Secure Exchange Data Software

A. Introductory: This is a Sources Sought set aside for Indian Economic Enterprise (IEE) and Indian Small Business Economic (ISBEE). This is NOT a solicitation for proposals, proposal abstracts, or quotations. The objective of this Sources Sought # IHS1526579 is to identify potential IEE and ISBEE vendor that can provide a base + 4 Option Periods for secure exchange data software for the Cheyenne River Health Center, Business Office/Patient Registration, 24276 166th St Airport Road Eagle Butte, SD 57625. B. Project Description: B.1 Background: The U.S. Department of Health and Human Services (HHS), Indian Health Service (IHS), is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states. The Great Plains Area Office (GPAO) collaborates with its 19 IHS and Tribally managed service units to deliver healthcare to approximately 130,000 Native Americans residing in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office’s service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics. B.2 Requirements: The contractor shall provide a secure exchange data software solution that includes technology for: • Connectivity to the Medicare DDE (Direct Data Entry) /FISS (Fiscal Intermediary Standard System) and automated claims status reporting, payment floor details, and other reports. • Eligibility verification for third-party payers to include Medicaid and Medicare. Anticipated monthly volume for Eligibility Checks: 100. • Eligibility results must include start and end dates of coverage. • Capability to search eligibility for third-party coverage for patients who do not provide or present insurance information. Anticipated volume for Insurance Searches per month: 1000. • Third-party insurance medical claims validation, approval, and processing services via a clearinghouse for Medicare, Medicaid, VA, and Commercial Payers (not limited to but including United Health Group) for the Cheyenne River Health Center. Anticipated volume for Claims Submission per month: 2,500. • Processes all claim types (professional and facility): Emergency, Inpatient, Outpatient, and Specialty Clinics; and provides both solicited and unsolicited claims status. Anticipated volume for Claims Status per month: 1000. • The software must provide rigorous and thorough claims rules and custom business rules. • Capability for self-monitoring usage of services for thresholds. • Training and support related to the scope of work – training provided either on-site or via teleconference. The software services shall comply with the following constraints: • The software service shall not require Cheyenne River Health Center to install contractor software within the Cheyenne River Health Center or the Indian Health Service network. • The service shall enable Cheyenne River Health Center to exchange data utilizing a Secure File Transfer Protocol (SFTP) as approved by the Indian Health Service Office of Information Technology. • The service shall support Electronic Data Interchange (EDI) transactions and interactive Telnet application protocol sessions. • The service should support an unlimited number of users, and access should be workstation independent. • The service shall not entail development of Health Insurance Portability and Accountability Act (HIPAA) transaction set translation or mapping processes, non-CMS or non-IHS-generated data or messages, or data reformatting. • The service shall also conform to a Business Associate Agreement to be established between the Cheyenne River Health Center and the Contractor. • The contractor shall support end-to-end communication testing, implementation, and daily operations of the data transfers from the contractor to the Cheyenne River Health Center, which shall include, at a minimum: • The contractor should provide routine technical support to implement corrections to services that occur as a result of errors, flaws, or other failures within their service. • The contractor shall notify a designated Cheyenne River Health Center point of contact (Contracting Officer’s Representative (COR)) of any scheduled maintenance that shall result in downtime at least two (2) days before the maintenance perio