What the buyer needs
AI summaryThe Veterans Health Administration Office of Community Care, Revenue Operations, eBusiness Solutions Office seeks a second Health Care Clearinghouse to conduct HIPAA Health Care Eligibility/Benefit Inquiry and Response 270/271 electronic transactions and insurance discovery services. The contractor will transmit real-time transactions received from the Austin Financial Services Center to expand access to significant payers not supported under the primary clearinghouse contract and perform customized searches for patient insurance when VHA lacks information on file. The contractor must provide minimum connectivity to health care payers on day one of the contract and be able to perform testing or certification mechanisms to validate coverage discovery transactions within 30 business days of award. Transaction deliverables are billed based on the volume of transactions processed, and the contractor must provide a closure transition plan covering an exit period not to exceed 30 days.
Scope of work
- Receive, process, and transmit CAQH CORE compliant HIPAA Health Care Eligibility/Benefit Inquiry and Response 270/271 transactions
- Translate proprietary formats to and from HIPAA compliant transactions
- Provide real-time HIPAA 270/271 transactions for standard, participating, and non-participating payers
- Perform testing and certification of transactions within 30 business days of award date
- Conduct customized insurance coverage discovery transactions via batch and/or real-time transfer
- Deliver electronic transaction acknowledgements per HIPAA standards
- Provide minimum essential connectivity to health care payers on day one of the contract
- Provide a Closure Transition Plan and complete transition period activities not to exceed 30 days
Minimum qualifications
- Staff with extensive knowledge of CORE operating Rules required in X12 and HIPAA Compliance standards
- Active participation in national standards groups such as Eligibility and Benefit Info workgroups
- Compliance with CAQH CORE Operating Rules at time of contract award and/or contract effective date
- Compliance with all VA security, data privacy, and HIPAA requirements
Documents to include with your response
- Confirmation of successful communication(s)
- Closure Transition Plan
- HIPAA X12 270/271 Payer List
- Insurance Coverage Discovery Payer List
- Signed VA Interconnection Security Agreement / Memorandum of Understanding (ISA/MOU)
- Signed Business Associate Agreement (BAA)
- Section 508 EIT Exceptions Certification Document, if applicable
- Privacy Impact Assessment (PIA)
Incumbent and award research
No incumbent history found for this requirement. The notice does not cite a current contract, and no earlier award from this buying office matches it.
Market context
Awards in the same category (Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services). This is not this requirement's award history.
Recent similar awards: Department of Veterans Affairs, NAICS 518210
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Top vendors in this category: Department of Veterans Affairs, NAICS 518210, since Oct 1, 2024
395 contract awards in this NAICS over the period.
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Source: USAspending.gov federal award data (U.S. federal public data). A contract is called the incumbent only when the notice or its documents cite it by number.