Pharmacy Claims Switching and Benefit Eligibility Verification Services
Overview
Buyer
Place of Performance
NAICS
PSC
Set Aside
Original Source
Timeline
Qualification Details
Fit reasons
- NAICS alignment with historical contract wins in similar service areas.
- Scope strongly matches core technical capabilities and delivery model.
Risks
- Past performance thresholds may require one additional teaming partner.
- Potential clarification needed on staffing minimums before bid/no-bid.
Next steps
Validate eligibility requirements, assign capture owner, and schedule partner outreach to confirm teaming strategy before submission planning.
Quick Summary
The Indian Health Service (IHS), under the Department of Health and Human Services, has issued a Sources Sought Notice for Pharmacy Claims Switching and Benefit Eligibility Verification Services. This market research aims to identify qualified vendors capable of providing integrated solutions that interface with IHS's existing Resource and Patient Management System (RPMS). The IHS seeks to assess industry capabilities and determine appropriate acquisition methods, including potential set-asides for Indian Small Business Economic Enterprises (ISBEE), Indian Economic Enterprises (IEE), or small businesses. Responses are due by February 10, 2026, at 5:00 PM EST.
Scope of Work
The IHS requires services for electronic claims submission, adjudication, and reimbursement from third-party payers. Key requirements include:
- Pharmacy Claims Switching: Electronic routing compliant with NCPDP D.0 standards, supporting Medicare Part D, Medicaid, commercial insurance, and other payers. Services must include secure internet-based connectivity, pre- and post-edit functionality, and advance notification for system updates. Pricing should be bundled, per-transaction, and consistent with GSA Schedule rates.
- Benefit Eligibility Verification: Real-time verification integrated with RPMS pharmacy Point-of-Sale (POS) operations. This includes support for PBM onboarding, eligibility database maintenance, audit logging, dispute resolution, and eligibility accuracy controls, with no additional cost to IHS for portal access or interfaces.
- Technical & Compliance: Solutions must have an existing, operational interface with RPMS and comply with FISMA, NIST SP 800-53, HIPAA Privacy and Security Rules, and Section 508 / WCAG 2.0 AA accessibility standards. The system must support nationwide IHS deployment.
Contract & Timeline
- Type: Sources Sought Notice (Market Research Only)
- Published: February 4, 2026
- Response Due: February 10, 2026, 5:00 PM EST
- NAICS Code: 513210 – Software Publishers
- Product Service Code: DA10
Eligibility / Set-Aside
This notice prioritizes responses from: 1. ISBEE, 2. IEE, and 3. Small business concerns. Organizations not falling into these categories under the applicable NAICS code should not submit a response. The final set-aside determination will be made based on the responses received.
Submission & Evaluation
Interested vendors must submit a capabilities statement, not exceeding 10 pages, addressing:
- Technical Capability: Existing solution, RPMS integration, NCPDP D.0 compliance.
- Relevant Experience: Federal healthcare clients, operational duration, enterprise-wide experience.
- Security & Compliance: FISMA/NIST approach, HIPAA safeguards, Section 508 conformance.
- Commercial Availability: Confirmation of services and high-level pricing structure. Generic capability statements are insufficient. A cover page with specific company information is also required.
Additional Notes
This notice is for planning purposes only and does not constitute a solicitation or obligation to award a contract. The Government will not reimburse costs incurred in responding. Responses must be emailed to Darryl.smith@ihs.gov with the subject line: “Pharmacy Claims – Your Company Name”. Do not include classified, confidential, or sensitive information.