Medical Claims Ajudication
Department of Justice, Bureau of Prisons | Published November 20, 2015
Contracting Office Address
Department of Justice, Bureau of Prisons, National Acquisitions and Systems Section, 320 First Street, NW, Washington, D.C. 20534
The Federal Bureau of Prisons, National Acquisitions and Systems Section, Washington, D.C. is seeking proposals from qualified and responsible sources having the ability to provide medical claims adjudication.
The request for proposal will be available on or about December 23, 2015. The closing date for receipt of proposal will be on or about January 19, 2016.
The primary objective of medical claims adjudication services, for healthcare service providers/contractors (healthcare providers) paid under Medicare-based rate structures, is to ensure compliance with Medicare Claims processing guidelines/manual in conjunction with the National Correct Coding Initiative edits; for fee schedule healthcare providers, the objective is to ensure compliance with the applicable negotiated fee schedule. In both cases, key considerations include avoidance of duplicate claims payments, erroneous claims and allowing the Bureau of Prisons to meet compliance requirements of the Prompt Payment Act and Statements of Federal Financial Accounting Standards (SFFAS).
Medical services rendered to all federal inmates are governed by federal law, BOP policies/procedures, the Joint Commission on Accreditation of Healthcare Organization (JCAHO), Health Insurance Portability and Accountability Act (HIPAA) and American Corrections Association (ACA) standards. Primary care is provided by BOP staff physicians and mid-level practitioners.
Only institutions with Comprehensive Medical Services (CMS) contracts will participate in claims adjudication. Each institution has separate and unique contract(s) with healthcare providers in their area.
The Performance Period for this requirement is for a five month base period to begin April 1, 2016 and 4 option periods as follows:
Base: April 1, 2016 through March 31, 2017
Option Period 1: April 1, 2017 through March 31, 2018
Option Period 2: April 1, 2018 through March 31, 2019
Option Period 3: April 1, 2019 through March 31, 2020
Option Period 4: April 1, 2020 through March 31, 2021
The following represent estimated quantities only. Actual quantities may vary.
Base Year: 80,000 claims
Option Year 1: 80,000 claims
Option Year 2: 80,000 claims
Option Year 3: 80,000 claims
Option Year 4: 80,000 claims
The request for proposal will be available on or about December 23, 2015. The closing date for receipt of proposal will be on or about January 20, 2016.
All information regarding this solicitation will be distributed solely through the General Services Administration's Federal Business Opportunities web site http://www.fedbizopps.gov. Hard copies of the proposal will not be available. The site provides downloading instructions.
Faith-Based and Community-Based Organizations can submit offers equally with other organizations for contracts for which they are eligible.
All future information about this acquisition, including amendments, will be distributed solely through this site. Interested parties are responsible for monitoring this site to ensure that they have the most up-to-date information about this acquisition.
Questions concerning this Pre-Solicitation Notice should be directed to Donna K. Grube, Contracting Officer, by email to firstname.lastname@example.org. Please reference RFQP0700NAS1600833 in the subject line.