Secure Exchange Data Software

Performance Work Statement (PWS)

To procure a secure exchange data software solution for the Cheyenne River Health Center (CRHC) to facilitate connectivity with Medicare DDE/FISS, perform eligibility verification, and process third-party insurance claims.

• Provide a secure data exchange software solution.

• Enable connectivity to Medicare DDE/FISS for claims status reporting and payment floor details.

• Perform eligibility verification for Medicare, Medicaid, and other third-party payers.

• Validate, approve, and process medical claims (professional and facility) for Medicare, Medicaid, VA, and Commercial Payers.

• Process all claim types and provide solicited/unsolicited claims status.

• Implement rigorous and thorough claims rules and custom business rules.

• Provide training and support for the scope of work.

• Availability: 24/7 availability of eligibility verification and search services, with minimal disruption (less than 1 hour, excluding scheduled disruptions).

• Access: Unlimited users must be able to utilize the service simultaneously.

• Response Time: Two (2) hour minimum response time from notification by IHS for technical support.

• Claims Submission: Submit third-party claims via clearinghouse by the close of the next business day after receipt.

• Reporting: Provide productivity and submission reports within 24 hours of batch transmission.

• Period of Performance: Base Year: July 1, 2026 - June 30, 2027, with four (4) one-year option periods extending to June 30, 2031.

• Place of Performance: Cheyenne River Health Center, Eagle Butte, South Dakota.

• The solution must not require installation of contractor software on CRHC or IHS networks.

• Data exchange via Secure File Transfer Protocol (SFTP) and support for EDI transactions and Telnet.

• Support for an unlimited number of workstation-independent users.

• Compliance with HIPAA, Privacy Act of 1974, and other relevant Federal regulations.

• Contractor must conform to a Business Associate Agreement.

• Routine technical support for corrections and issue resolution.

• Notification of scheduled maintenance and service disruptions.

• Customer support via telephone and email.

• Contractor Responsibility includes secure internet-based connectivity, sending claims, and providing reports and acknowledgements.

Form / Attachment / Pricing Sheet

This document is the "Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form." It serves as a self-certification for offerors to confirm they meet the definition of an "Indian Economic Enterprise" as defined by HHSAR 326.601, in response to a Solicitation, Sources Sought, or Request for Information (RFI) under the Buy Indian Act.

• Self-Certification: Offerors must attest whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Eligibility Period: The enterprise must meet the definition at the time of offer, contract award, and throughout the contract performance period.
• Required Information: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of the IEE Firm
  • Business Name
  • Unique Entity Identifier (UEI) Number
  • Certifying Signature and Printed Name
• Compliance: False or misleading information is a violation of law and subject to penalties.
• Additional Requirements: Offerors must also be registered with the System of Award Management (SAM).

This form is critical for any bidder seeking to participate in opportunities designated under the Buy Indian Act. Bidders must accurately complete and submit this representation to self-certify their eligibility as an "Indian Economic Enterprise." Failure to meet the definition or accurately complete the form may impact the ability to be considered for award.