SOURCES SOUGHT
70 -- Payer Compliance Tool Request for Information (RFI) (VA-25-00095966)
- Notice Date
- 7/24/2025 4:10:40 PM
- Notice Type
- Sources Sought
- NAICS
- 541519
— Other Computer Related Services
- Contracting Office
- TECHNOLOGY ACQUISITION CENTER NJ (36C10B) EATONTOWN NJ 07724 USA
- ZIP Code
- 07724
- Solicitation Number
- 36C10B25Q0464
- Response Due
- 8/11/2025 9:00:00 AM
- Archive Date
- 10/10/2025
- Point of Contact
- Felica Griffin, Contract Specialist, Phone: 848-377-5107
- E-Mail Address
-
Felica.Griffin@va.gov
(Felica.Griffin@va.gov)
- Awardee
- null
- Description
- Department of Veterans Affairs (VA) Veteran Health Administration (VHA) Integrated Veteran Care(IVC) Payer Compliance Tool Request for Information (RFI) Introduction This Request for Information (RFI) is issued for information and planning purposes only and does not constitute a solicitation nor does it restrict the Government as to the ultimate acquisition approach. In accordance with Federal Acquisition Regulation (FAR) 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. The purpose of this RFI is to identify qualified vendors, who are able to meet Department of Veterans Affairs (VA) requirements for the Payer Compliance Tool (PCT). Any contract/order that might be awarded based on information received or derived from this market research will be the outcome of the competitive process. The purpose of this RFI is to obtain market information on capable sources of supply, industry best practices, and input specific to the information provided. The Government is not responsible for any cost incurred by industry in furnishing this information. All costs associated with responding to this RFI will be solely at the interested vendor s expense. Not responding to this RFI does not preclude participation in any future Request for Proposal (RFP), if any is issued. Any information submitted by respondents to this RFI is strictly voluntary. All submissions will become Government property and will not be returned. Interested vendors are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. Be advised that set-aside decisions may be made based on the information provided in response to this RFI. Responses should be as complete and informative as possible. The North American Industry Classification System (NAICS) for this requirement is 541519 with a size standard of $34.0 million. Generic capability statements or marketing materials will not be accepted or reviewed. RFI Response Instructions NOTE: The capability package must be clear, concise, and complete. VA is under no obligation to provide feedback to the company, or to contact the company for clarification of any information submitted in response to this RFI. Provide the following information: Provide Company Information: Company Name Unique Entity Identifier Number (UEI) under which the company is registered in SAM Company Address Point of contact name Telephone number Email address Small Business size status based upon the applicable NAICS code of 541519. For more information refer to http://www.sba.gov/. If SDVOSB/VOSB, is your business verified in the VetCert database (https://veterans.certify.sba.gov) For small business concerns, indicate whether at least 50 percent of the total amount paid by the Government will be paid to firms that are similarly situated. List any existing contracting vehicles you currently maintain that cover the intended scope of work Brief summary describing your company s technical approach to meeting the requirements, to include; Company Background and Experience Can you provide an overview of your company and its experience in developing payment integrity tools, specifically for government or healthcare organizations? What are some of your previous projects or case studies related to payment integrity and business compliance? What core features does the solution offer? Is the solution user friendly? What best practices or implementation lessons learned can you share from deploying your system in other large payer or federal healthcare environments? Technical Capabilities Data Integration and Management How does your solution integrate with multiple claims systems and external data sources? Can your tool harmonize and centralize data from various sources into a common data model? Describe your system s ability to integrate with VA s adjudicated 837 claim files and reference external data sources such as CMS FEE Schedules, PPS, NCCI, MUE, and VA specific pricing policies. Is the solution an on-premises integration, within the VA IT infrastructure, fully integrated with VA systems or Cloud based? What data formats and standards are supported? Payment Integrity and Analytics What core compliance, pricing, and predictive analytics rules are included in your solution out-of-the-box, and how frequently are they updated to align with CMS and other payer policies? Please describe any advanced features, including AI, machine learning, or behavioral analytics, that help identify suspicious billing patterns or emerging risks that may not be detectable through static business rules. How does your tool support both pre-payment and post-payment integrity checks? How does the tool handle regulatory compliance? Customizability and Flexibility How customizable is your solution to meet the specific needs of the VA, including integration with existing VA-approved tools and databases? Can your tool support the development and implementation of customized rules and models specific to VA data and policies? How customizable is the pct? What level of configurability does your rule engine support for custom business logic, geographic pricing, program specific rules, and escalation thresholds? Operational and Performance Metrics Implementation and Scalability What is the typical implementation timeline for your solution, and how do you ensure a smooth transition? How scalable is your solution to handle the volume and complexity of VA Community Care Claims? Performance Monitoring and Reporting How does your solution monitor and report on the performance of payment integrity models and rules? How does your solution use business rules, logic, machine learning, to predict potential patterns? Can your tool provide customizable real-time dashboards and reports for various stakeholders, including OIG, IVC, and finance departments? And dashboards/reports/visualizations to support improper payment detection, trend analysis, audit readiness, and ROI tracking? Utilization Management Can your solution provide real-time alerts and notifications for potential over-utilization or under-utilization of healthcare services? What types of analytics and reporting capabilities does your tool offer related to utilization management? How does the solution help in identifying trends and patterns in service utilization that could indicate potential compliance issues? How does your tool ensure that the utilization of services aligns with established clinical guidelines and best practices? Can your tool provide dashboards and reports that monitor utilization metrics in real-time? Compliance and Security Regulatory Compliance How does your solution ensure compliance with relevant regulations and standards (e.g., HIPAA, VA policies)? Describe your approach to maintaining data security and privacy within your solution. Support and Training What kind of training and support do you provide to ensure effective use of your solution by VA staff? What resources will be made available during and post implementation with the VA? How do you handle updates and maintenance for your solution to keep it aligned with evolving regulations and requirements? Cost and Value Cost Structure Can you provide a cost-benefit analysis or ROI projections based on similar implementations? Value Proposition How does your solution enhance the efficiency and effectiveness of payment integrity and business compliance for the VA? What differentiates your solution from other similar tools in the market? Responses to this RFI shall be submitted electronically by 12:00 PM Eastern Standard Time, August 11, 2025 via email the Technology Acquisition Center (TAC) point of contacts: Contract Specialist, Felica Griffin, Felica.Griffin@va.gov and Contracting Officer Kimberly Geran, Kimberly.Geran@va.gov. Please note Response to RFI Payer Compliance Tool in the subject line of your response. Q&A cut-off date: August 5, 2025 by 12:00 PM Eastern Standard Time WARNING: Please do not wait until the last minute to submit your responses! To avoid submission of late responses, we recommend the transmission of your response file 24 hours prior to the required response due date and time. Please be advised that timeliness is determined by the date and time an Offeror s response is received by the Government not when an Offeror attempted transmission. Offerors are encouraged to review and ensure that sufficient bandwidth is available on their end of the transmission. All responsible sources may submit a response in accordance with the following: All proprietary/company confidential material shall be clearly marked on every page that contains such. No more than 20 pages (excluding transmittal page). Responses should be submitted in Microsoft Word format with Times New Roman font, 12 pt. minimum that addresses the above information. Interested parties should limit marketing material in order to allow sufficient space for adequately, directly, and substantively responding with the information of most interest to the Government. See attached: Draft Statement of Work - Payer Compliance Tool VA will not be able to grant any extensions to this RFI.
- Web Link
-
SAM.gov Permalink
(https://sam.gov/opp/e68a69d9643a4fe88554a707a6b61b07/view)
- Record
- SN07523971-F 20250726/250724230056 (samdaily.us)
- Source
-
SAM.gov Link to This Notice
(may not be valid after Archive Date)
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