​Solicitation: HHS IHS Clearinghouse and Claims Submission Services

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This solicitation is intended to “… Procure clearinghouse services for the Indian Health Service (IHS). Clearinghouse service shall provide claim submission services, as well as ERA services produced by Resource and Patient Management System (RPMS). Provide enhanced and maximized third party revenue in a streamlined, electronic approach to claim submission…”

“Standardize and streamline the claim submission process. Provide instant point-of-service eligibility data for third party insurance databases; provide secure data transmission of all electronic claims at approximately 70,000 claims per year, provide initial data checks, initial data scrubbing to ensure clean claim submission to the end-payer, all claims with errors will be rejected to a site within the portal where rework can occur, provide drop to paper option as necessary for any initial claims as well as paper-required secondary submissions. a. Technical Capabilities

1. Provide a web-based application the provides a method of securely exchanging claim information with outside insurance payers.

2. Provide initial scrubbing of all third party claims produced by RPMS.

3. Provide enhanced and maximized third party revenue in a streamlined, electronic approach to claim submission.

4. Provide instantaneous receipt verification of claim, ability to correct claims within portal, identification of incorrect or nonmatching codes and procedures all within website.

5. Provide instant point-of-service eligibility data from third party insurance databases.

6. Provide initial data checks, initial data scrubbing to ensure clean claim submission to the end-payer.

7. All claims with errors to be rejected to a site within the portal where rework can occur.

8. Provide electronic VA claims…”

RFQ Close Date: 01/23/2017 03:00 PM

G2X TAKE: Released out of HHS Indian Health Service, this 5 year contract is to provide a set of services and technology solution to support a streamlined, electronic approach to claims submission.

Looking to partner? Some firms that score high on the G2X partnering algorithm at IHS include ASRC Federal/Data Networks Corporation, Dev Technology Group Inc; Alliant SB CTA, LLC, Medsphere and GDIT, but this is the type of solicitation that will tend to draw interest from firms who might typically play in other parts of the government, such as VA and CMS and the commercial sector (see Optum), as they look to showcase their capabilities providing similar solutions for other groups.

This was released on IT-70. Need a copy of the SOW? A link to the document is included as a comment in the thread below. Note: you will need to be logged in. 


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