R710--Third Party Billing

I. Introduction:� � � In accordance with� Revolutionary FAR Overhaul (RFO) Part 10.001 Market Research Requirements, RFO 15.101(c) Requests for Information and RFO 19.101� Presolicitation� Small Business Goals and Veterans Administration Acquisition Regulation (VAAR) 810.000� Market� Research, this request is for information and planning purposes only and shall not be construed as a solicitation or as an obligation on the part of the Department of Veterans Affairs (VA).� � The Department of Veterans Affairs, Regional Procurement Office Central Supplies and Services Division,� is conducting market research and is seeking written responses with information to assist the Government with identifying potential sources that are interested in, and capable of,� Third Party Billing through� Consolidated Patient Account Center (CPAC) Revenue Operations (RO).� Tasks include� authorization and release of outpatient medical claims and authorization and release of� outpatient medical claims for VA Care in the Community.� � The North American Industry Classification System (NAICS) Code for this acquisition is 524292 -� Pharmacy Benefit Management and Other� Third Party� Administration of Insurance and Pension Funds. The small Business size standard is $45.5 million.� Pursuant to� RFO Part 10, Market Research, the purpose of this notice is to� determine� if sources capable of satisfying the agency's requirements exists and to� determine� the commercial practices of company's engaged in providing the needed service.� Pursuant to� RFO Part 6 and RFO Part 19, competition and set-aside decisions may be based on the results of this market research. This notice in no way� obligates� the Government to any further action.� SAM: Interested parties should register in the System for Award Management (SAM) as prescribed in RFO Clause 52.204-7, which can be accessed at� https://sam.gov/.� SMALL BUSINESS ADMINISTRATION CERTIFICATION (VetCert):� Interested Service-Disabled Veteran-Owned Small Business and Veteran-Owned Small Businesses must be registered in the Small Business Administration s Small Business Search (SBS) found at� https://search.certifications.sba.gov/.� II. Requirements:� � � � � Please see attached DRAFT Performance Work Statement (PWS).� � III. Submittal Information:� Companies having the skills and capabilities necessary to meet or exceed the stated requirements are invited to provide information to contribute to this Sources Sought Notice including commercial market information and company information.� Companies may respond to this Sources Sought Notice via e-mail to Contract Specialist Lisa Strawbridge at� Lisa.Strawbridge@va.gov� and Contracting Officer, Kymberly Morgan at� Kymberly.Morgan@va.gov.� The subject line must read 36C24C27Q0001 Third Party Billing.� Responses must be� submitted� no later than 07/20/2026, at 2:00pm� Eastern Time.� � The submission cannot exceed 10 pages in length, single spaced, 11-point Calibri font that addresses the questions fully.� � The Government will not review any other data or attachments that are� in excess� of� the 10 pages.� � � Companies should provide clear and unambiguous evidence to substantiate their capability to fulfill these requirements. The capability documentation should include, at a minimum, the following information with their response:� � Company Name and Address:� Point of Contact (POC)� Name:� Email Address:� Phone Number:� SAM UEI Number:� � Mark if your firm is eligible for participation in one of the following small business programs. If so, please� indicate� the program:� � � � [ ]� yes� [ ]� no - Small Business (SB)� � � [ ]� yes� [ ]� no - HUBZone� � � [ ]� yes� [ ]� no - Small Business 8(a)� � � [ ]� yes� [ ]� no - Small Disadvantaged Business (SDB)� � � [ ]� yes� [ ]� no - Women-Owned (WO) Small Business� � [ ]� yes� [ ]� no - Service Disabled Veteran Owned Small Business (SDVOSB)� � [ ]� yes� [ ]� no - Veteran Owned Small Business (VOSB)� [ ]� yes� [ ]� no - Large Business� � � [ ]� yes� [ ]� no - Other (please specify)� � � � � Please answer the following questions:� � Industry Experience� How many years has your company been providing medical billing services? What type of services do you cover including Durable Medical Equipment (DME) and Dental, customer service, and work claim rejections?� � � Please� provide� at least one example of a project of� similar size� and scope that your firm has successfully completed within the past 5 years. Include contract number, period of performance, total dollar value, average number of claims processed per month and number of staff on the contract (full time and part time).� � � � Technical Questions� Key Personnel� Per the PWS Section 11.6, does your company have on staff a manager with a minimum of 5 years of outpatient third party medical billing claims submissions experience (2-3 years in management role) and a supervisor with a minimum of 3� years� of� experience� (1-2 years in management role)? (Additional experience preferred in supporting Durable Medical Equipment (DME) and Dental, customer service, and work claim rejections.) If yes, provide a summary of education/experience as it relates to this government requirement. If no, describe how your company would fill these roles.� Staffing and Volume Per the PWS Section 4, VISTA is a Disk Operating System (DOS) based system. Minimum expectation is to manually process 16-25 VA Care claims, and� approximately 12-18� Community Care claims per hour per biller. Our legacy VA systems do not� interface with� modern Graphical User Interface billing software.� Does your company� have the ability to� process a minimum of 250,000-350,000 claim encounters per month? Demonstrate the resources,� competencies� and qualified staff to fulfill the requirements of the� PWS estimated� quantities.� � � Could you be ready to begin services within 60 days after contract award? How would you ramp up staffing and training� e.g.� summarize an action plan.� � � � Would you be able to commit to 30% of staff being permanent staff that is not otherwise employed at CPAC? If yes, please share how� you ll� achieve this.� � � Do you have staffing resources to respond to surges in workload volume within 30-60 days? If yes, please explain.� Claims Processing� Describe how your company will meet the following claims processing standards:� Medical claims are generated within the month they are received from CPAC.� � Rejected work claims will have� an initial� review within 5 business days, with follow-up every 15 days.� What is your process to� monitor� claim requirements for the month to forecast workload completion? How is this communicated to CPAC if issues arise?� Invoice/Billing Disputes� Describe the process your company uses for handling denied claims and billing disputes that� demonstrates� resolution within the same reporting month.� Compliance and Security� � What protocols do you have in place to� maintain� Health Insurance Portability and Accountability Act (HIPAA) compliance as well as Personally Identifiable Information (PII) and Protected Health Information (PHI) protocol?� � Training Updates� How will you distribute or provide training on� policy, procedures, and regulations released by Medicare and Center for Medicaid Services (CMS).� � � 3. Performance Work Statement (PWS) Questions� Are any of the requirements included in the draft PWS unclear and/or ambiguous? If so, how would you recommend clarifying them?� � � � � � What else has your firm seen/experienced that could better structure the VA requirements? What recommendations do you have to improve upon the scope of work?�