Medicare Claim Management/Revenue Cycle Management (RCM) Service

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

The primary objective 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 Medicare claims management and eligibility verification services. This aims to improve healthcare business operations and revenue generation.

• Eligibility Verification: Provide technology for real-time and batch eligibility checks for Medicare and other third-party payers. This includes obtaining comprehensive eligibility information, verifying coverage dates, and identifying dual eligibility or Medicare as a Secondary Payer scenarios.

• Claims Management: Offer a secure data exchange solution for connectivity to Medicare DDE/FISS, automated claims status reporting, and payment floor details. This includes third-party insurance medical claims validation, approval, and processing via a clearinghouse for Medicare, Medicaid, and VA.

• Workflow & Reporting: Implement a customizable dashboard for managing workflow, prioritizing tasks, and generating daily Medicare AR reports for efficient account management.

• Data Exchange: Utilize Secure File Transfer Protocol (SFTP) and support Electronic Data Interchange (EDI) transactions. The service must not require installation of contractor software on FPSU or IHS networks.

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

• Claims submitted via the clearinghouse by the close of the next business day after receipt.

• Claims transmitted electronically.

• Routine editing procedures to detect and reject defective claims, with edit status reports provided.

• Claims rejected by carriers/payers (except for format issues) must be corrected and resubmitted electronically within 4 hours of batch submission.

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

• Compliance with HIPAA, IHS OIT mandates, and the Privacy Act.

• Conformance to Revised Section 508 and WCAG 2.0 Level AA standards for all Information and Communication Technology (ICT) deliverables.

• Period of Performance: Base Year 10/01/2026 to 09/30/2027, plus 4 option years.

• Place of Performance: Fort Peck Service Unit, Poplar, MT, via online insurance verification software access.

• Security: All electronic transactions must provide confidentiality, authentication, integrity, and non-repudiation. Compliance with Privacy Act and Confidential Information clauses is mandatory.

• Accessibility: All ICT deliverables must comply with Revised Section 508 Standards and WCAG 2.1 Level AA Standards, requiring a VPAT/ACR or HHS Section 508 Accessibility Checklists.

• Users: Support unlimited users with workstation-independent access.

• Data Handling: No development of HIPAA transaction set translation, mapping, non-CMS/IHS data reformatting.

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 Criteria: Offerors must certify whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership." This definition must be met at the time of offer, contract award, and throughout the contract performance period.
• Reporting Requirement: Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
• Verification: 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 31 U.S.C. 3729-3731.
• Required Fields: Offerors must provide:
  • Business Name
  • UEI SAM Number
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of IEE Firm
  • Certifying Signature and Print Name

This form is critical for any bidder intending to claim status as an "Indian Economic Enterprise" under the Buy Indian Act. Bidders must accurately complete this form to self-certify their eligibility. Failure to meet these requirements or accurately represent the business's status can lead to disqualification or penalties. It also highlights the need for SAM registration.

Form / Attachment / Pricing Sheet

This document is a pricing schedule (Excel spreadsheet) for the Medicare Claims Management Services opportunity. Bidders are instructed to fill in the blue cells with their pricing information. The form will auto-calculate totals.

• The schedule outlines pricing for "FPSU Claims Management / Revenue Cycle Management (RCM) Service" and a "Setup Fee."
• Pricing is broken down by Base Year and four Option Years.
• Columns include Quantity (QTY), Unit, Unit Price, and Total Price for each contract line item.
• The document includes fields for "Quoter's Company Name" and "Quoter's SAM UEI."

This is a critical document for bidders to complete and submit as part of their proposal. It requires bidders to input their proposed unit prices for the services, which will be used to calculate the total contract value. Bidders must pay close attention to the "Contractor Fill-In Blue Cells" instruction for accurate data entry.

Solicitation / RFP / RFQ

This is a combined synopsis/solicitation (RFQ) for Claims Management / Revenue Cycle Management (RCM) Services. The government intends to award a contract to a responsible party offering the "Best Value to the Government" based on price and other factors.

• The core requirement is for Claims Management / Revenue Cycle Management (RCM) Service.

• Detailed requirements are provided in the attached Statement of Work (SOW).

• Offerors must be registered and active in the System for Award Management (SAM) at the time of quotation submission.

• Electronic and Information Technology (EIT) supplies and services must comply with Section 508 of the Rehabilitation Act and HHS EIT accessibility standards. Offerors must submit an HHS Section 508 Product Assessment Template or provide sufficient information for services.

• The initial Period of Performance is intended to start October 1st, 2026, through September 30th, 2027.

• The contract includes a base year and four (4) option years.

• Option Year 1: 10/01/2027 – 09/30/2028

• Option Year 2: 10/01/2028 – 09/30/2029

• Option Year 3: 10/01/2029 – 09/30/2030

• Option Year 4: 10/01/2030 – 09/30/2031

• The total contract duration, including options, shall not exceed five (5) years.

• Quotation Submission Deadline: June 29th, 2026, at 1:00 pm MDT.

• Submission Method: Email to Nikki.ferguson@ihs.gov. Subject line: 75H70926BAO-039-RFQ.

• Questions Deadline: June 15th, 2026, at 5:00 pm MDT. Email to Nikki.ferguson@ihs.gov. Subject line: 75H70926BAO-039-RFQ - Questions.

• Quote Validity: 90 days from submission deadline.

• Evaluation Factors: Technical proposal (max 5 pages), Past Performance, and Price. Technical and Past Performance are significantly more important than price.

• Award: The Government intends to award without discussions.

• This acquisition is set-aside 100% for Indian Small Business Economic Enterprise (ISBEE) small business concerns.

• See Attachment: B01 – Price Schedule for line items.

• See Attachment: B01 – Statement of Work for description of requirements.

• Payment requests must be submitted electronically via the Department of Treasury Invoice Processing Platform (IPP).