R710--Third Party Billing Bridge Contract (VA-26-00040654)

Performance Work Statement (PWS)

To outline the medical billing services required for the Department of Veterans Affairs (VA) Consolidated Patient Account Centers (CPAC) to generate accurate and timely third-party claims for healthcare insurance carriers nationwide.

• Provide labor and equipment for generating VA claims to third-party healthcare insurance carriers for CPAC sites.

• Bill and collect from insurance companies for medical treatment provided to veterans for non-service connected (NSC) conditions.

• Establish and authorize outpatient medical claims in the VA Veterans Health Information Systems and Technology Architecture (VistA) or current system.

• Process claims within industry standards and VA guidelines, with an estimated 3 minutes per claim.

• Ensure medical claims are generated within 2 business days of receipt of information.

• Review and work rejected claims within 5 business days, with follow-ups every 15 days.

• Cancel claims appropriately and assign correct "reason not billable" (RNB).

• Maintain open communication for billing-related questions and concerns.

• Participate in conference calls as needed.

• Maintain VistA access by logging in at least once every 14 days.

• Ensure confidentiality and compliance with VA requirements.

• Claims generated within 2 business days of receipt.

• Billing accuracy in accordance with CPAC guidebooks and VA policy.

• Rejected claims reviewed within 5 business days.

• No more than 50 claims per CPAC per month unauthorized or without an RNB.

• No more than two failed communication attempts per quarter.

• 100% of contractor billing leadership attend required conference calls.

• No more than one system access reset per month.

• Monthly Itemized Statement due by the fifth business day of each month.

• Monthly Staffing Report due by the fifth business day of each month.

• IDIQ contract with a sixty (60) month ordering period.

• Period of Performance and quantities will be established for each Task Order.

• Contractor is responsible for providing a remote and secure business setting; no space will be provided by CPAC.

• Contractor key personnel must be available for communication between 8:30 am to 5:00 pm ET during all federal workdays.

• Compliance with HIPAA and all pertinent privacy regulations.

• Contractor personnel must have expertise in outpatient medical billing, with specific experience requirements for Manager (5+ years) and Supervisor (5+ years).

• All contractor employees require a Tier 1/Low Risk background investigation.

• Contractor must provide all equipment and maintain patient confidentiality and database security.

• No decisions regarding service-connected treatment will be made by the contractor.

• Compliance with VA Directive 6102 and VA Handbook 6102 for Internet/Intranet Services.

• Adherence to the CPAC Billing Guidebook.

Notice of Intent to Sole Source

The Veterans Health Administration (VHA), Program Contracting Activity Central (PCAC), intends to award a follow-on contract on a sole source basis to Receivia, Inc., a Woman-Owned Small Business (WOSB). This contract is for Third Party Billing Services to support the Consolidated Patient Account Center (CPAC) Revenue Operations (RO). The primary purpose is to ensure continuity of services while a new competitive contract is being acquired. The services are crucial for handling overflow work in generating claims for third-party billing.

• Provide all labor and equipment for generating VA claims to third-party healthcare insurance carriers for CPAC sites nationwide.

• Establish and authorize outpatient medical claims to third-party insurance carriers within the VA's VistA information system.

• Services are related to VA's authority to seek reimbursement from third-party payers for medical care provided to veterans (both non-service connected and service-connected conditions treated for non-service connected issues).

• This is a sole source intent, citing statutory authority 41 USC §3304(a)(1) (Only One Responsible Source).

• The NAICS code is 524292 (Pharmacy Benefit Management and Other Third-Party Administration of Insurance and Pension Funds) with a size standard of $45.5 million.

• The Product Service Code (PSC) is R710 (Support Management - Financial).

• This notice is NOT a request for competitive quotes. No solicitation document is available.

• Interested and capable sources may submit a capability statement by the response date.

• Responses are due by February 20, 2026, 2:00 PM Eastern Time.

• Submissions should be via email only to Lisa Strawbridge (Lisa.Strawbridge@va.gov) and Kymberly Morgan (Kymberly.Morgan@va.gov) with the subject line "36C77626Q0084– Notice of Intent – Third Party Billing".

• Capability statements must include company name, POC, email, phone, SAM UEI, and small business program eligibility.

• The intent is to award to Receivia, Inc., a WOSB.

• Prospective contractors must be registered in SAM.

• Responders should indicate their small business program eligibility (SB, HUBZone, 8(a), SDB, WO, SDVOSB, VOSB, Large Business, Other).

• The government is not responsible for any costs incurred in responding.

• Responses are not offers and do not form a binding contract.

• This notice does not commit the government to issuing a solicitation or awarding a contract.

• A draft PWS is referenced as attached.