Q--DO NOT DISCLOSE - Patient Centered Community Care - Option Year 6

Sources Sought: The Department of Veterans Affairs (VA), Commodities and Services Acquisition Service (CSAS), in support of the Veterans Health Administration (VHA) Chief Business Office, Office of Community Care, is issuing a sources sought for a Third Party Administrator (TPA). The purpose of this Sources Sought is to provide interested parties the opportunity to inform the VA of their capabilities to perform the services listed. THIS IS NOT A SOLICITATION FOR OFFERS AND NO CONTRACT WILL BE AWARDED FROM THIS EVENT. This announcement serves as a Sources Sought, issued solely for information and planning purposes. OVERVIEW AND PURPOSE: The VA is interested in parties with the current capability to perform Third Party Administrator services across the nation. RESPONSES TO THE SOURCES SOUGHT WILL ONLY BE CONSIDERED BY THE VA IF RESPONDENTS HAVE AT A MINIMUM, CURRENT PROVIDER NETWORK CAPABILITIES IN PLACE TO PERFORM ALL DUTIES LISTED BELOW UNDER STATEMENT OF OBJECTIVES. Should respondents have additional capabilities not listed please include in capabilities statement. CAPABILITIES STATEMENT NOT TO EXCEED TWO (2) PAGES. The contracts will be available for all VA Medical Centers throughout the Veterans Health Administration and will be centrally supported by the VHA Chief Business Office. Program Objective The objective of the VHA Chief Business Office s Third-Party Administrator procurement is to support VHA with the Patient Centered Community Care (PCCC). This includes establishing a high quality network, or networks, of individual and institutional providers, responding to Veteran and clinician inquiries, tracking, monitoring and reporting on Veteran utilization and management of claims adjudication, and payment to include receipt of clinical documentation. The TPA will also facilitate and manage patient referrals, establishment of a utilization review department to make Non-Service Connected/Service Connected/Special Authority (NSC/SC/SA) determinations. The TPA will provide Veterans with preferred provider network, internal and/or external to the VA. The TPA may also be asked to provide a pharmacy benefits management (PBM) network as well as access to urgent care facilities. The TPAs responsibilities include, but are not limited to the following: Claims Adjudication and Payment Eligibility Determination and Enrollment Referral and Authorization Provider Options Claims Adjudication and Payment Reconsideration and Appeals Management Quality Control and Internal Controls Reporting Analysis and Testing Implementation/Integration Appointment Scheduling Configuration Management Logistics Management Objective Communications The contractor would be expected to coordinate and provide health care resources which are in accordance with VA standards. Services are required in the following locations: Region 1 consists of VISN s 01, 02, 03, and 04. Region 2 consists of VISN s 05, 06, 07, and 08 Region 3 consists of VISN s 09, 15, 16, and 17 Region 4 consists of VISN s 10, 11, 12, 19, and 23. Region 5a consists of VISN s 18, 20 (excluding Alaska), 21 (excluding Hawaii & Pacific Islands), and 22. Region 5b consists of VISN 21 (Hawaii & Pacific Islands) Region 6 consists of VISN 20 Alaska only. Responses are due back no later than Aug 15, 2018 @ 1:00pm MST. Electronic responses are required to be addressed to the Contracting Specialist, Joseph Hodge at [email protected]. Responses are not to be longer than 2 pages in length. Contractor s must have an established network of providers in the entire area listed above and must be able to conduct services immediately in order to be qualified.