00134 - No Surprises Act Services

Questions & Answers / Clarifications

This document provides responses to vendor questions regarding the "No Surprises Act" opportunity.

• Contract Type & Vehicle: The contract type (e.g., Fixed Price, Cost Plus) and the procurement vehicle have not yet been determined.
• Training Time: Staff training for complaint handling involves approximately 4 x 90-minute sessions, plus self-study and on-the-job learning.
• Staff Education: Customer service staff require a Bachelor's degree in any subject.
• Complaint Volume: Approximately 100 new complaints are expected per workday. The percentage of complaints from non-medical providers or outside DOL's jurisdiction is very small.
• Complaint Resolution Time: It takes approximately 4 hours per complaint to track and resolve those within DOL's jurisdiction.
• Escalation: Initially, most tasks will require guidance from OEA, with decreasing direction needed as staff gain experience.
• Complaint Channels: Complaints are transmitted electronically by another Federal agency; specific channels (phone, email, etc.) are not directly used by the vendor.
• Service Level Agreements (SLAs): Timelines are guidelines, not guarantees. Key metrics include initial contact within 45 days and status updates every 30 days. Delays will be communicated.
• Technology: Current systems include a Case Tracking System and Genesys Cloud IVR software. The tracking system (TAIS) is built on Oracle, with existing APIs.
• Data Access: Contractors can access TAIS data via canned reports and direct queries. A cloud environment/warehouse for data analysis is available.
• Surge Capacity Data: Historical data for steady-state and surge volumes is not available.

This Q&A document clarifies several aspects of the PWS and acquisition background. Bidders should note that contract type and vehicle are undetermined. Key performance metrics and technology requirements are detailed, which will inform proposal development.

Form / Attachment / Pricing Sheet

This document is an Excel spreadsheet containing a Quality Assurance (QA) Log. It appears to be a template or a log used for tracking quality-related issues or activities.

The log includes columns for 'Section', 'Question', and 'Response'. However, the provided content for these columns is empty or contains only whitespace.

As this QA Log is currently empty, it does not provide specific details or requirements for bidders at this time. Bidders should monitor for any updates or further instructions regarding its use in relation to the opportunity.

Statement of Work (SOW) / Performance Work Statement (PWS)

This document outlines the scope of work for a contractor supporting the Department of Labor's Employee Benefits Security Administration (EBSA) in managing complaints related to the No Surprises Act (NSA). The primary goal is to triage and handle complaints from medical providers regarding alleged NSA violations, ensuring timely responses and comprehensive documentation.

• Complaint Reception and Management: Prioritize and resolve complaints within EBSA customer service standards and the NSA's 60-day response mandate.

• Contract Training: Receive comprehensive training on health plans, the NSA, the Technical Assistance Inquiry System (TAIS), agency standard operating procedures (SOPs), and complaint handling requirements.

• Daily Complaint Review: Assess approximately 100 new complaints daily to identify non-provider complaints, those outside DOL jurisdiction, correct data errors, and designate alleged violations.

• Jurisdiction Notification: Inform the Office of Outreach, Education and Assistance (OEA) about complaints outside DOL jurisdiction or those concerning specific entities (e.g., Certified Independent Dispute Resolution Entities, government-sponsored plans, Medicaid/Medicare).

• Complaint Management Process: Process complaints per SOPs, gather necessary information from complainants and health plans, advise on self-correction of violations, document actions, and notify complainants of review results. Communication will use pre-approved templates and follow OEA directives.

• Reporting: Provide monthly reports to OEA detailing complaint status, closures, and benefit recoveries.

• Surge Capacity (Optional): Provide additional resources during periods of increased complaint volume when authorized.

• Respond to complaints within 60 days as mandated by the NSA.

• Adhere to EBSA customer service standards.

• Maintain detailed records in the Agency's TAIS system.

• Provide monthly reports on complaint metrics.

• One 12-month base period (September 16, 2026, to September 15, 2027).

• Four 12-month option periods.

• Contractor personnel must be available for training.

• Training documents are confidential and cannot be shared.

• Adherence to OEA directives and customer service standards is crucial.

• Minimize disclosure of personally identifiable information and protected health information.