Q601--RFI – Information Sought: Code Sets

The U.S. Department of Veterans Affairs (VA) is conducting market research to identify vendors capable of developing, maintaining, and regularly delivering comprehensive billing code sets that align with VA’s Community Care Referral Guidelines (CCRGs). The selected vendor will be responsible for creating code sets that accurately map all applicable billing codes under each allowable service category. The vendor must have expertise, tools, and coding resources necessary to translate CCRG clinical guidance into validated, up-to-date code sets and provide recurring deliverables for VA review and approval. Some key aspects of the job include: • Developing and maintaining healthcare billing code sets (CPT, HCPCS, ICD-10, DRG, APC) • Ensuring alignment with national standards and VA payment policy • Incorporating new codes, retiring obsolete codes, and applying pricing and bundling rules • Providing standardized code sets for use across the Next Generation community care environment • Supporting accurate claims adjudication, policy compliance, and consistency across community care referrals