcontracts. In addition, the proposed subcontractors must be registered and verified in the VIP database ( HYPERLINK "" ).(End of Provision)A.38 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) (a) Any protest filed by an interested party shall: (1) Include the name, address, fax number, and telephone number of the protester; (2) Identify the solicitation and/or contract number; (3) Include an original signed by the protester or the protester's representative and at least one copy; (4) Set forth a detailed statement of the legal and factual grounds of the protest, including a description of resulting prejudice to the protester, and provide copies of relevant documents; (5) Specifically request a ruling of the individual upon whom the protest is served; (6) State the form of relief requested; and (7) Provide all information establishing the timeliness of the protest. (b) Failure to comply with the above may result in dismissal of the protest without further consideration. (c) Bidders/offerors and contracting officers are encouraged to use alternative dispute resolution (ADR) procedures to resolve protests at any stage in the protest process. If ADR is used, the Department of Veterans Affairs will not furnish any documentation in an ADR proceeding beyond what is allowed by the Federal Acquisition Regulation.(End of Provision)A.39 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) As an alternative to filing a protest with the contracting officer, an interested party may file a protest with the Deputy Assistant Secretary for Acquisition and Materiel Management, Acquisition Administration Team, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, or for solicitations issued by the Office of Construction and Facilities Management, the Director, Office of Construction and Facilities Management, 810 Vermont Avenue, NW., Washington, DC 20420. The protest will not be considered if the interested party has a protest on the same or similar issues pending with the contracting officer.(End of Provision)A.40 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): (End of Provision)A.41 52.203-98 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS—REPRESENTATION (DEVIATION) (FEB 2015) (a) In accordance with section 743 of Division E, Title VII, of the Consolidated and Further Continuing Resolution Appropriations Act, 2015 (Pub. L. 113-235), Government agencies are not permitted to use funds appropriated (or otherwise made available) under that or any other Act for contracts with an entity that requires employees or subcontractors of such entity seeking to report fraud, waste, or abuse to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or contactors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information. (b) The prohibition in paragraph (a) of this provision does not contravene requirements applicable to Standard Form 312, Form 4414, or any other form issued by a Federal department or agency governing the nondisclosure of classified information. (c) Representation. By submission of its offer, the Offeror represents that it does not require employees or subcontractors of such entity seeking to report fraud, waste, or abuse to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or subcontractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information.(End of Provision)A.42 52.216-1 TYPE OF CONTRACT (APR 1984) The Government contemplates award of a fixed price Indefinite Delivery/Indefinite Quantity contract resulting from this solicitation.(End of Provision)A.43 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003) The Government intends to evaluate proposals and award a contract without exchanges with offerors. Therefore, each initial offer should contain the offeror's best terms from a cost or price and technical standpoint. However, the Government reserves the right to conduct exchanges if later determined by the contracting officer to be necessary.(End of Provision) PLEASE NOTE: The correct mailing information for filing alternate protests is as follows:Deputy Assistant Secretary for Acquisition and Logistics,Risk Management Team, Department of Veterans Affairs810 Vermont Avenue, N.W.Washington, DC 20420 Or for solicitations issued by the Office of Construction and Facilities Management:Director, Office of Construction and Facilities Management811 Vermont Avenue, N.W.Washington, DC 20420BUSINESS ASSOCIATE AGREEMENT BETWEEN THE DEPARTMENT OF VETERANS AFFAIRS VETERANS HEALTH ADMINISTRATION AND(Company Name)Purpose. The purpose of this Business Associate Agreement (Agreement) is to establish requirements for the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) and in accordance with the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH) Act, and the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules (“HIPAA Rules”), 45 C.F.R. Parts 160 and 164, for the Use and Disclosure of Protected Health Information (PHI) under the terms and conditions specified below.Scope. Under this Agreement and other applicable contracts or agreements, will provide services to, for, or on behalf of .In order for to provide such services, will disclose Protected Health Information to and will use or disclose Protected Health Information in accordance with this Agreement.Definitions. Unless otherwise provided, the following terms used in this Agreement have the same meaning as defined by the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information (PHI), Required by Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.“Business Associate” shall have the same meaning as described at 45 C.F.R. § 160.103. For the purposes of this Agreement, Business Associate shall refer to , including its employees, officers, or any other agents that create, receive, maintain, or transmit PHI as described below.“Covered Entity” shall have the same meaning as the term is defined at 45 C.F.R. § 160.103. For the purposes of this Agreement, Covered Entity shall refer to .“Protected Health Information” or “PHI” shall have the same meaning as described at 45 C.F.R. § 160.103. “Protected Health Information” and “PHI” as used in this Agreement include “Electronic Protected Health Information” and “EPHI.” For the purposes of this Agreement and unless otherwise provided, the term shall also refer to PHI that Business Associate creates, receives, maintains, or transmits on behalf of Covered Entity or receives from Covered Entity or another Business Associate. “Subcontractor” shall have the same meaning as the term is defined at 45 C.F.R. § 160.103. For the purposes of this Agreement, Subcontractor shall refer to a contractor of any person or entity, other than Covered Entity, that creates, receives, maintains, or transmits PHI under the terms of this Agreement.Terms and Conditions. Covered Entity and Business Associate agree as follows:1. Ownership of PHI. PHI is and remains the property of Covered Entity as long as Business Associate creates, receives, maintains, or transmits PHI, regardless of whether a compliant Business Associate agreement is in place. 2. Use and Disclosure of PHI by Business Associate. Unless otherwise provided, Business Associate: A. May not use or disclose PHI other than as permitted or required by this Agreement, or in a manner that would violate the HIPAA Privacy Rule if done by Covered Entity, except that it may use or disclose PHI: (1) As required by law or to carry out its legal responsibilities; (2) For the proper management and administration of Business Associate; or (3) To provide Data Aggregation services relating to the health care operations of Covered Entity. B. Must use or disclose PHI in a manner that complies with Covered Entity’s minimum necessary policies and procedures. C. May de-identify PHI created or received by Business Associate under this Agreement at the request of the Covered Entity, provided that the de-identification conforms to the requirements of the HIPAA Privacy Rule.3. Obligations of Business Associate. In connection with any Use or Disclosure of PHI, Business Associate must: A. Consult with Covered Entity before using or disclosing PHI whenever Business Associate is uncertain whether the Use or Disclosure is authorized under this Agreement. B. Implement appropriate administrative, physical, and technical safeguards and controls to protect PHI and document applicable policies and procedures to prevent any Use or Disclosure of PHI other than as provided by this Agreement. C. Provide satisfactory assurances that PHI created or received by Business Associate under this Agreement is protected to the greatest extent feasible. D. Notify Covered Entity within twenty-four (24) hours of Business Associate’s discovery of any potential access, acquisition, use, disclosure, modification, or destruction of either secured or unsecured PHI in violation of this Agreement, including any Breach of PHI. (1) Any incident as described above will be treated as discovered as of the first day on which such event is known to Business Associate or, by exercising reasonable diligence, would have been known to Business Associate. (2) Notification shall be sent to and and to the VHA Health Information Access Office, Business Associate Program Manager by email at HYPERLINK "mailto:VHABAAIssues@" VHABAAIssues@. (3) Business Associate shall not notify individuals or the Department of Health and Human Services directly unless Business Associate is not acting as an agent of Covered Entity but in its capacity as a Covered Entity itself. E. Provide a written report to Covered Entity of any potential access, acquisition, use, disclosure, modification, or destruction of either secured or unsecured PHI in violation of this Agreement, including any Breach of PHI, within ten (10) business days of the initial notification. (1) The written report of an incident as described above will document the following: (a) The identity of each Individual whose PHI has been, or is reasonably believed by Business Associate to have been, accessed, acquired, used, disclosed, modified, or destroyed; (b) A description of what occurred, including the date of the incident and the date of the discovery of the incident (if known); (c) A description of the types of secured or unsecured PHI that was involved; (d) A description of what is being done to investigate the incident, to mitigate further harm to Individuals, and to protect against future incidents; and (e) Any other information as required by 45 C.F.R. §§ 164.404(c) and 164.410. (2) The written report shall be addressed to: and submitted by email to and to the VHA Health Information Access Office, Business Associate Program Manager at HYPERLINK "mailto:VHABAAIssues@" VHABAAIssues@ F. To the greatest extent feasible, mitigate any harm due to a Use or Disclosure of PHI by Business Associate in violation of this Agreement that is known or, by exercising reasonable diligence, should have been known to Business Associate. G. Use only contractors and Subcontractors that are physically located within a jurisdiction subject to the laws of the United States, and ensure that no contractor or Subcontractor maintains, processes, uses, or discloses PHI in any way that will remove the information from such jurisdiction. Any modification to this provision must be approved by Covered Entity in advance and in writing. H. Enter into Business Associate Agreements with contractors and Subcontractors as appropriate under the HIPAA Rules and this Agreement. Business Associate: (1) Must ensure that the terms of any Agreement between Business Associate and a contractor or Subcontractor are at least as restrictive as Business Associate Agreement between Business Associate and Covered Entity. (2) Must ensure that contractors and Subcontractors agree to the same restrictions and conditions that apply to Business Associate and obtain satisfactory written assurances from them that they agree to those restrictions and conditions. (3) May not amend any terms of such Agreement without Covered Entity’s prior written approval. I. Within five (5) business days of a written request from Covered Entity: (1) Make available information for Covered Entity to respond to an Individual’s request for access to PHI about him/her. (2) Make available information for Covered Entity to respond to an Individual’s request for amendment of PHI about him/her and, as determined by and under the direction of Covered Entity, incorporate any amendment to the PHI. (3) Make available PHI for Covered Entity to respond to an Individual’s request for an accounting of Disclosures of PHI about him/her. J. Business Associate may not take any action concerning an individual’s request for access, amendment, or accounting other than as instructed by Covered Entity. K. To the extent Business Associate is required to carry out Covered Entity's obligations under Subpart E of 45 CFR Part 164, comply with the provisions that apply to Covered Entity in the performance of such obligations. L. Provide to the Secretary of Health and Human Services and to Covered Entity records related to Use or Disclosure of PHI, including its policies, procedures, and practices, for the purpose of determining Covered Entity’s, Business Associate’s, or a Subcontractor’s compliance with the HIPAA Rules. M. Upon completion or termination of the applicable contract(s) or agreement(s), return or destroy, as determined by and under the direction of Covered Entity, all PHI and other VA data created or received by Business Associate during the performance of the contract(s) or agreement(s). No such information will be retained by Business Associate unless retention is required by law or specifically permitted by Covered Entity. If return or destruction is not feasible, Business Associate shall continue to protect the PHI in accordance with the Agreement and use or disclose the information only for the purpose of making the return or destruction feasible, or as required by law or specifically permitted by Covered Entity. Business Associate shall provide written assurance that either all PHI has been returned or destroyed, or any information retained will be safeguarded and used and disclosed only as permitted under this paragraph. N. Be liable to Covered Entity for civil or criminal penalties imposed on Covered Entity, in accordance with 45 C.F.R. §§ 164.402 and 164.410, and with the HITECH Act, 42 U.S.C. §§ 17931(b), 17934(c), for any violation of the HIPAA Rules or this Agreement by Business Associate.4. Obligations of Covered Entity. Covered Entity agrees that it: A. Will not request Business Associate to make any Use or Disclosure of PHI in a manner that would not be permissible under Subpart E of 45 C.F.R. Part 164 if made by Covered Entity, except as permitted under Section 2 of this Agreement. B. Will promptly notify Business Associate in writing of any restrictions on Covered Entity’s authority to use or disclose PHI that may limit Business Associate’s Use or Disclosure of PHI or otherwise affect its ability to fulfill its obligations under this Agreement. C. Has obtained or will obtain from Individuals any authorization necessary for Business Associate to fulfill its obligations under this Agreement. D. Will promptly notify Business Associate in writing of any change in Covered Entity’s Notice of Privacy Practices, or any modification or revocation of an Individual’s authorization to use or disclose PHI, if such change or revocation may limit Business Associate’s Use and Disclosure of PHI or otherwise affect its ability to perform its obligations under this Agreement.5. Amendment. Business Associate and Covered Entity will take such action as is necessary to amend this Agreement for Covered Entity to comply with the requirements of the HIPAA Rules or other applicable law.6. Termination. A. Automatic Termination. This Agreement will automatically terminate upon completion of Business Associate’s duties under all underlying Agreements or by termination of such underlying Agreements. B. Termination Upon Review. This Agreement may be terminated by Covered Entity, at its discretion, upon review as provided by Section 9 of this Agreement. C. Termination for Cause. In the event of a material breach by Business Associate, Covered Entity: (1) Will provide an opportunity for Business Associate to cure the breach or end the violation within the time specified by Covered Entity; (2) May terminate this Agreement and underlying contract(s) if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity. D. Effect of Termination. Termination of this Agreement will result in cessation of activities by Business Associate involving PHI under this Agreement. E. Survival. The obligations of Business Associate under this Section shall survive the termination of this Agreement as long as Business Associate creates, receives, maintains, or transmits PHI, regardless of whether a compliant Business Associate Agreement is in place.7. No Third Party Beneficiaries. Nothing expressed or implied in this Agreement confers any rights, remedies, obligations, or liabilities whatsoever upon any person or entity other than Covered Entity and Business Associate, including their respective successors or assigns.8. Other Applicable Law. This Agreement does not abrogate any responsibilities of the parties under any other applicable law.9. Review Date. The provisions of this Agreement will be reviewed by Covered Entity every two years from Effective Date to determine the applicability and accuracy of the Agreement based on the circumstances that exist at the time of review.10. Effective Date. This Agreement shall be effective on the last signature date below.Department of Veterans Affairs Veterans Health AdministrationBy: By: Name: Name: Title: Title: Date: Date: ................
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