SAMDaily.us | PRESOL | R | 3rd Party Billing Eligibility Services

SAMDAILY.US - ISSUE OF MARCH 08, 2020 SAM #6674
SOLICITATION NOTICE

R -- 3rd Party Billing Eligibility Services

Notice Date: 3/6/2020 5:57:25 AM
Notice Type: Combined Synopsis/Solicitation
NAICS: 541611 — Administrative Management and General Management Consulting Services
Contracting Office: OK CITY AREA INDIAN HEALTH SVC OKLAHOMA CITY OK 73114 USA
ZIP Code: 73114
Solicitation Number: 246-20-Q-0030
Response Due: 3/11/2020 1:30:00 PM
Archive Date: 03/26/2020
Point of Contact: Sean Long, Phone: 9183426509
E-Mail Address: sean.long@ihs.gov
(sean.long@ihs.gov)
Small Business Set-Aside: SBA Total Small Business Set-Aside (FAR 19.5)
Description: This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6, as supplemented with additional information included in this notice.� This announcement constitutes the only solicitation; quotes are being requested in response to this notice and a written solicitation will NOT be issued. This solicitation is being issued as a Request for Quote (RFQ) 246-20-Q-0030.��Submit only written quotes for this 3rd Party Billing RFQ. This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2020-04.� This solicitation is a 100% Small Business set-aside. The associated NAICS code is 541611 with a small business size standard of $15 Million. This RFQ contains five (5) Line Items: CLIN DESCRIPTION QTY UNIT Unit Price TOTAL 0001 Year Look Back - Initial Batch File Processing of Unlimited Records 1 EA � � 0002 Monthly Fee for Insurance Scan of Patients - Base Period 12 MO � � 0003 Converted CIH Beneficiary Patient to Outside Insurance � Base Period 360 EA � � 0004 Monthly Fee for Insurance Scan of Patients � Option Year One 12 MO 0005 Converted CIH Beneficiary Patient to Outside Insurance � Option Year One 360 EA �PERIOD OF PERFORMANCE: 12 months from Date of Award, with one 12-month option period. Vendor Requirements: �Small Business, - Properly trained and certirifed staff to include background investigations. Submit Quotes no later than: March 6, 2020 @ 3:30PM CST� to the Following Point of Contact: Sean Long at - Email: sean.long@ihs.gov�� Questions and Answers: N/A Evaluation:� FAR 52.212-2 Evaluation -- Commercial Items (completed as follows): (a) The Government will award a firm fixed price contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers: Lowest Price Technically Acceptable To be considered technically acceptable you must be able to meet the requirement of the statement of work VENDORS SUBMITTING OR EQUAL ITEMS MUST SUBMIT DESCRIPTITVE LITERATURE SHOWING HOW THEIR PRODUCT MEETS OR EXCEEDS THE REQUIREMENTS BEING SOLICITED. This solicitation will result in a firm fixed price purchase order pursuant to the terms and conditions below.� Terms and conditions other than those stated will not be accepted.� The above pricing is all inclusive.� PROVISIONS:� The following FAR provisions apply to this solicitation: FAR 52.212-1, Instructions to Offeror- Commercial Items; FAR 52.212-3, Offeror Representations and Certifications- Commercial Items (the offeror should include a completed copy of this provision with their quote). CLAUSES:� The following FAR clauses apply to this solicitation: FAR 52.212-4, Contract Terms and Conditions-Commercial Items; FAR 52.212-5, Contract Terms and Conditions Required to Implement Statues or Executive Orders-Commercial Items (to include the following clauses sited): �FAR 52.203-6 Restrictions on Subcontractor Sales to the Government;� 52.203-13, Contractor Code of Business Ethics and Conduct; FAR 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards; FAR 52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment; FAR 52.217-8, Option to Extend Services, FAR 52.217-9, Option to Extend the Term of the Contract, FAR 52.219-6, Notice of Total Small Business Aside; FAR 52.219-8, Utilization of Small Business Concerns; FAR 52.219-13, Notice of Set-Aside of Orders; FAR 52.219-28, Post-Award Small Business Program Representation; FAR 52.222-3, Convict Labor; FAR 52.222-19, Child Labor-Cooperation with Authorities and Remedies; 52.222-21, Prohibition of Segregated Facilities; FAR 52.222-26, Equal Opportunity; FAR 52.222-35 Equal Opportunity for Veterans; FAR 52.222-36, Equal Opportunity for Workers with Disabilities; FAR 52.222-37 Employment Reports on Veterans; FAR 52.222-40, Notification of Employee Rights Under the National Labor Relations Act; FAR 52.222-50, Combating Trafficking in Persons; FAR 52.223-18, Encouraging Contractor Policies to Ban text Messaging While Driving;� FAR 52.225-1, Buy American Act--Supplies;� FAR 52.225-13, Restriction on Certain Foreign Purchases; FAR 52.232-33, Payment by Electronic Funds Transfer- System for Award Management; FAR 52.222-41, Service Contract Act of 1965; FAR 52.222-43 Fair Labor Standards Act and Service Contract Act � Price Adjustment.��The above Provisions and Clauses may be obtained via internet at http://farsite.hill.af.mil. FAR 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011) HHSAR 352.224-70 Privacy Act (DEC 2015) This contract requires the Contractor to perform one or more of the following: (a) design; (b) develop; or (c) operate a Federal agency system of records to accomplish an agency function in accordance with the Privacy Act of 1974 (Act) (5 U.S.C. 552a(m)(1)) and applicable agency regulations. The term system of records means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. Violations of the Act by the Contractor and/or its employees may result in the imposition of criminal penalties (5 U.S.C. 552a(i)). The Contractor shall ensure that each of its employees knows the prescribed rules of conduct in 45 CFR part 5b and that each employee is aware that he/she is subject to criminal penalties for violation of the Act to the same extent as Department of Health and Human Services employees. These provisions also apply to all subcontracts the Contractor awards under this contract which require the design, development or operation of the designated system(s) of records (5 U.S.C. 552a(m)(1)). The contract work statement: (a)�� Identifies the system(s) of records and the design, development, or operation work the Contractor is to perform; and (b)�� Specifies the disposition to be made of such records upon completion of contract performance. HHSAR 352.237-70 Pro-Children Act of 1994 (DEC 2015) (a)�� Public Law 103-227, Title X, Part C, also known as the Pro-Children Act of 1994 (Act), 20 U.S.C. 7183, imposes restrictions on smoking in facilities where certain federally funded children's services are provided. The Act prohibits smoking within any indoor facility (or portion thereof), whether owned, leased, or contracted for, that is used for the routine or regular provision of: (i) kindergarten, elementary, or secondary education or library services or (ii) health or day care services that are provided to children under the age of 18. The statutory prohibition also applies to indoor facilities that are constructed, operated, or maintained with Federal funds. (b)�� By acceptance of this contract or order, the Contractor agrees to comply with the requirements of the Act. The Act also applies to all subcontracts awarded under this contract for the specified children's services. Accordingly, the Contractor shall ensure that each of its employees, and any subcontractor staff, is made aware of, understands, and complies with the provisions of the Act. Failure to comply with the Act may result in the imposition of a civil monetary penalty in an amount not to exceed $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. Each day a violation continues constitutes a separate violation. HHSAR 352.237-71 Crime Control Act of 1990�Reporting of Child Abuse (DEC 2015) (a)�� Public Law 101-647, also known as the Crime Control Act of 1990 (Act), imposes responsibilities on certain individuals who, while engaged in a professional capacity or activity, as defined in the Act, on Federal land or in a federally-operated (or contracted) facility, learn of facts that give the individual reason to suspect that a child has suffered an incident of child abuse. (b)�� The Act designates �covered professionals� as those persons engaged in professions and activities in eight different categories including, but not limited to, teachers, social workers, physicians, dentists, medical residents or interns, hospital personnel and administrators, nurses, health care practitioners, chiropractors, osteopaths, pharmacists, optometrists, podiatrists, emergency medical technicians, ambulance drivers, alcohol or drug treatment personnel, psychologists, psychiatrists, mental health professionals, child care workers and administrators, and commercial film and photo processors. The Act defines the term �child abuse� as the physical or mental injury, sexual abuse or exploitation, or negligent treatment of a child. (c)�� Accordingly, any person engaged in a covered profession or activity under an HHS contract or subcontract, regardless of the purpose of the contract or subcontract, shall immediately report a suspected child abuse incident in accordance with the provisions of the Act. If a child is suspected of being harmed, the appropriate State Child Abuse Hotline, local child protective services (CPS), or law enforcement agency shall be contacted. For more information about where and how to file a report, the Childhelp USA, National Child Abuse Hotline (1-800-4-A-CHILD) shall be called. Any covered professional failing to make a timely report of such incident shall be guilty of a Class B misdemeanor. (d)�� By acceptance of this contract or order, the Contractor agrees to comply with the requirements of the Act. The Act also applies to all applicable subcontracts awarded under this contract. Accordingly, the Contractor shall ensure that each of its employees, and any subcontractor staff, is made aware of, understands, and complies with the provisions of the Act. HHSAR 352.237-72 Crime Control Act of 1990�Requirement for Background Checks (DEC 2015) (a)�� Public Law 101-647, also known as the Crime Control Act of 1990 (Act), requires that all individuals involved with the provision of child care services to children under the age of 18 undergo a criminal background check. �Child care services� include, but are not limited to, social services, health and mental health care, child (day) care, education (whether or not directly involved in teaching), and rehabilitative programs. Any conviction for a sex crime, an offense involving a child victim, or a drug felony, may be grounds for denying employment or for dismissal of an employee providing any of the services listed above. (b)�� The Contracting Officer will provide the necessary information to the Contractor regarding the process for obtaining the background check. The Contractor may hire a staff person provisionally prior to the completion of a background check, if at all times prior to the receipt of the background check during which children are in the care of the newly-hired person, the person is within the sight and under the supervision of a previously investigated staff person. (c)�� By acceptance of this contract or order, the Contractor agrees to comply with the requirements of the Act. The Act also applies to all applicable subcontracts awarded under this contract. Accordingly, the Contractor shall ensure that each of its employees, and any subcontractor staff, is made aware of, understands, and complies with the provisions of the Act. HHSAR 352.237-73 Indian Child Protection and Family Violence Act (DEC 2015) (a)�� This contract is subject to the Indian Child Protection and Family Violence Act, Pub. L. 101-630 (25 U.S.C. 3201 et seq.) The duties and responsibilities required by this contract may involve regular contact with or control over Indian children. Pub. L. 101-630 prohibits employment, including Personal Service Contracts, with anyone who has been convicted of any crime of violence. Any such conviction should immediately be brought to the attention of the Contracting Officer. The contractor will be subject to a character investigation, conducted by the Indian Health Service, Office of Human Resources. Until such time as the contractor has been notified of completion of the investigation, the contractor shall have no unsupervised contact with Indian children. In order to initiate this background investigation, the contractor must provide information as required in this contract or as directed by the Contracting Officer. (b)�� As a prerequisite to providing services under this contract, the Contractor is required to complete and sign the declaration found in Section J of this contract. INDIAN HEALTH SERVICE, DIVISION OF INFORMATION SECURITY � INTERCONNECTION SECURITY AGREEMENT CLAUSE: A Business Partner Interconnection Security Agreement is used to define procedures of reciprocal cooperation and coordination between the Indian Health Service (IHS) and a business partner to identify and implement information security safeguards and responsibilities required for the establishment of a connection between the IHS network and the business partner's network. System Interconnection means the direct connection of two or more IT systems for the purpose of sharing data and other information resources.� The OCAO IT Department will get with the awardee and obtain signatures as needed. BUSINESS ASSOCIATE AGREEMENT CLAUSE I. Authority: Pursuant to 45 C.F.R. � 164.502(e), the Indian Health Service (IHS), as a covered entity, is required to enter into an agreement with a �business associate,� as defined by 45 C.F.R. � 160.103, under which the business associate must agree to appropriately safeguard Protected Health Information (PHI) that it will use and disclose when performing functions, activities or services pursuant to its contract with the IHS. By performing services under a ________________, _______________________._ agrees that it is a Business Associate and will comply with the terms below, in addition to other applicable Contract terms and conditions, and applicable law, relating to the safekeeping, use, and disclosure of PHI. This Appendix comprises the Business Associate Agreement (Agreement). II. Definitions: The following terms shall have the same meaning as those terms in 45 C.F.R. Part 160 and Part 164, which are the federal regulations implementing the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended: Breach, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, PHI, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured PHI, and Use. A. Business Associate. �Business Associate� shall generally have the same meaning as the term �business associate� at 45 C.F.R. � 160.103, and in reference to the party to this Agreement shall mean ____________________________ B. Covered Entity. �Covered Entity� shall generally have the same meaning as the term �covered entity� at 45 C.F.R. � 160.103, and in reference to the party to this Agreement, shall mean the IHS. C. HIPAA Rules. �HIPAA Rules� shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R. Part 160 and Part 164. D. Master Patient Index (MPI). The �Master Patient Index� or �MPI� is composed of a unique list of patients and a current list of medical centers where each patient has been seen. This enables the sharing of patient data between operationally and regionally diverse systems. Each record (or index entry) on the MPI contains a small amount of patient data used to identify individual entries. The mission of the MPI is to uniquely identify a patient and to �link� that patient�s data throughout the IHS facilities using the Integration Control Number (ICN). The MPI is the authoritative source of a patient�s ICN, the enterprise-wide identifier for IHS facilities and the key to accessing a patient�s record. The accuracy of patient information and patient identification directly affects clinical, administrative, billing, and interdepartmental processes. III. Obligations and Activities of Business Associate: A. Compliance: Business Associate agrees not use or disclose PHI other than as authorized by the Agreement or as required by law. Business Associate acknowledges that it is directly liable under the HIPAA Rules and subject to civil and, in some cases, criminal penalties for making uses and disclosures of PHI that are not authorized by the Agreement or required by law. Business Associate agrees that it will require all of its agents, employees, subsidiaries, and affiliates, to whom Business Associate provides PHI, or who create or receive PHI on behalf of Business Associate for Covered Entity, to comply with the HIPAA Rules and to enter into written agreements with Business Associate that provide the same restrictions, terms, and conditions as set forth in the Agreement. B. Subcontractors: In accordance with 45 C.F.R. �� 164.502(e)(1)(ii) and 164.308(b)(2), which govern relations with subcontractors, Business Associate agrees to ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree to the same restrictions, terms, and conditions that apply to Business Associate with respect to such PHI. C. Safeguarding PHI: Business Associate shall develop and use appropriate procedural, physical, and electronic safeguards to protect against the use or disclosure of PHI in a manner not authorized by this Agreement or required by law. Business Associate will limit any use, disclosure, or request for use or disclosure of PHI to the minimum amount necessary to accomplish the intended purpose of the use, disclosure, or request. D. Safeguarding Electronic PHI: Business Associate agrees to use appropriate safeguards, as set forth in Subpart C of 45 C.F.R. Part 164 with respect to electronic PHI, to prevent use or disclosure of electronic PHI other than as authorized by this Agreement or required by law. E. Reporting Use or Disclosures Not Authorized By this Agreement or Required by Law: Business Associate agrees to report to Covered Entity any use or disclosure of PHI not authorized by this Agreement or required by law within thirty (30) days of discovering the use or disclosure, or any security incident of which it becomes aware. In addition, Business Associate shall mitigate, to the extent practicable, any harmful effect that is known to Business Associate of the use, disclosure, or security incident. F. Reporting of Breach: In accordance with the policy of the Department of Health and Human Services, Business Associate will report, within one hour of discovery, all suspected or confirmed breaches to Covered Entity. G. Notification of Breach of Unsecured PHI: In addition to the above, Business Associate shall notify Covered Entity of a breach, as set forth in 45 C.F.R. �164.410, of the security of any unsecured PHI that Business Associate received from, or created or received on behalf of, Covered Entity within thirty (30) calendar days after the discovery of the breach by Business Associate, its employees, officers, and/or other agents, unless notification is specifically excepted by 45 C.F.R. � 164.412. 1. Requirements of Notice. Such notice shall include, to the extent possible, the identification of each individual whose unsecured PHI has been, or is reasonably believed by Business Associate to have been, accessed, acquired, or disclosed during such breach; a brief description of the circumstances of the breach of security, including the date of the breach and the date of Business Associate�s discovery of the breach; and the type of unsecured PHI involved in the breach. Business Associate agrees to provide any other available information that Covered Entity is required to include in notification to the individual under 45 �164.404(c). In the event notification is delayed, evidence demonstrating the necessity of the delay shall accompany the notification. H. Individual Access to PHI: Business Associate shall maintain a designated record set for each individual for whom it maintains PHI. In accordance with an individual�s right to access his or her PHI, Business Associate shall make available all PHI in the individual�s designated record set to the individual to whom that information pertains, or, upon the request of the individual, to that individual�s authorized representative, as necessary to satisfy Covered Entity�s obligations under 45 C.F.R. � 164.524. Availability to access PHI shall be made within five (5) calendar days of receipt of a valid request. I. Accounting of Disclosures: Business Associate shall maintain records of PHI received from, or created or received on behalf of, Covered Entity and shall document subsequent uses and disclosures of such information by Business Associate. Business Associate shall, within five (5) calendar days after receiving a request from Covered Entity, provide to Covered Entity such information as Covered Entity may require to fulfill its obligations to account for disclosures of PHI pursuant to 45 C.F.R. � 164.528. J. Amendment of PHI: Business Associate shall, within five (5) calendar days of a request by Covered Entity, make PHI available to Covered Entity for Covered Entity to fulfill its obligations under 45 C.F.R. � 164.526 to amend PHI and shall, as directed by Covered Entity, within five (5) calendar days of receipt of such direction, incorporate any amendments into PHI held by Business Associate. In addition, Business Associate shall ensure incorporation of any such amendments into PHI held by its agents or subcontractors within ten (10) days of such direction, and shall notify Covered Entity within five (5) calendar days of when those agents or subcontractors have completed the incorporation of the amendments. Business Associate shall forward to Covered Entity all requests to amend PHI that it receives directly from individuals within five (5) calendar days of its receipt of a request. K. Carrying out Covered Entity�s Obligations: To the extent Business obligation(s) under Subpart E of 45 C.F.R. Part 164, Business Associate agrees to comply with the requirements of Subpart E that apply to Covered Entity in the performance of such obligation(s). L. Disclosures for Verifying Compliance: Upon request, Business Associate shall permit access by the Secretary and Covered Entity during normal business hours to its facilities, books, records, accounts, and any other sources of information, including PHI and any agreements that it has with subcontractors, vendors, and/or other agents relating to the use and disclosure of PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, for purposes of determining both Business Associate�s and Covered Entity�s compliance with the HIPAA Rules. IV. Permitted Uses and Disclosures by Business Associate: A. Business Associate shall not use or disclose PHI except to perform functions, activities, or services on behalf of Covered Entity as provided for in the Contract, this Agreement, the HIPAA Rules, or other applicable law. B. Business Associate agrees that it may use or disclose PHI on behalf of Covered Entity only: 1. Upon obtaining the authorization of the individual to whom the PHI pertains; 2. For the purposes of treatment, payment or health care �� operations unless Covered Entity has agreed to a restriction pursuant to 45 C.F.R. � 164.520(b)(iv)(A) or 45 C.F.R. �164.522; or 3. Without an authorization or consent, if in accordance with 45 C.F.R. � 164.510, 45 C.F.R. � 164.512, 45 C.F.R. � 164.514(e), 45 C.F.R. � 164.514(f), or 45 C.F.R. � 164.514(g). C. Business Associate shall use and disclose PHI in compliance with each applicable requirement of 45 C.F.R. � 164.504(e), which section is fully incorporated herein. D. Business Associate agrees to make uses, disclosures, and requests for PHI consistent with Covered Entity�s minimum necessary policies and procedures. E. It is anticipated that Business Associate will have access to the MPI. F. Business Associate may not use or disclose PHI in a manner that would violate Subpart E of 45 C.F.R. Part 164 if done by Covered Entity, except for the specific uses and disclosures set forth below. �� 1. Business Associate may disclose PHI for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided the disclosures are required by law, or Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached. V. Obligations of Covered Entity: A. Covered Entity shall provide Business Associate with its Notice of Privacy Practices and any changes to the Notice. B. Covered Entity shall notify Business Associate of any limitation(s) in Covered Entity�s Notice of Privacy Practices under 45 C.F.R. � 164.520, to the extent that such limitation may affect Business Associate�s use or disclosure of PHI. C. Covered Entity shall notify Business Associate of any change in, or revocation of, the permission by an individual to use or disclose his or her PHI to the extent that such changes may affect Business Associate�s use or disclosure of PHI.� D. Covered Entity shall notify Business Associate of any restriction on the use or disclosure of PHI that Covered Entity has agreed to or is required to abide by under 45 C.F.R. � 164.522, to the extent that such restriction may affect Business Associate�s use or disclosure of PHI. E. Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under Subpart E of 45 C.F.R. Part 164 if done by Covered Entity, except as provided in Part IV, Subpart F, Section 1. VI. Termination: A. Term: The Term of this Agreement shall be effective as of the date Business Associate signs the underlying Contract and shall terminate when the Contract ends or on the date covered entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner. B. Termination for Cause: Business Associate authorizes termination of this Agreement by Covered Entity, if Covered Entity determines Business Associate has violated a material term of the Agreement and Business Associate has not ended the violation within the time specified by Covered Entity. C. Obligations of Business Associate Upon Termination: Upon termination of this Agreement for any reason, Business Associate, with respect to PHI received from Covered Entity, or created, maintained, or received by Business Associate on behalf of Covered Entity, shall: �� 1. Retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; �� 2. Return to Covered Entity, or, if agreed to by Covered Entity, destroy, the remaining PHI that Business Associate does not need to continue its proper management and administration or to carry out its legal responsibilities; �� 3. Continue to use appropriate safeguards, in compliance with Subpart C of 45 C.F.R. Part 164, with respect to electronic PHI to prevent use or disclosure of electronic PHI, other than as provided for in this Part, for as long as Business Associate retains the PHI; �� 4. Not use or disclose PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions set out above, at Part IV, Subpart F, Section 1 of the Agreement which applied prior to termination; �� 5. Return to Covered Entity, or, if agreed to by Covered Entity, destroy, the PHI retained by Business Associate when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities; and �� 6. If Business Associate or its agent or subcontractor destroys any PHI, Business Associate will provide Covered Entity with documentation evidencing such destruction within thirty (30) days of completion of destruction. D. Survival: The obligations of Business Associate under this Part shall survive the termination of this Agreement. VII. Indemnification: In the event Business Associate is investigated and/or becomes a party to a civil or criminal cause of action in any forum relating to its failure to comply with the HIPAA Rules, Business Associate shall reimburse Covered Entity all reasonable costs and expenses Covered Entity may incur relating to such investigation and/or cause of action, and will otherwise hold Covered Entity harmless for any and all reasonable costs and expenses relating to the foregoing. VIII. Miscellaneous: A. Incorporation: This Agreement is attached to and fully incorporated into the Contract. B. Notices: All notices under this Agreement shall be provided by certified mailing, and shall require proof of date of receipt. C. Regulatory References: A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended. D. Amendment: The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law. E. Interpretation: Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules. F. Successors and Assigns: This Agreement shall be binding upon, inure to the benefit of and be enforceable by and against the Parties and their successors and assigns.G. Severability: If a court of competent jurisdiction deems any provision of this Agreement unenforceable, such provision shall be severed from this Agreement and every other provision of the Agreement shall remain in full force and effect. IX. Payments: Payments for these services will be made by Claremore Indian Hospital through an automated clearinghouse (ACH) method and will not be billed to Medicare or any other insurance provider. Agrees to the above clause for purchase order: ______________________________________________ Company President �� Dated (End of clause) Miscellaneous: NO FAX QUOTATIONS ELECTRONIC SUBMISSIONS � SUBMISSION VIA EMAIL IS THE ONLY ACCEPTABLE ELECTRONIC SUBMISSION. (sean.long@ihs.gov)� Mail quotations to Claremore Indian Hospital, Attn: Sean Long, 101 S Moore Ave, Claremore, OK 74017 All contractors must be registered in the System for Award Management database located at https://www.sam.gov/sam/ prior to any contract award.� Please submit the following information with each quote: Vendor Name, Cage Code, DUNS number, Tax Identification Number, Prompt Payment Terms, Delivery Time, GSA Contract Number (if applicable), Date quote expires, warranty, total price for each line item, total quote price, and technical documentation in sufficient detail to determine technical acceptability.� Failure to provide sufficient technical detail may result in rejection of your quote. For additional information, please contact the Supervisory Contract Specialist, Sean Long, sean.long@ihs.gov or (918) 342-6509. STATEMENT OF WORK Third Party Eligibility Services PURPOSE OF THE PROJECT The Claremore Indian Hospital has a requirement for third party eligibility monitoring services related to the eligibility and enrollment of referred patients to assist patients in obtaining financial aid under federal, state and local programs to pay for medical expenses incurred by patients of the hospital.� �� DETAILED DESCRIPTION OF THE TECHNICAL REQUIREMENTS The contractor shall provide the following services: Eligibility Services: � The contractor shall provide on-site representation to screen inpatient, outpatient and ED referrals.� � Contractors contact for screening shall be attempted at bedside in the facility. If this does not occur or if the account is a non-inpatient date of service, the contractor�s contact with the patients will include, but are not limited to, phone, mail, and coordination with facility should the patient return for services.� � Contractor shall provide comprehensive and in depth screening for patients to determine eligibility for the following assistance programs:� � Medicaid Social Security Disability (SSI / SSDI) Health Information Exchange (ACA) ESRD Medicare Crime Victim Compensation Fund Medicaid Secondary Coverage to Medicare Long Term Care COBRA insurance eligibility or other commercial options available to provide payor source. � Screening shall confirm all demographic and coverage information. Complete financial/employment questionnaire is completed with the patient to include the patient providing information regarding household members, reason for services received, and historical personal medical information. � The contractor shall assist and/or complete the necessary forms/applications for patients deemed eligible for financial assistance and obtain signed release form from patient allowing further assistance. � The contractor shall submit application on patient�s behalf to the appropriate agency or institution.� � The contractor shall assist in scheduling any needed personal interviews with appropriate agencies, as well as appointment verification of those appointments, either arranged for or provided by the contractor at no additional cost to the Hospital.� � The contractor shall independently determine and gather verifications that are needed to ensure application approval.� If any required documentation must be purchased for verification requirements, this will be provided at no cost to the patient or hospital.�� The contractor shall follow up weekly with the agency or institution responsible for enrollment determination. � The contractor shall pursue appeal of unfavorable decision on patient�s behalf, as appropriate. � The contractor shall coordinate with the Hospital to assist with needed information in regards to Coordination of Benefits including the completion of any needed forms to allow for reevaluation of claim for possible payment.� � The contractor shall update hospital system with current account status information. � The contractor shall verify billing information and effective dates before submitting to hospital for coverage of past medical bills.� � The contractor shall update and correct, as needed, any portion of referred accounts within granted system access parameters. � Batch Filing Services: a.�� The contractor shall attempt to find existing Medicaid, Medicare and other insurance coverage through ProfitPal or other contractor electronic batch filing software. Upon notification to the contractor that coverage exists under any insurance program, return such member coverage information to follow and billing.� � The contractor shall provide the hospital with accurate, complete and timely eligibility information within 72 hours of information being obtained. � The contractor shall provide the Hospital with a monthly summary report of all identified member eligibility summarizing inventory account volume in an agreed upon file format. PERIOD OF PERFORMANCE � 12 months from date of award with one (1) twelve (12) month option period. � LEVEL OF EFFORT � The contractor shall possess an internal account management system for tracking and reporting of patient accounts and will utilize this system as the main workflow driver.� � The contractor shall accept account placements and account updates via auto-outsourcing secure databases or secure manual file transfer.� � The contractor shall provide comprehensive notation on assigned accounts demonstrating substantial and meaningful service work.� Accurate notation reflects RCA detailed account activities.� � The contractor shall provide experienced service line subject matter experts appropriate to successfully fulfill work requirements complying with requirements as specified in the job description and will demonstrate competency levels of the job.� � The contractor shall provide staff appropriate training and support to all assigned staff for the execution of the contract.� � The contractor shall ensure staff has current certifications as needed.� � The contractor shall ensure all staff activities comply with all applicable Federal, State and local laws and regulations. � The contractor shall ensure that all employees assigned to the contract have completed a background check, passed a competency assessment and are not on the HHS-OIG list of excluded individuals. � The contractor shall provide a monthly distribution of proprietary performance reports and make available via secured online client portal and/or printed copies.� � The contractor shall produce, at hospital�s request, any custom reports that hospital may deem as necessary.� � The contractor shall ensure that the services provided are in accordance with all applicable federal, state and local laws, regulations, and rules governing contracted services; including the Fair Debt Collection Practices Act (FDCPA), PCI Compliance, 501R Compliance (patient notification of credit reporting), and HIPAA. � The contractor shall treat all patients, employees, and business partners in accordance with the values and mission of the Hospital.� � The contractor shall not retain any information related to accounts other than that which is required by law. � The contractor shall warrant that it will use best practices in performing all services. � SPECIAL REQUIREMENTS �In accordance with HHSAR 304.1300(b) non-routine contractor employees shall comply with OPDIV DHHS/SE Region � Human Resources, Security Clearance Guidance � Visitors (3/29/12) policy for contract performance period.� Contractor employees will be required to obtain a visitor�s pass upon arrival for services from Facilities Management.- (Security Clearance for on-site human services) The US PHS Claremore Indian Hospital is a tobacco/smoke free environment (buildings and grounds). No tobacco/smoking use will be tolerated during service. Security Requirements:� Contractor personnel will be required to contact the government designated point of contact upon arrival when reporting for service calls or delivery supplies.� The contractor shall be responsible for the security of all organizational information.� Current rules and regulations applicable to the premises, where the work shall be performed shall apply to the contractor and its employees while working on the premises.� These regulations include but are not limited to, escort by Claremore Indian Hospital official, presenting valid identification, smoking restriction and any safety procedures. � The contractor shall not disclose or cause to disseminate any information concerning operations of Claremore Indian Hospital.� Such action(s) could result in violation of the contract and possible legal actions. All inquiries, comments, or complaints arising from any matter observed, experienced or learned of as a result of or in connection with the performance of the contract, the resolution of which may require the dissemination of official information, shall be directed to the government�s designated representative. � APPLICABLE STANDARDS: � 6.1.1�� Joint Commission on Accreditation of Healthcare Organizations (JC)�� website: http://www.jcaho.org �� 6.2.2 Centers for Medicare and Medicaid Services (CMS) Standards�� website: http://www.cms.hhs.gov/ 6.1.2�� Health Insurance Portability and Accountability Act (HIPAA) of 1996.�� website: http://www.hhs.gov/ocr/hipaa/ 6.1.3�� Privacy Act of 1974�� website: (45 CFR 5b) 6.1.4�� IHS Information Technology and records security / safeguard policies.�� website: http://home.ihs.gov/ITSC-CIO/security/index.asp Indian Health Services Information Security Program SOPs �� HHS information security policies and procedures American Health Information Management Association (AHIMA)� Website:� http://www.ahima.org 6.1.8�� guides/ ISPP/Information Security Program Policy 07192005.docs http://intranet.hhs.gov/infosec/docs/policies_guides/ispph/pg_it_security_handbook_12012005.doc Federal Information Security Management Act of 2002 (FISMA), Title III, E-Government Act of 2002, Pub. L. No. 107-347 (Dec. 17, 2002 Indian Health Manual Part 8, Chapter 12, National Institute of Standards and Technology (NIST):� Federal Information Processing Standards (FIPS) Publications Special Publications (SP)�� Draft Special Publications (SP) Federal Preparedness Circulars (FPC), FPC 65, Federal Executive Branch Continuity of Operations, July 26, 1999. Presidential Decision Directives (PDD):� PDD 67, Enduring Constitutional Government and Continuity of Government Operations, October 21, 1998. Homeland Security Presidential Directive/HSPD-7, Critical Infrastructure Identification, Prioritization, and Protection, December 17, 2003. All relevant Public Laws. � DELIVERABLES AND REPORTING REQUIREMENTS Contractor Point of Contact:� The contractor shall furnish one designated point of contact (POC) to the government�s designated representative for coordination of supplies, delivery, and/or maintenance.� The POC will be empowered to make daily decisions to ensure that the contract implementation and day-to-day maintenance meets the terms and conditions of this contract. Contractor�s Phone Numbers:� The contractor shall provide a toll-free telephone number for service calls, which must be answered during at least eight working hours, between 8:00 am and 4:30 pm, Monday through Friday. Personnel Qualifications: � Must know eligibility requirements of various third party resources such as Medicare, Medicare Part D and C, Medicaid, Social Security Administration, County DHS Office, Tribal Programs and the Affordable Care Act.� Knowledge to include other related agency policies/procedures for enrollment in alternate resources and required forms. � Has the ability and skill to interview patients in-depth in order to determine eligibility of alternate funding. Ability to communicate to the patient what specific information is needed, the reason for that specific information, and be able to ascertain that it is as accurate as possible. Must possess tactfulness and ability to deal effectively with persons of diverse backgrounds. � A thorough knowledge of the Privacy Act of 1974, which mandates that the incumbent shall maintain complete confidentiality of all administrative, medical, and personnel records, and all other pertinent information that comes to his/her attention or knowledge. � Must possess the ability to follow directions and absorb quantities of material necessary to the efficient performance of assigned duties and responsibilities. GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES: � Claremore Indian Hospital (CIH) shall assign a main point of contact as a contractor liaison. � CIH shall provide the contractor with appropriate access to systems for patient account access to perform the contracted services.�� CIH shall provide the monthly reporting of patients with coverage to an approved secured FTP site. � CIH shall provide on-site office space for the use by the contractor and its employees to conduct the services in the hospital.� � CIH shall provide the contractor representatives with any necessary security clearances, identification badges, parking privileges, mail privileges, and any other necessary authorizations to complete performance of the work within this scope of work. � CONTRACTOR FURNISHED PROPERTY, FACILITIES AND SERVICES Services shall be performed as stated herein. � 10.� CHANGES TO THE STATEMENT OF WORK (SOW) Any changes to this SOW shall be authorized and approved only through written correspondence from the Contracting Officer.� Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor. 11. DELIVERABLES/PERFORMANCE METRIX Properly trained and certirifed staff to include background investigation Screening of patients for third party billing Monthly report of eligible patients for third party billing Submission of third party billing applications for patients
Web Link: SAM.gov Permalink
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Place of Performance: Address: Claremore, OK 74017, USA; Zip Code: 74017; Country: USA
Record: SN05581944-F 20200308/200307085918 (samdaily.us)
Source: SAM.gov Link to This Notice
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R -- 3rd Party Billing Eligibility Services