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5. PROJECT NUMBER (if applicable)CODE7. ADMINISTERED BY2. AMENDMENT/MODIFICATION NUMBERCODE6. ISSUED BY8. NAME AND ADDRESS OF CONTRACTOR4. REQUISITION/PURCHASE REQ. NUMBER3. EFFECTIVE DATE9A. AMENDMENT OF SOLICITATION NUMBER9B. DATEDPAGEOF PAGES10A. MODIFICATION OF CONTRACT/ORDER NUMBER10B. DATEDBPA NO.1. CONTRACT ID CODEFACILITY CODECODE Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of OffersE. IMPORTANT:is extended, (a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAYis not extended.12. ACCOUNTING AND APPROPRIATION DATA(REV. 11/2016)is required to sign this document and return ___________ copies to the issuing office.is not,A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.15C. DATE SIGNEDB. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b). RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:D. OTHERBYContractor16C. DATE SIGNED14. DESCRIPTION OF AMENDMENT/MODIFICATION16B. UNITED STATES OF AMERICAExcept as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.15A. NAME AND TITLE OF SIGNER16A. NAME AND TITLE OF CONTRACTING OFFICER15B. CONTRACTOR/OFFERORSTANDARD FORM 30 PREVIOUS EDITION NOT USABLEPrescribed by GSA - FAR (48 CFR) 53.243(Type or print)(Type or print)(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)(Number, street, county, State and ZIP Code)(If other than Item 6)(Specify type of modification and authority)(such as changes in paying office, appropriation date, etc.)(If required)(SEE ITEM 11)(SEE ITEM 13)(X)CHECKONE13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONSAMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT(Signature of person authorized to sign)(Signature of Contracting Officer)15A0000304-14-2017741-17-1-1802-0009741-17-1-356-0002000259Department of Veterans AffairsNetwork Contracting OfficeNCO 193773 Cherry Creek North DriveDenver CO 8020900259Department of Veterans AffairsNetwork Contracting OfficeNCO 193773 Cherry Creek North DriveDenver CO 80209To all Offerors/Bidders VA259-17-R-018104-14-2017 XXX1April 23, 2017, 12:am(midnight)MT741-36X0172-1802-866800-2580-SPW0BP8A1741-3670152-356-805100-2580-SPW0APPA4X1The purpose of this amendment is to answer questions from the vendors.A modified PWS and CLIN structure are attached. Replace B1.3 Contractor Remittance Address: All payments by the Government to the Contractor will be made in accordancewith FAR.232-33 Payment by Electronic Funds - Systems for Award Management All other terms and conditions remain the same. Timothy J. MyersContracting OfficerPCOE15L3-2709 CONTINUATION PAGEB.3 PRICE/COST SCHEDULEMAXIMUM ORDERS: The maximum limit of contractor’s obligation to deliver is $20,000,000.00.Base Year May 01, 2017 – April 30, 2018CLINDeliverablesEst. Annual QuantityUnit of IssueUnit PriceEst. Total PricePWS Ref0001Provide single location for mail service to receive, convert, and transmit all paper-based-forms as identified in the PWS. Unit pricing shall be for receipt, conversion, and transmission of forms to VA Clearing house, Change Healthcare in accordance with the terms, conditions and schedule of the contract. 5,020,000EA$$2.20002Provide weekly, a detailed report on volumes processed by category as to Total Paper Received, # Professional,# Institutional,# Dental,# converted, and # conversion failures52WEEK$$2.4.10003Provide ad hoc reports analyzing Total Paper Received, # Professional,# Institutional, # Dental, # converted, and # conversion failures. From the time of award, the report might be needed two per quarter within five (5) business days of the reporting date.8 EA$$0004Startup: Provide Project Management for 90-day start-up to include written weekly status updates reporting on schedules review, risk review, tasks accomplished in the past week, explanation of tasks not accomplished as expected and tasks to be completed.90DAYS$ $(End of Page)Option Year One (1) May 01, 2018 – April 30, 2019CLINDeliverablesEst. Annual QuantityUnit of IssueUnit PriceEst. Total PricePWS Ref1001Provide single location for mail service to receive, convert, and transmit all paper-based-forms as identified in the PWS. Unit pricing shall be for receipt, conversion, and transmission of forms to VA Clearing house, Change Healthcare in accordance with the terms, conditions and schedule of the contract.8,750,000EA$$2.21002Provide weekly, a detailed report on volumes processed by category as to Total Paper Received, # Professional,# Institutional,# Dental,# converted, and # conversion failures52week$$2.4.11003Provide ad hoc reports analyzing Total Paper Received, # Professional,# Institutional, # Dental, # converted, and # conversion failures. From the time of award, the report might be needed two per quarter within five (5) business days of the reporting date.8 EA$$(End of Page)Option Year Two (2) May 01, 2019 – August 31, 2019CLINDeliverablesEst. Annual QuantityUnit of IssueUnit PriceEst. Total PricePWS Ref2001Provide single location for mail service to receive, convert, and transmit all paper-based-forms as identified in the PWS. Unit pricing shall be for receipt, conversion, and transmission of forms to VA Clearing house, Change Healthcare in accordance with the terms, conditions and schedule of the contract.3,214,850EA$$2.22002Provide weekly, a detailed report on volumes processed by category as to Total Paper Received, # Professional,# Institutional, # Dental, # converted, and # conversion failures.52week$$2.4.12003Provide ad hoc reports analyzing Total Paper Received, # Professional,# Institutional, # Dental, # converted, and # conversion failures. From the time of award, the report might be needed two per quarter within five (5) business days of the reporting date.8 EA$$B.4 PERFORMANCE WORK STATEMENTGENERAL INFORMATION1.1 TITLE OF PROJECT1.1 Healthcare Clearinghouse Support for paper-based Health claims and associated medical documentation.1.2 Background The VA Office of Community Care (CC), operating as a payer in the medical billing process, accepts both paper and electronic submissions for health claims and for their supporting documentation (i.e. attachments). Submissions are received from community healthcare providers in support of both Veteran and Veteran Family Member health benefit programs for processing and payment. The electronic submissions are healthcare electronic data interchanges (EDI) compliant with and governed by the Department of Health and Human Services (HHS) through the Health Insurance Portability and Accountability Act (HIPAA). VA currently uses the X12 5010 standard, which will be updated per HHS timelines. VA receives EDI through a single contracted clearinghouse, Change Healthcare, which provides batch file deliveries twice daily. Paper claims and supporting documentation are received locally at the medical centers across the country or, for family members’ claims at the Health Administration Center in Denver, CO.VA seeks to employ contracted resources utilizing a single national location that will receive paper-based submissions and convert these submissions to electronic formats and transmit these submissions via EDI to its contracted clearinghouse. VA’s uses the 5010 version of the X12 standards for all of its EDI transactions. VA expects to implement its internal solution for the management of attachments using the X12 EDI 275 transaction concurrent with the award of this contract for paper to EDI conversion. 1.3 Scope of WorkThe Contractor shall provide all services related to receiving paper claims and/or paper medical documentation from community health care providers, in a single location, converting these documents to the appropriate HIPAA-compliant EDI transactions and sending these documents to VA’s contracted clearinghouse, Change Healthcare, as EDI transactions.2.0 DESCRIPTION OF REQUIREMENTS, SERVICES, AND DELIVERABLESThe contractor shall meet the general requirements, complete the tasks and provide the deliverables outlined below.2.1 GENERAL REQUIREMENTS2.1.1 The Contractor shall provide full and complete implementation within 90 days of award.2.1.2 The contractor shall provide services capable of receiving paper claims and paper claims’ attachments via postal mail per month in a single location. 2.1.3 The contractor must be a fully accredited “Healthcare Network” by the Electronic Healthcare Network Accreditation Commission (EHNAC) at the time of proposal submission and maintain accreditation for the duration of the contract.2.1.4 The contractor must be certified by the Council for Affordable and Quality Healthcare (CAQH) as a CORE Phase I and II Certified Clearinghouse at the time of award and maintain certifications in accordance with CAQH Guidelines for the duration of the contract.2.1.5 The Contractor shall utilize transaction formats that are compliant with the mandated HIPAA-compliant X12 EDI in the 5010 standard. The contractor shall be able to implement new standards as the industry moves to future mandates. 2.1.6 The Government shall complete their review of draft deliverables within seven (7) business days from date of receipt. The contractor shall have 5 business days to deliver the final deliverable from the date of receipt of the Government’s comments.2.1.7 During Implementation and transition activities, the contractor shall provide written weekly status updates to report on topics such as: schedule review, risk review, tasks accomplished in the past week, explanation of tasks not accomplished as expected, and tasks to be accomplished in the upcoming week.2.1.8 The contractor shall create and distribute routine reports that fully document the details of the transaction and conversion volumes. 2.1.9 The contractor shall have the capability to send transaction in HIPAA-compliant EDI format to VA’s current clearinghouse.2.1.10 The contractor shall acknowledge in their proposal they are a Covered Entity under the Administrative Simplification provisions of HIPAA and comply with all privacy, security, and disclosure requirements. 2.2 TASK ONE: PAPER CLAIMS AND/ OR MEDICAL DOCUMENTATION TO EDI2.2.1 The contractor shall receive paper healthcare claims at a single location through postal services from VA community providers. Claims received will be reformatted into the industry standard healthcare claims form format (identified below). The contractor shall create from that input the appropriate HIPAA-compliant X12 837 (i.e. Electronic Data Interchange (EDI) Claim) transactions and deliver them to Change Healthcare. 2.2.2 The contractor shall receive the following paper claims forms: Red HCFA (CMS-1500), Black HCFA (CMS-1500), Red UB (UB-04), Black UB (UB-04) and American Dental Association (ADA) Dental Form. For purposes of pricing, for the types of forms presented herein, the volumes are estimated as follows. Quantities are estimates only and pricing shall not be adjusted based on neither higher nor lower quantities being requested. The contractor shall provide a single price for receipt, conversion and transmission to the VA clearing house Change Healthcare, in accordance with the schedule of pricing.Base YearPaper based form Red HCFA (CMS 1500) to EDI 8371,550,000EAPaper based form Black HCFA (CMS 1500) to EDI 837750,000EAPaper based form Red UB (UB 04) to 837700,000EAPaper based form Black UB (UB 04) to 837700,000EAPaper based form Red ADA Dental Form to 83720,000EAPaper based form Supporting Documentation to 2751,300,000EAOption Year One (1)Paper based form Red HCFA (CMS 1500) to EDI 8372,375,000EAPaper based form Black HCFA (CMS 1500) to EDI 8371,625,000EAPaper based form Red UB (UB 04) to 8371,100,000EAPaper based form Black UB (UB 04) to 8371,525,000EAPaper based form Red ADA Dental Form to 83725,000EAPaper based form Supporting Documentation to 2752,100,000EAOption Year Two (2)Paper based form Red HCFA (CMS 1500) to EDI 8371,000,000EAPaper based form Black HCFA (CMS 1500) to EDI 837550,000EAPaper based form Red UB (UB 04) to 837400,000EAPaper based form Black UB (UB 04) to 837400,000EAPaper based form Red ADA Dental Form to 83714,850EAPaper based form Supporting Documentation to 275850,000EA2.2.3 The contractor shall receive paper medical documentation at a single location through postal services in support of healthcare claims or authorizations and create HIPAA-compliant X12 EDI 275 (i.e. Claims Attachments) transactions and deliver them to the VA.2.2.4 The Contractor shall convert ninety-eight percent (98%) of all clean paper-based forms to HIPAA compliant EDI transactions within 2 business days of receipt and one hundred percent (100%) of all paper-based forms within 5 business days. 2.2.5 The Contractor shall return one hundred percent (100%) of claims, other than Clean Claims, to the provider and with a clear explanation of deficiencies within ten (10) business days of original receipt. 2.2.6 The Contractor shall confirm the actual date of receipt is recorded in order to report on claims aging and inventory controls. These controls are defined in the preceding general requirements.2.2.7 The contractor shall provide within Claims Attachments transactions identifiers and means to match to the existing claim.2.2.8 The Contractor shall meet a data quality performance metric of >99.5% for overall data quality inclusive of Optical Character Recognition (OCR) and keyed data (including hand written forms). 2.2.9 The contractor performs data validation for the transfer of paper through OCR to meet the established performance metric.2.2.10 The contractor shall provide for paper retention of received paper claims or paper medical documentation for six calendar weeks after receipt. 2.2.11 The contractor shall provide all services necessary to return to sender the “inappropriate paper” and paper forms that are illegible that may be received, i.e. claims that are not contained on designated claims forms or valid medical documentation.2.2.12 The EDI 275 transaction file shall include a unique Trace Number (TRN) segment that contains the Provider Attachment Control Number.?2.2.13 The EDI 837 transaction file shall include a Paperwork (PWK) segment that contains the Attachment Control Number to include the matching unique TRN.? 2.2.14 The Contractor shall comply with those EDI Standard Transactions by the compliance dates as specified by HHS when additional accompanying EDI Standard Transactions are adopted and mandated by CMS for use at a future date. 2.3 TASK TWO: EDI SUBMISSIONS 2.3.1 The contractor shall deliver EDI transactions, i.e. X12 837 and X12 275 to Change Healthcare. The approach should mitigate the risks of a potential inability to reconcile the attachment with the associated claim. For purposes of pricing, for the types of transmissions presented herein, the volumes are estimated as follows. Quantities are estimates only and pricing shall not be adjusted based on neither higher nor lower quantities being requested. The contractor shall provide a single price for receipt, conversion and transmission to the VA clearing house Change Healthcare in accordance with the schedule of pricing. Base YearTransfer EDI Claims 837 to HCCH3,670,000EATransfer EDI Attachment 275 to VA HCCH1,300,000EAOption Year One (1)Transfer EDI Claims 837 to HCCH6,650,000EATransfer EDI Attachment 275 to VA HCCH2,100,000EAOption Year Two (2)Transfer EDI Claims 837 to HCCH2,364,850EATransfer EDI Attachment 275 to VA HCCH850,000EA2.4 TASK THREE: REPORTING AND ACCOUNTABILITY2.4.1 The Contractor shall provide Weekly Reports to VA that summarizes all paper preparation and transmission volumes. The Contractor shall include totals for: Total Paper Received, # Professional,# Institutional,# Dental,# converted, and # conversion failures.2.4.2 The Contractor shall provide EDI ad hoc reports, Total Paper Received, # Professional,# Institutional,# Dental,# converted, and # conversion failures. From the date of award, the report might be needed twice per quarter due within five (5) business days of the date the Contracting Officer Representative (COR) request the report.2.5 INSPECTIONSVA shall be allowed to schedule inspections of centralized mail services with advance notice of 2 weeks and be provided with documentation as to the error rate with regards to any aspect of the process as necessary. 2.6 HOURS OF WORKNormal operational hours for the EDI Program Office are from 7:00 AM to 4:30 PM Mountain Time. 2.7 MATERIALS TO BE FURNISHEDThis section is not applicable. 2.8 RECORDSThe contractor shall maintain the paper received for six calendar weeks from receipt before destroying. 2.9 QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)The Government shall evaluate the Contractor’s performance as stated in the QASP. For those tasks listed in the QASP, the COR or evaluators shall follow the methods of surveillance specified in this agreement. The Government shall record all surveillance observations. When an observation indicates defective performance, the COR shall forward the observation to the Contractor manager or alternate(s), who shall initial the observation. The initialing of the observation does not necessarily constitute concurrence with the observation, only acknowledgement that he or she has been made aware of the defective performance. Government surveillance of tasks not listed in the QASP or by methods other than those listed in the QASP may occur during the performance period of this agreement. Such surveillance shall be done according to standard inspection procedures or other agreement provisions. Any action taken by the Contracting Officer as a result of surveillance shall be in accordance with the terms of this agreement.The COR will serve as the final authority on whether a task is performed accurately. The Government will return deliverables to the Contractor as needed for re-work; a task shall not be considered accurate until all applicable re-work has been performed.2.10 PERFORMANCE EVALUATION MEETINGSThe Contracting Officer may require the Contractor to meet with Government personnel as deemed necessary. The Contractor may request a meeting with the Contracting Officer or COR when the Contractor believes such a meeting is necessary. At a minimum, the Contractor’s Account or Project Manager (and other Key Personnel), and the Contracting Officer or COR (or other Government personnel as deemed necessary) shall meeting monthly to discuss the ongoing operation of the Contract. The Contractor shall prepare written minutes of such meetings, which shall be recorded in the COR contract file. The Contractor’s Account or Project Manager and the VA COR shall sign the minutes indicating their approval or provide in writing their non-concurrence within five calendar days following receipt of the minutes.2.11 CONTRACTOR SOFTWARE CONFIGURATION MANAGEMENT REQUIREMENTSThe Contractor shall utilize a solution to support the requirements herein that is configurable to allow for changes to be tested, accepted, and implemented. When VA requests a change, the Contractor shall implement the change by the mutually agreed upon date.3.0 KEY PERSONNEL Approval of key personnel, Sr. Project Manager and Sr. Technical Manager for Digital Conversion, as specified in the contractor’s proposal, who will be working on this project, must be obtained from the government within five business days of any change in these key personnel. The contractor’s account/project manager is a key person as defined by this section contract type. Substitution of Key Personnel: All Contractor requests for approval of substitutions hereunder shall be submitted in writing to the Contracting Officer Representative (COR) and the Contracting Officer at least thirty (30) calendar days in advance of the effective date, whenever possible, and shall provide an explanation of the circumstances necessitating the proposed substitution, a complete resume for the proposed substitute, and any other information requested by the Contracting Officer necessary to approve or disapprove the proposed substitution.? New personnel shall not commence work until all necessary security requirements have been fulfilled and resumes provided and accepted. The COR and the Contracting Officer will evaluate such requests and promptly notify the Contractor of approval or disapproval in writing. The Contractor shall be responsible for managing and overseeing the activities of all Contractor personnel, as well as subcontractor efforts used in performance of this effort.? The Contractor’s management responsibilities shall include all activities necessary to ensure the accomplishment of timely and effective support, performed in accordance with the requirements contained in the Performance Work Statement. 4.0 PLACE OF PERFORMANCEThe Contractor shall support this effort at approved Contractor facilities as directed by the VA COR and mutually agreed to by the Contractor.5.0 ADMINISTRATIVE INFORMATIONThe VA point of contact for this effort is:EDI Program Manager Office of Community CareBusiness Systems Management3773 Cherry Creek Drive N Suite 910 Denver, Colorado 80209 6.0 ACRONYMS/TERMS AND DEFINITIONSAcronym/TermDefinitionClean ClaimA health claim that is legible and contains all information necessary to create a HIPAA-compliant EDI transactionHCFAHealth Care Finance Administration, the former name for CMSCMSCenters for Medicare and Medicaid Services7.0 REFERENCE DOCUMENTS 9.1 The ASC X12 Standards for Electronic Data Interchange (EDI) TR3 - Health Care Claim: Dental (837), May 2006, ASC X12N/005010X224, and Version 5010 to Health Care Claim Dental (837), ASC X12 Standards for EDI TR3, October 2007, ASC X12N/ 005010X224A1, as referenced in § 162.1102 and § 162.1802.9.2 The ASC X12 Standards for EDI TR3 - Health Care Claim: Professional (837), May 2006, ASC X12N/005010X222, as referenced in § 162.1102 and § 162.1802.9.3 The ASC X12 Standards for EDI TR3 - Health Care Claim: Institutional (837), May 2006, ASC X12N/005010X223, and Version 5010 to Health Care Claim: Institutional (837), ASC X12 Standards for EDI Technical Report Type 3, October 2007, ASC X12N/ 005010X223A1, as referenced in § 162.1102 and § 162.1802.9.4 The ASC X12 Standards for EDI TR3 – Additional Information to Support a Health Care Claim or Encounter (275), 2007, ASC X12N/005010X210.8. 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