Industry Day for Healthcare Claims Adjudication Software Robert
Industry Day for Healthcare Claims Adjudication Software Robert Kately, Contracting Officer, Technical Acquisition Center (TAC) Steve Spurlin, Contracting Officer’s Representative, FSC
5/22/2017 Purpose and Agenda • Purpose: To remove ambiguity regarding the Performance Work Statement (PWS) requirements and discuss the framework of the forthcoming solicitation. • Agenda • 9: 00 am – 9: 15 am – Opening Remarks • 9: 15 am – 10: 15 am – PWS Overview • 10: 15 am – 11: 00 am – Evaluation Plan Overview • 11: 00 am – 12: 00 pm – Written Q&A Overview • 12: 00 pm – 1: 00 pm – Lunch • 1: 00 pm – 4: 00 pm – Open Q&A Period 2
5/22/2017 Administrative Remarks • Security • Restrooms • Lunch • Slides/Notes on FBO. gov • Save questions for Q&A period • All information presented today is subject to change prior to official release of the final solicitation 3
• FSC • • • 5/22/2017 Introductions Steve Spurlin, COR Terry Riffel, Director, FSC Thomas Rielly, Director, Financial Healthcare Service Angela Repka, Chief, Medical Claims Division Walter Bruning, Chief, Program Management Office Ron Sommer, Supervisor, ECD Production Support Laura Barnett, Systems and Procedures Analyst Kelley Coleman, Claims Adjudication and Reimbursement Site Officer TAC • • • Robert C. Kately, Contracting Officer Lauren Sankar, Contract Specialist Carol Phelan, Business Resource Specialist Colin Nash, Office of General Counsel Jamie Ford, Office of General Counsel 4
5/22/2017 Opening Remarks Ms. Terry Riffel, Director, FSC 5
PWS Overview Robert Kately, Contracting Officer, TAC Steve Spurlin, Contracting Officer’s Representative, FSC
5/22/2017 PWS Structure 1. 0 Background 2. 0 Applicable Documents 3. 0 Scope of Work 4. 0 Performance Details 5. 0 Specific Tasks and Deliverables 6. 0 Other General Requirements (IT, Security, etc. ) 7
• • Franchise Fund…always growing • • May expand program offerings • Separate from Community Care Network Simple business rules • Medicare-based rules and pricing Currently, four programs • VA Choice • Camp Lejeune Family Member Program • Dialysis • Other Government Agencies 5/22/2017 1. 0 Background / 3. 0 Scope of Requirement • No complex rules such as: • Capitation; • In/out of network; • Coordination of benefits; • Accumulators; • Limits; or • Exclusions 8
5/22/2017 4. 0 Period of Performance Po. P Requirement Base Period 24 months Configuration, Implementation, Integration, Testing, Deployment, Training, Maintenance, and Technical Support Option Period 1 12 months Maintenance, technical support, patches, upgrades, etc. Option Period 2 12 months Maintenance, technical support, patches, upgrades, etc. Option Period 3 12 months Maintenance, technical support, patches, upgrades, etc. Optional Tasks 1 -6 Time of award through (within each period) end of current period Additional claims Optional Tasks A-H Delivered NLT 90 days (stand-alone) after exercise of task Additional features and capabilities 9
Base Period 24 months 5/22/2017 4. 0 Period of Performance (continued) Configuration, Implementation, Integration, Testing, Deployment, Training, Maintenance, and Technical Support Program Offerings Required in Base Period: • • VA Choice – Implementation required NLT 12 months after award Dialysis – Implementation required NLT 18 months after award Camp Lejeune Family Member Program – Implementation required NLT 21 months after award OGA – Implementation required NLT 24 months after award All products lines use Medicare-based rules and pricing. There are no complex rules such as capitation, in/out of network, coordination of benefits, accumulators, limits, or exclusions. 10
5/22/2017 4. 0 Period of Performance (continued) Option 12 months Maintenance, technical support, Periods 1 -3 each patches, upgrades, etc. FSC intends to use the software for an indefinite and unlimited number of additional program offerings in the future (beyond VA Choice, Dialysis, Camp Lejeune, and OGA) but VA expects to be capable of doing its own configuration & implementation by that point. Any additional software maintenance and technical support associated with the Government expanding to additional program offerings is anticipated to be relatively minimal and therefore included in the Offeror’s total firm-fixed-price. 11
5/22/2017 5. 2 Licensing Structure BASE PERIOD Base Requirement 0 – 2, 000 claims Optional Task 1 – Additional Claims 2, 000, 001 - 5, 000 claims Optional Task 2 – Additional Claims 5, 000, 001 - 10, 000 claims Optional Task 3 – Additional Claims 10, 001 - 15, 000 claims Optional Task 4 – Convert to Perpetual License 15, 000, 001+ OPTION PERIODS 1, 2, 3 Optional Task 1 – Initial Lot of Claims 0 – 1, 000 claims Optional Task 2 – Additional Claims 1, 000, 001 - 2, 000 claims Optional Task 3 – Additional Claims 2, 000, 001 - 5, 000 claims Optional Task 4 – Additional Claims 5, 000, 001 - 10, 000 claims Optional Task 5 – Additional Claims 10, 001 - 15, 000 claims Optional Task 6 – Convert to Perpetual License 15, 000, 001+ 12
Base Requirements 5. 3. 1 5. 3. 2 5. 3. 3 5. 3. 4 5. 3. 5 5. 3. 6 5. 3. 7 5. 3. 8 5. 3. 9 5. 3. 10 5. 3. 11 5. 3. 12 5. 3. 13 5. 3. 14 5. 3. 15 5. 3. 16 5. 3. 17 5. 3. 18 5. 3. 19 5. 3. 20 5. 3. 21 5. 3. 22 5. 3. 23 5. 3. 24 5. 3. 25 5. 3. 26 Member Management and Eligibility Benefit Administration Provider Management Fee Schedule and Contract Management Authorizations and Referrals Data Input, Claims Intake, and Data Accessibility Work Assignments and Workflow Claims Adjudication Customer Management Financials and Accounts Payable Correspondence Data Storage and Data Management Reporting Security and Audit Trails Data Exchange Services, Electronic Data Interchange, and CAQH Core Capacity and Scalability Flexibility Security and Confidentiality Level of Automation System Integration and Interoperability High Availability Technical Reference Model Technology Stack Historical Data Purging and Reloading System Configuration Retention and Migration System Status 5/22/2017 5. 3 System Features And Capabilities Optional Tasks A-H 5. 3. 27. 1 5. 3. 27. 2 5. 3. 27. 3 5. 3. 27. 4 5. 3. 27. 5 5. 3. 27. 6 5. 3. 28. 7 Alias Records (Optional Task A) Web-based Provider Portal (Optional Task B) Fee Schedule and Contract Management (Optional Task C) Web-based Authorizations and Referrals Portal (Optional Task D) Data Input, Claims Intake, and Data Accessibility (Optional Task E) Customer Management (Optional Task F) Correspondence (Optional Task G) Cloud Environment (Optional Task H) 13
Base Requirements 5. 3. 1 5. 3. 2 5. 3. 3 5. 3. 4 5. 3. 5 5. 3. 6 5. 3. 7 5. 3. 8 5. 3. 9 5. 3. 10 5. 3. 11 5. 3. 12 5. 3. 13 5. 3. 14 5. 3. 15 5. 3. 16 5. 3. 17 5. 3. 18 5. 3. 19 5. 3. 20 5. 3. 21 5. 3. 22 5. 3. 23 5. 3. 24 5. 3. 25 5. 3. 26 Member Management and Eligibility Benefit Administration Provider Management Fee Schedule and Contract Management Authorizations and Referrals Data Input, Claims Intake, and Data Accessibility Work Assignments and Workflow Claims Adjudication Customer Management Financials and Accounts Payable Correspondence Data Storage and Data Management Reporting Security and Audit Trails Data Exchange Services, Electronic Data Interchange, and CAQH Core Capacity and Scalability Flexibility Security and Confidentiality Level of Automation System Integration and Interoperability High Availability Technical Reference Model Technology Stack Historical Data Purging and Reloading System Configuration Retention and Migration System Status 5/22/2017 5. 3 System Features And Capabilities Optional Tasks A-H 5. 3. 27. 1 5. 3. 27. 2 5. 3. 27. 3 5. 3. 27. 4 5. 3. 27. 5 5. 3. 27. 6 5. 3. 28. 7 Alias Records (Optional Task A) Web-based Provider Portal (Optional Task B) Fee Schedule and Contract Management (Optional Task C) Web-based Authorizations and Referrals Portal (Optional Task D) Data Input, Claims Intake, and Data Accessibility (Optional Task E) Customer Management (Optional Task F) Correspondence (Optional Task G) Cloud Environment (Optional Task H) * Changes from previous solicitation in red 14
5/22/2017 5. 4 System Documentation This includes, at a minimum, technical user guides, system and data architecture and schemas, and interoperability specifications; and one software configuration users guide. Online Wiki is acceptable for any documentation created by the vendor. The Contractor shall provide any necessary updates to the system documentation and software configuration Users Guide within seven days after an update or upgrade becomes available. 5. 5 System Configuration and Implementation The Contractor shall offer VA-FSC solutions and perform associated services for the ongoing configuration and implementation of the configurable software and claims adjudication environment 15
5/22/2017 5. 6 Software Updates and Quality Improvement The Contractor shall continually seek ways to improve the software and integrate the improvements into the configured software being utilized by VA-FSC. The Contractor shall provide software releases at least semi-annually and provide release notes with each software release. 5. 7 Patches for Bugs and Issues The Contractor shall provide necessary patches to the software product to ensure its continuous operation. High security vulnerabilities within 15 days, Medium security vulnerabilities within 30 days, Low security vulnerabilities within 45 days. 16
5/22/2017 5. 8 Training and User Documentation The Contractor shall provide at least one Software Training Manual and one Users Guide at least 60 calendar days prior to scheduled deployment of configured software to production. The Contractor shall conduct training classes at the FSC in Austin, Texas or as otherwise determined by VA-FSC. Initial training class shall be no less than five (5) days long and conducted within 30 calendar days after initial installation of the software product. The Contractor shall conduct subsequent training classes each time the software is updated or upgraded, during the entire period of performance. 5. 9 Software Technical Support The Contractor shall provide technical support 24/7/365 throughout the period of performance and acknowledge requests for technical support within one (1) hour via email to the COR. The Contractor shall commence remediation of identified problems within 24 hours of receiving the request. The Contractor shall record all service calls in a Technical Services Log. 17
Evaluation Plan Overview Robert Kately, Contracting Officer, TAC Steve Spurlin, Contracting Officer’s Representative, FSC
The Technical Factor is significantly more important than the Past Performance Factor, which is significantly more important than the Price Factor, which is significantly more important than the Small Business Participation Commitment Factor, which is slightly more important than the Veterans Involvement factor. The non-Price Factors, when combined, are significantly more important than the Price Factor. 5/22/2017 Basis for Award * TECHNICAL Past Performance * The Technical Factor is comprised of three Sub-factors: (A) Technical Execution, (B) Project Execution, and (C) Product Demonstration. The Technical Sub-factors are equal in importance. Price SBPC Vets Involvement 19
5/22/2017 Basis for Award (continued) To receive consideration for award, a rating of no less than "Acceptable" must be achieved for the Technical Factor and each Technical sub-factor. Offerors are cautioned that the award may not necessarily be made to the lowest price offered or the most highly rated technical proposal. In accordance with FAR 52. 215 -1, Offerors are reminded that if the Contracting Officer determines that the number of proposals that would otherwise be in the competitive range exceeds the number at which an efficient competition can be conducted, the Contracting officer may limit the number of proposals in the competitive range to the greatest number that will permit and efficient competition among the most highly rated proposals. 20
5/22/2017 Evaluation Approach All proposals shall be subject to evaluation by a team of Government personnel. The Government reserves the right to award without discussions based upon the initial evaluation of proposals. Proposals which merely restate the requirement or state that the requirement will be met, without providing supporting rationale, are not sufficient. Offerors who fail to meet the minimum requirements of the solicitation will be rated Unacceptable and thus, ineligible for award. All Offerors’ written proposals will be evaluated. However, only those Offerors considered to be in the competitive range after evaluation of the written proposals will be invited to participate in the product demonstration. 21
Technical Execution Technical Project Execution Product Demonstration Sub-factor A All three subfactors are equal in weight. Sub-factor B The cumulative page limit for Sub-factors A & B is 50 pages. Sub-factor C 5/22/2017 Evaluation Approach – TECHNICAL For the Technical Execution Sub-factor, the Offeror shall: 1. Demonstrate how its proposed product will comply with Section 508 as described in Section A 3. 0 of Addendum A of the PWS. 2. Demonstrate how its proposed product will comply with being deployed in a FISMA-HIGH environment. 3. Describe its approach to converting the software from its COTS state to one that will meet the requirements set forth in the PWS. Offerors shall identify which functional requirements in PWS para 5. 3 are provided out-ofthe-box or with minimal configuration, which functionalities must be customized/developed over the 24 -month Base Period, and the Offeror’s proposed schedule and approach to deliver those functionalities. 22
Technical Execution Technical Project Execution Product Demonstration Sub-factor A All three subfactors are equal in weight. Sub-factor B The cumulative page limit for Sub-factors A & B is 50 pages. Sub-factor C 5/22/2017 Evaluation Approach – TECHNICAL For the Project Execution Sub-factor, the Offeror shall: 1. Discuss its project execution processes (i. e. , CMMI, ISO 9001, etc. ) and describe how those processes will be applied to the products and services required by the PWS. The Offeror shall also discuss these processes with respect to managing the configuration and customization effort during the entire duration of the contract period. 2. Discuss its process for providing the VA-FSC with technical support and maintenance up to and including patches for bugs and software. Offerors shall also submit a sample Technical Service Log where all software maintenance and technical support will be recorded. 23
Technical Execution Technical Project Execution Product Demonstration Sub-factor A All three subfactors are equal in weight. Sub-factor B The cumulative page limit for Sub-factors A & B is 50 pages. 5/22/2017 Evaluation Approach – TECHNICAL Sub-factor C For the Project Execution Sub-factor, the Offeror shall: 3. Submit an integrated master schedule (IMS) and Work Breakdown Structure (WBS) that addresses all events associated with implementation within the first two years. Offerors shall identify risks associated with the proposed schedule and the associated mitigation strategies. 4. Submit a summary of the Offeror’s and its subcontractors’ qualifications and expertise with respect to claims adjudication software. The Offeror is encouraged to address the expertise it has regarding the implementation of a COTS based claims processing solution in a Government or large commercial industry healthcare claims processing setting. 24
Technical Execution Technical Project Execution Product Demonstration Sub-factor A Sub-factor B Sub-factor C All three subfactors are equal in weight. 5/22/2017 Evaluation Approach – TECHNICAL The cumulative page limit for Sub-factors A & B is 50 pages. Each Offeror whose written proposal is determined to be among the most highly rated shall provide a live, realtime, demonstration of the solution as described in its proposal. Offerors will be notified a minimum of 2 days in advance of the specific date/time of their demonstration and may bring no more than 5 personnel. The demonstration will be conducted at either the VA Technology Acquisition Center in Eatontown, New Jersey or VA-FSC. The conference room will contain several 120 VAC outlets. The Government will not provide internet access. All resources and equipment required for the demonstration, including internet connectivity, shall be provided by the Offeror. 25
Technical Execution Technical Project Execution Product Demonstration Sub-factor A All three subfactors are equal in weight. Sub-factor B The cumulative page limit for Sub-factors A & B is 50 pages. Sub-factor C 5/22/2017 Evaluation Approach – TECHNICAL All costs associated with the demonstration shall be borne by the Offeror and will not be reimbursed by the Government. The demonstration will occur over a period not to exceed six hours. Vendors do not have to use the entire six hour time period allotted, but cannot exceed the allotted time period. The Offeror will be allowed 30 minutes prior to the demonstration for any necessary set-up and 30 minutes following the demonstration for tear-down. The Offeror shall conduct its demonstration in accordance with the Demonstration Plan which will be attached to the solicitation. * Interactions between Offeror and Government personnel shall be limited during the demonstration. * 26
5/22/2017 Evaluation Approach – TECHNICAL For the Technical Execution and Project Execution Sub-factors, the evaluation process will consider the following: i. Understanding of the Problem: The proposal will be evaluated to determine the extent to which it demonstrates a clear understanding of all features involved in solving the problems and meeting and/or exceeding the Healthcare Claims Adjudication Software requirements; and the extent to which uncertainties are identified and resolutions proposed. ii. Feasibility of Approach: The proposal will be evaluated to determine the extent to which the proposed approach is workable and the end results achievable. The proposal will be evaluated to determine the level of confidence provided to the Government with respect to the Offeror's methods and approach in successfully meeting and/or exceeding the requirements in a timely manner. 27
5/22/2017 Evaluation Approach – TECHNICAL For the Product Demonstration Sub-Factor, the evaluation process will consider the following: i. Understanding of Problems: The demonstration will be evaluated to determine the extent to which the Offeror demonstrates a clear understanding of all features involved in solving the problems and meeting the requirements presented by the product demonstration; and the extent to which uncertainties are identified and resolutions proposed. ii. Feasibility of Approach: The demonstration will be evaluated to determine whether the Offeror's methods and approach to meeting the product demonstration requirements provides the Government with a high level of confidence that the proposed solution offers the capabilities needed by VA-FSC to accomplish its purpose, and/or can be configured to deliver those capabilities and function in accordance with the requirements presented in the solicitation. 28
5/22/2017 Evaluation Approach – PAST PERFORMANCE The Past Performance evaluation will assess the relative risks associated with an Offeror's likelihood of success in fulfilling the solicitation's requirements as indicated by that Offeror's record of past performance. The Government will conduct a performance risk assessment based on the quality, relevancy, and recency of the Offeror's past performance, as well as that of its major subcontractors, as it relates to the probability of successful accomplishment of the required effort. A project is considered relevant if it comprises both the software product and the services required to tailor the software product to meet the needs of the Customer, and if the volume of claims processed is comparable to that of FSC. The Government considers recency to be within the past three (3) years from date of solicitation release. 29
5/22/2017 Evaluation Approach – PAST PERFORMANCE Offerors are cautioned that the Government will review available past performance data in the Past Performance Information Retrieval System (PPIRS) and reserves the right to obtain past performance information from any available source. It is incumbent upon the Offerors to explain the relevance of the data provide and the burden of proving low performance risk rests with the Offerors. In the case of an Offeror without a record of relevant past performance or for whom information on past performance is not available, the Offeror may not be evaluated favorably or unfavorably on past performance. 30
5/22/2017 Evaluation Approach – PRICE Firm-Fixed-Price The Government will evaluate price by adding the total of all line item prices, including all options. The total evaluated price will be that sum. 31
5/22/2017 Evaluation Approach – SBPC Commitment to Small Business Participation The proposal will be evaluated to determine the extent to which the Offeror demonstrates a commitment to meeting or exceeding the following small business goals: SDVOSB 5% Small Disadvantaged Business 5% WOSB 5% HUBzone 3% Any inability to meet the Government’s subcontracting goal(s) for this procurement must be supported by an adequate explanation as to why that goal(s) cannot be met. 32
5/22/2017 Evaluation Approach – Vets Involvement In accordance with VAAR 852. 215 -70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, the Government will assign evaluation credit for an Offeror (prime contractor) which is a SDVOSB or a VOSB. Non-SDVOSB/VOSB Offerors proposing to use SDVOSBs or VOSBs as subcontractors will receive some consideration under this evaluation Factor. In accordance with VAAR 852. 219 -72, Evaluation Factor for Participation in the VA Mentor. Protégé Program, the Government will assign credit to non-SDVOSB/VOSBs with approved Mentor-Protégé Agreements. 33
Written Q&A Overview Robert Kately, Contracting Officer, TAC Steve Spurlin, Contracting Officer’s Representative, FSC
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 1 Recommend that the selected vendor demo its Scenarios are needed to evaluate “apple-to. OOB capability absent of a scenario, and apples” amongst the vendor demonstrations. provide a plan and schedule to deliver, incrementally, the remaining requirements. 2 Recommend that the government consider a trade-off analysis during the demonstrations. The Product Demonstration Sub-factor rating will roll up into the overall Technical Factor rating, which will be part of the overall best value determination. 3 Recommend the FSC enter into a traditional software licensing agreement. A standard agreement provides the FSC with access to all future releases, patches and upgrades as well as traditional help desk and IT support. FSC’s requirements include all of the referenced support. Vendors are permitted to propose a perpetual license up front. 35
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 4 Regarding previous PWS: There is a concern that VA may be severely limiting competition with its “out of the box” requirements. Current PWS revised to include only the requirement to delivery the first program offering (VA Choice) NLT 12 months from date of award. 5 Recommend page limit of 50 pages vice 40 pages. Page limit will be increased to 50 pages. 6 Having a well-defined list of mandatory out-ofthe-box requirements, but then making an exception for customization for 508 compliance is contrary to the definition of COTS. There are viable COTS products that meet FSC requirements and are largely 508 compliant out of the box and may not require customizations for 508 ADA compliance. FSC’s primary concern is that the product is 508 compliant by the time it is implemented (i. e. , NLT 12 months for VA Choice). FSC does not want to limit competition if configuration related to 508 compliance is necessary out of the box, however FSC recognizes that a requirement for significant 508 compliance configuration would increase relative risk associated with an Offeror’s proposal. 36
# Industry Question/Comment 7 Reference applicable documents section, vendor requests that the government reconsider simplification of the contract terms by only including IT standards which are, to the maximum extent practicable, consistent with customary commercial practices and as necessary to implement Statutes or Executive Orders, and thereby eliminating all other standards that are redundant, conflicting or unnecessarily restrictive. 5/22/2017 Written Q&A Overview VA Response FSC has to follow all of the standards listed. 37
5/22/2017 Written Q&A Overview # Industry Question/Comment VA Response 8 Reference Paragraph 3, Scope of Work: CLARIFICATION REQUESTED: Please provide a detailed definition of “unlimited use” in this context, since the Government’s licensing rights in COTS software generally governed by the terms of the contractor’s End User License Agreement or other commercial licensing agreement. Can the VA please fully describe the requested scope of its licensing rights in the COTS software? For a perpetual license, unlimited use is defined as unlimited number of concurrent users and an unlimited number of medical claims processed. For a transactional license, the payment for the license is based on the number of claims processed with an unlimited number of concurrent users. 9 Due to the complexities of the agency’s 30 -45 days will be provided depending on date of requirements, it is requested that the deadline release. for RFP responses be at least 30 days from the RFP release date. 38
# 10 Industry Question/Comment Is VA willing to provide more than 24 months to complete the amount of work required by the Base Period? 5/22/2017 Written Q&A Overview VA Response FSC requires all four product lines (VA Choice, Dialysis, Camp Lejeune, OGA) to be implemented within 24 months of award. 39
# 11 Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response Reference Section 5. 2. 2, Software No answer at this time. Product/License: Since FAR 27. 405 -3, “Commercial Computer Software” expresses a preference that commercial computer software or commercial computer software documentation be acquired under licenses customarily provided to the public to the extent the license is consistent with federal law and otherwise satisfies the Government’s needs. Vendor proposes to offer to the Government a standard commercial license to its software products and associated documentation, etc. , modified to exclude those aspects contrary to federal law. Vendor would retain ownership and grant to the Government a non-exclusive, perpetual license grant to the government for its use on commercially standard terms. 40
# 12 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response Vendor must take exception to the language in Section 5. 2. 2 (Perpetual Software Product/License) that states “The Government shall retain unlimited data rights for any software developed to meet the requirements of this contract. ” Generally, vendor cannot agree to unlimited data rights, and may consider granting the Government limited and/or restricted data rights using vendor’s commercial standard license agreement. FSC needs to retain ownership of VA data (claims and veteran data), business rules, and any code pertaining to custom development that it paid for. 41
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 13 Reference Section 5. 3. 1. a, ability to import member data from external data sources in real time, after performing validation rules that define a valid member: Vendor needs to know if this is a real-time eligibility verification that is required for a claims payment, utilization review, in customer service. Yes, real-time eligibility verification is required for a claims payment, utilization review and in customer service from an external source of truth when the member does not exist in the system. 14 Reference Section 5. 3. 1. j, can track and store dental data, patient conditions, and clinical history; which can be added manually, imported from member data, or added from claim details: Vendor needs to know the data elements that define dental clinical history. Dental data will come from the claim and we need to track for future claims. For example, tooth #4 was extracted and 2 years later, we receive another claim for services of the same tooth, the system should flag the claim. 42
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 15 Reference Section 5. 3. 10 c. , capable of accepting at least 160 characters per accounting line. Vendor requires definition as to what qualifies as an accounting line (i. e. provide an example)? The requirement is for the system to accept an accounting string of up to 160 alpha-numeric characters. When a claim is paid, the system should store the accounting line detail per claim line. This could be an obligation number or some other string of accounting information. (Will add to PWS) 16 Reference Section 5. 3. 11. a. allows for the import of form letters from varying formats, Vendor requires elaboration on this requirement in order to review. Requirement is to import from Microsoft Word, Adobe PDF files, etc. 17 Reference Section 5. 3. 12. c. , can identify and segregate data per FSC customer/lines of business, Vendor requires clarification on how FSC customers are distinguished to review. The requirement is to segregate data according to the line of business; however, we do not want to prescribe how to separate the data. 43
# 18 Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response Reference Section 5. 3. 15. d. , remains current Vendor should remain current to ongoing with on-going healthcare; electronic standards during the period of performance for transactions; information exchange maintenance and support services. regulations; national format/standards; and versions of national standards including HIPAA; the Affordable Healthcare Act; and the CAQH CORE. Vendor requires clarification regarding the data exchange services, electronic data interchange, and CAQH CORE and if they should remain current with the referenced ongoing standards solely during the period of performance for which vendor’s maintenance and support services are provided. Existing language can be misconstrued to indicate an ongoing obligation beyond the period of performance to maintain current with changing standards. 44
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 19 Reference Section 5. 3. 15. i, CAQH CORE Rules, Vendor requests that phase IV rules, 450, 452 and 470 be removed. The Government is required to comply with these rules. 20 Reference Security and Audit Trails, Vendor will This needs to be included in the contract pricing need Subject Matter Experience in The VA”s and not an additional charge. implementation of FIPS 200, FIPS 199 and NIST 800 -53 in order to fully evaluate changes required to meet requirements. The expertise necessary and the roadmap changes to support, can be added in for additional costs, once contract is awarded. 21 Vendor requests language supporting roadmap changes to support HL 7 that can be added in for additional costs, once contract is awarded. Supporting HL 7 is a basic requirement because interfaces with other VA systems use HL 7. 45
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 22 Reference Section 5. 3. 17, Flexibility, Vendor Changes based on the requirements in this requests language supporting roadmap section should be covered in the maintenance changes to support changing VA needs that can and support CLINs. be added in for additional costs, once contract is awarded. 23 Reference Section 5. 3. 19, Level of Automation, Vendor requests modification to strike 85% in favor of determining the minimum upon learning the Vas business rules and business complexity through an assessment. VA goal is to achieve a minimum of 85% autoadjudication. 46
# 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response 24 Any standards and approved software changes in the TRM that apply to Vendor solutions and require roadmap changes, can be added in for additional costs, once the change is understood and agreed by the VA and Vendor. TRM approval is required before the system can go into production. Vendor should price these requirements in their base period of performance. If any subsequent changes are required after initial production capability, the price should be included in the maintenance and support services CLINs. 25 Reference Section 5. 5, System Configuration, The Contractor shall conduct initial implementation assessments and periodic implementation assessments throughout the life of the contract, in order to properly scope the implementation services. Vendor requests clarification as to if this means ongoing configuration services. The Government intends for this to be through the base period of performance as well as subsequent option years (which will be for maintenance and service only). The intent is for the Government to learn system configuration in order to lessen our reliance on the vendor in the option years. 47
# 26 Industry Question/Comment Reference Section 5. 6, Software Updates, Vendor requests that a separate maintenance agreement be signed for release support. 5/22/2017 Written Q&A Overview VA Response This will be included in the base period of performance and subsequent option years. The Government intends for the option years to be for service and maintenance only. 48
# 27 Industry Question/Comment Reference Section 5. 6, Software Updates, Updates may involve such complex software customization, engineering and development that it may not always be possible to implement updates at least three months prior to the effective compliance date stated in the Federal Register. Also, new federal mandates incorporated into the contract after award should be handled as a change and priced as such, with the timeline for implementation of the change being mutually agreed between the parties in a contract modification. In any event, the timeline and pricing for implementation of updates/changes to the software solution to bring it into compliance with new or modified federal mandates should be mutually agreed upon by the parties. 5/22/2017 Written Q&A Overview VA Response If the contracting officer determines the federal mandate is outside the scope of the contract, then the Government will negotiate a contract modification. Otherwise, any subsequent changes should be included in the maintenance and support services CLINs. 49
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 28 Reference Section 5. 6, Software Updates, The Government intends for the option years to Contractor shall have 20 calendar days to be for service and maintenance only, which technically integrate the updated software and includes upgrade services. commence providing technical support for the updated software. Vendor requests that a separate Upgrade Services Agreement be signed for integration of updated software with technical support. 29 Reference Section 5. 6, Software Updates, The Contractor shall provide the VA-FSC Customer with a patch for a software bug or issue that negatively affects its performance; within 15 calendar days of being informed by the VA-FSC Customer of operability problems with the software, or of learning of a security vulnerability in the software. Vendor requests language change to support mutually agreeable negotiated SLAS upon contracting. If a vendor needs more than 15 days to remedy a software bug or issue, the vendor shall notify the COR and contracting officer with the appropriate rationale. (Added to PWS Section 5. 7) 50
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 30 Vendor requests that 60 days replace the 3 Requirement can be updated to 7 days after business days stated to provide a roster of award. contractor and subcontractor employees to the COR. 31 In the previous RFP, it was requested an FFP contract type even though volume and scale are dynamic with no defined increased volume schedule. Additionally, there was too much risk for offerors to price as an FFP, and the Government stated in several answers, “Technical specifications will be provided to the awardee. ” Offerors would have to increase their price to provide risk mitigation for the numerous unknowns in the requirements. We recommend the government to consider some of the tasks be FFP and some to be T&M as a hybrid contract type. VA assumes that the vendor is referring to Q&A’s from the prior solicitation which asked VA to release technical specifications regarding our document management system, OCR/Imaging System, Financial System (FMS), and CRM Systems. VA felt an API would suffice. VA market research showed that most implementation costs were included in the price of a license and thus decided on a FFP contract type 51
# 32 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response PWS Para 5. 3. 1 Requirement: Ability to import member data from external data sources in real time, after performing validation rules that define a valid member. It is unclear from the requirement what method of creating member data is to be used with each of the lines of business processed by the new system at FSC. . Previous versions of the Draft PWS for this opportunity referenced X 12 N 834 transactions as a vector for adding eligibility information but also mentioned ETL loads for eligibility. The current version mentions import from 'external sources' but it is unclear if either or both methods previously mentioned in earlier Draft PWS versions are still required. Member data will be created from an Application Program Interface (API) for exchange of data between the software, existing interfaces, and external web portals. 52
# 33 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response PWS Para 5. 3. 10 Requirement: Capable of integrating with a COTS financial accounting software. Calculation of an appropriate FFP bid is very problematic for this area of the Draft PWS requirements. Lack of integration details, such as workflows and interfaces involved, and how the required new fields mentioned would be used in the workflows required, combine to make only a rough estimate possible. Our understanding of the specifics of the FSC implementation, based on previous experience with FSC’s Financial Management System (FMS) and other payment related subsystems, leads us to believe there will be customization we have not been able to specifically identify based on the Draft PWS requirements. For instance we understand that VA/FSC have workflows in this area, possibly involving VA-specific or Federally mandated services and features, that would all need to be considered to have a complete understanding of the totality of the effort required to integrate the COTS claims system into FSC's accounting system(s). Identification of all of the workflows and subsystems, that will be involved in the validation of payments and transmission of 835/ACH data, need to be clarified for submitted bids to accurately reflect the appropriate LOE required to implement the functionality. The more detail the Government can provide to us, helps us bid FFP opportunities with less risk and therefore lower cost to the Government. The software will need to integrate with the FSC’s Financial Management System (FMS) using published interfaces available for applications to consume (SOAP) using an Enterprise Service Bus to orchestrate the services. The VA is upgrading the current FMS to a COTS solution (Momentum) in 2019 and the system will have to integrate with it at that time. At this time, we do not know the workflows and interfaces needed for Momentum; however we know Web Services Model (Preferred) is supported by Momentum. 53
# 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response 34 PWS Para 5. 3. 13 Requirement: Can monitor and track processor productivity, performance, and audits; and provide resulting metrics in ad hoc reports or on a role-based dashboard. It would be helpful to have clarification on the features and workflows envisioned for the dashboard so that evaluation against a COTS products feature set can be evaluated accurately. To provide the metrics, vendor has the option of providing configurable ad-hoc reports; a dashboard; or both. 35 Vendor takes exception to the express general No answer at this time. prohibition against offshoring performance. Vendor determines it reasonable to have the ability to use offshore resources during contract performance, with the knowledge and consent of the agency. Vendor is open to discussing and negotiating this aspect of contract performance with the agency. 54
# 36 Industry Question/Comment Requirements in the areas of confidentiality and security should allow vendors to describe confidentiality, data access, and security configurations without including unnecessarily broad absolute requirements around specific data types. 5/22/2017 Written Q&A Overview VA Response These requirements are prescribed by the VA and the acquiring office has no authority to waive them. 55
# 37 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response Recommend the agency exclude the requirement to comply with EIT Accessibility Standards in 36 CFR Part 1194, based on the “undue burden” exception in FAR 39. 204 requires an agency to consider the difficulty or expense of compliance and resources available to its program for which the service is being acquired. FAR 39. 204 also sets forth that, when acquiring commercial items, an agency must comply with those accessibility standards that can be met with supplies and services available in the commercial marketplace in time to meet the agency’s delivery requirements. These requirements are prescribed by the VA and the acquiring office has no authority to waive them. User-facing screens need to be 508 compliant and market research has shown that there are capable products that are 508 compliant today. 56
# 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response 38 How many contractor staff will VA-FSC accommodate from a workspace perspective? What is the expectation for daily on-site VA-FSC team presence? Estimated number of trips is necessary to help minimize impact to contractor overall pricing strategy. Contractor may propose on-site and/or remote/virtual workspaces for their employees. The number of trips necessary depends on what the contractor proposes in their project schedule for a successful implementation. 39 References to real-time were removed in provider section (5. 3. 3), and in authorizations and referrals section (5. 3. 5). Should real-time reference be removed from member section as well? Does the removal of direct reference to HIPAA 834 transaction indicate that proprietary formats will/may be used to communicate member details? Real-time references for member section (5. 3. 1) are required. The software shall be able to import 834 transactions, per section 5. 3. 6. e. v. In addition, the software shall support importing authorizations in various formats, such as HL 7 and SOAP XML. 57
# Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response 40 Does the removal of direct reference to HIPAA 278 transaction indicate that proprietary formats will/may be used to communicate authorization and referral details for the members? The software shall be able to import 278 transactions, per section 5. 3. 6. e. iii. In addition, the software shall support importing authorizations in various formats, such as HL 7 and SOAP XML. 41 Does the removal of real-time reference indicate that batch files will be used to synchronize data between the external source and the claims system? We will add the following verbiage to Paragraph 5. 3. 3 a, “… importing and real-time integration of provider …” 58
# 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response 42 The software shall provide an Application Program Interface (API) for exchange of data between the software, existing interfaces, and external web portals. Would this be expected within the first six (6) months (for the first business line)? What type of information would need to be able to be exchanged via API? Would the data from the claim system be read only, or would the external software, interfaces and web portals be able to update the core system? This would be expected in the 8 -12 months after contract award when VA Choice goes into operational production. Please see paragraph 5. 3. 3. for data to be exchanged via API. The external software, interfaces and web portals should be able to update the core system. 43 Does the removal of real-time reference indicate that batch files will be used to create authorizations and referrals in the new claims admin system? (5. 3. 5. c) We will add the following verbiage to Paragraph 5. 3. 3 c, “… importing and real-time integration of authorization/referral …” 59
# 5/22/2017 Written Q&A Overview Industry Question/Comment VA Response 44 There is no reference to an outbound X 12 -278. Does that indicate that the 278 will be used as initial request only, and that there will be no acknowledgement? Or does this mean that the 278 will not be using the request/response pattern at all? (5. 3. 6. f) Will include 278 in the export verbiage paragraph 5. 3. 6. f in the PWS. 45 Regarding pharmacy claims, will the VA-FSC receive and have to process/adjudicate individual claims from pharmacies, which would be outside of transactions included in a PBM encounter (NCPDP) file? We will remove “pharmacy claims” from that paragraph. 46 Due to the removal of most real-time references in para 5. 3. 15, should support of real-time processing per CAQH/CORE Rules be considered optional? No, we must follow the CAQH/CORE rules. 60
# 47 Industry Question/Comment 5/22/2017 Written Q&A Overview VA Response Reference para 5. 3. 27. 2, is there an Currently, pharmacy claims are submitted to expectation that the bulk bill for NCPDP claims PBM and the PBM vendor seeks reimbursement (priced and paid by the PBM) would be (bulk bill) from the VA. imported into the claim system for adjudication and pricing? Or would these bulk bills be imported into the ODS for reporting and analytic needs only? Excluding prescriptions from 837 P and I claims and prescription claims submitted from the member, would there be a situation where a pharmacy would be submitting Rx claims to the VA (to be processed in the proposed claim system)? Or would these pharmacy claims be submitted to a PBM for processing and payment? 61
Open Q&A Period Robert Kately, Contracting Officer, TAC Steve Spurlin, Contracting Officer’s Representative, FSC
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