SOURCES SOUGHT - CLEARINGHOUSE SERVICES FOR OKLAHOMA AREA IHS

Statement of Work (SOW)

To provide a secure software application for the Oklahoma City Area Indian Health Service (OCA I H S) that ensures confidentiality, authentication, integrity, and non-repudiation for electronic transactions and Direct Data Entry (DDE) / Florida Information Shared System (FISS) access across twelve IHS facilities.

• Develop and provide a secure exchange data software solution.

• Enable connectivity to Medicare DDE/FISS products.

• Facilitate eligibility verification and third-party insurance claims validation, approval, and processing services via a clearinghouse for Medicare, Medicaid, VA, and Commercial Payers.

• Support both medical and dental claims processing.

• The service must not require installation of contractor software within the OCA I H S environment.

• Utilize secure File Transfer Protocol (FTP) as approved by the I H S Office of Information Technology.

• Support EDI transactions and interactive telnet sessions.

• Support multiple users with workstation-independent access.

• Not develop HIPAA transaction set translation or mapping processes, non-CMS or non-IHS generated data, or data reformatting.

• Conform to Interconnection Security Agreements and Memoranda of Understanding with I H S, and Business Associate Agreements with OCA facilities.

• Provide end-to-end communication testing, implementation, and daily operations support.

• Provide routine technical support for corrections to service errors, flaws, or failures.

• Notify designated OCA point of contact (COR) of scheduled maintenance downtime at least two (2) days prior.

• Notify OCA point of contact immediately of any disruptions to data exchange capabilities.

• Provide customer support via telephone and email (8:00 am - 5:00 pm CST) for problem reporting, tracking, and resolution.

• Provide secure internet-based connectivity to all current fiscal intermediaries.

• Ability to send claims to Medicare Contractor using secure data exchange technology.

• Unlimited DDE and PPTN online Medicare claims status/corrections for Medicare Part A.

• Automated batch 837/835 file transfers and automated batch 276/277 claims correction capability.

• Accept electronic claims from RPMS.

• Obtain reports and acknowledgements on claims sent.

• Provide a single location to manage all electronic claims, including VA claims.

• Verify Medicare and Commercial Payer eligibility in real-time.

• Offer a flat fee for unlimited transactions.

• Provide knowledgeable support personnel with a two (2) hour minimum response time during normal business hours (8 am - 5 pm, Mon-Fri, excluding Government holidays).

• Third-party insurance claims submitted via clearinghouse by close of the next business day after receipt.

• Third-party insurance claims transmitted electronically.

• Use routine editing procedures to detect claim defects; provide edit reports for rejected claims.

• Return claims rejected by the carrier/payer (for reasons other than format) to IHS for correction at no charge.

• Reprocess and resubmit claims with errors at the Contractor's expense.

• Provide a productivity spreadsheet within 24 hours of batch transmission.

• Deliver standardized weekly reports on claims approval and clearinghouse activity.

• Period of Performance: One (1) Year with an option to extend for four (4) additional Option Years.

• Place of Performance: Twelve (12) OCA I H S facilities located in Oklahoma and Kansas.

• Contractor shall adhere to all official coding rules published by the American Hospital Association (AHA).

• Maintain confidentiality in accordance with HIPAA, Privacy Act of 1974, and other pertinent Federal regulations.

• Billing will be at a flat rate for all services.

• Contractor shall attend meetings/conference calls scheduled by the PO.

• Any delays or downtime due to Contractor equipment failure must be communicated to the COR within two hours via telephone.