Medicare Claim Management/Revenue Cycle Management (RCM) Service

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

The goal of this contract is to enhance and maximize third-party revenue and collection activities for the Fort Peck Service Unit (FPSU) by implementing an efficient, streamlined process for claims management and insurance eligibility verification services.

• Eligibility Verification: Attain comprehensive eligibility information from Medicare and commercial payers through batch and real-time checks.

• Claims Management: Provide technology for connectivity to Medicare DDE/FISS, automated claims status reporting, and payment floor details.

• Workflow Management: Offer a customizable dashboard to prioritize tasks, manage patients and payers, and set reminders.

• Data Exchange: Utilize secure SFTP for data exchange, supporting EDI transactions and Telnet sessions.

• Clearinghouse Services: Validate, approve, and process medical claims via a clearinghouse for Medicare, Medicaid, VA, and Commercial Payers.

• Claim Types: Process all claim types (Emergency, Inpatient, Outpatient, Specialty) and provide solicited/unsolicited claims status.

• Reporting: Provide daily Medicare AR reports and productivity/submission reports.

• Training & Support: Offer on-site or teleconference training and toll-free technical support during business hours with a two-hour response time.

• Claims submitted to carriers/payers by the close of the next business day after receipt.

• Claims transmitted electronically.

• Rejection and processing of claims with defects, with edit status reports provided.

• Correction and resubmission of rejected claims within 4 hours of batch submission.

• Productivity and submission reports available within 24 hours of batch transmission.

• Period: Base Year 04/01/2026 to 03/31/2027, plus 4 option years.

• Place: Fort Peck Service Unit, Poplar, MT, via online software access.

• Compliance: Adherence to HIPAA, IHS OIT mandates, and the Privacy Act.

• Accessibility: Conformance to Revised Section 508 and WCAG 2.0 Level AA standards.

• Security: Secure internet-based connectivity; no contractor software installation required on FPSU/IHS networks.

• Data Handling: Strict adherence to Privacy Act and Confidential Information clauses regarding patient and proprietary data.

Form / Attachment / Pricing Sheet

This document is the "Indian Economic Enterprise Representation Form" required for the "Medicare Claims Management Services" solicitation (75H70926BAO-39). It serves as a self-certification for Offerors to confirm they meet the definition of an "Indian Economic Enterprise" as per the Buy Indian Act.

• Eligibility Requirements: Offerors must meet the "Indian Economic Enterprise" definition at the time of offer, contract award, and throughout the contract performance period.
• Notification: Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
• Documentation: Contracting Officers may require documentation of eligibility, and awards may be subject to protest.
• Registration: Successful Offerors must be registered with the System of Award Management (SAM).
• Penalties: False or misleading information is a violation of law, punishable under 18 U.S.C. 1001, and false claims are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
• Representation Section: Bidders must indicate whether they represent that their offer meets the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Required Fields: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity
  • Name of the 51% owner of IEE Firm
  • Business Name
  • UEI SAM Number
  • Certifying Signature
  • Print Name

This form is critical for any bidder intending to self-certify as an "Indian Economic Enterprise" under the Buy Indian Act for this opportunity. Failure to complete and submit this form accurately may impact eligibility for award, especially if the contract is set-aside or awarded under the Buy Indian Act provisions.

Sources Sought Notice

This notice is issued by the Indian Health Service (IHS) to identify potential sources for Medicare Claim Management / Revenue Cycle Management (RCM) Services. This is NOT a solicitation for proposals, but rather a market research effort to gauge vendor capabilities.

The government is seeking vendors capable of performing Medicare Claim Management / RCM Services. The North American Industry Classification System (NAICS) code for this requirement is 518210 (Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services).

The anticipated contract duration is a Base Year plus four (4) Option Years.

Vendors interested in this opportunity should submit a capability statement demonstrating their experience and ability to perform the required services. Responses must include:

• Years of experience in Medicare Claim Management / RCM.
• A list of past jobs/contracts related to Medicare Claim Management / RCM.
• A clear demonstration of how the company meets the definition of an Indian Economic Enterprise (IEE), specifically regarding:
  • Receiving at least 51% of the earnings from the contract (either as prime or in combination with a subcontractor).
  • Management and daily operations being controlled by one or more individuals who are Indians.

Failure to address these specific IEE criteria may result in exclusion from consideration as a capable ISBEE source.

Preference will be given to Indian Small Business Economic Enterprises (ISBEEs) and Indian Economic Enterprises (IEE) under the Buy Indian Act. However, other categories of vendors are also invited to respond.

Responses are due by email to Nikki.ferguson@ihs.gov by Tuesday, April 14, 2026, at 2:00 pm. The Sources Sought ID is 75H70926BOA-39. Respondents are encouraged to include the Sources Sought ID in the email subject line. A copy of the Buy Indian Act Indian Economic Enterprise Representation Form must also be submitted.