Description
The Indian Health Service (IHS) is seeking a secure exchange data software solution to provide connectivity to the Medicare Fiscal Intermediary Standard System and direct data entry service for the Pine Ridge IHS Hospital. The solution should provide eligibility verification, third-party insurance claims processing, and remittance advice services for Medicare, Medicaid, VA, and commercial payers. The contractor will provide a secure exchange data software solution that meets the described objectives and requirements. The period of performance is 365 calendar days from the date of award.
Key features and requirements of the solution include:
• Connectivity to Medicare electronic claims submission systems and real-time claim status inquiry capabilities
• Eligibility verification for third-party payers, including Medicare and Medicaid
• Third-party insurance medical claims validation, approval, and processing services via a clearinghouse for Medicare, Medicaid, VA, and commercial payers
• Ability to process all claim types, including inpatient, outpatient, and specialty clinics
• Compliance with HIPAA, CMS transaction standards, and secure data exchange protocols
• Support for multiple users and access via workstation-independent secure file transfer protocols
• Capability for end-to-end communication testing, implementation, and daily operations of data transfers
• Routine technical support and maintenance, including notification of scheduled maintenance and issues that result in disruption of data exchange capabilities
• Customer support for reporting, documenting, tracking, and resolving service problems
The contractor shall provide a capability statement that addresses the described objectives and requirements, including a commercial capability overview, alignment with government objectives, relevant experience, security and compliance, small business status, and commercial pricing models.