DESCRIPTION:The Space and Naval Warfare Systems Center (SPAWARSYSCEN) Atlantic, Health Systems and Applications (Code 6320) is seeking information on available patient billing and collections systems. The purpose of the AFMS Patient Billing and Collections Program initiative is to determine the data and solution for all 75 Air Force Military Medical Treatment Facilities (MTFs). The solution will provide electronic & manual billing, insurance verification, recovery and claims generation, and denial management for all three major patient billing components: A. Third Party Collections (TPC) Program: This program consists of reimbursements from health insurance companies. Monies are due to the MTFs for healthcare services rendered to patients who have health insurance other than the Department of Defense (DoD) TRICARE program. B. Medical Services Accounts (MSA): The MSA program consists of reimbursements due to MTFs for healthcare services rendered to patients who are not entitled to healthcare at DoDs expense. Individuals not entitled to DoD healthcare are referred to as non-beneficiaries. Non-beneficiaries include civilian emergencies, patients from other Federal agencies, and foreign military personnel and dependents. C. Medical Affirmative Claims (MAC) Program: This program consists of tort claims filed on behalf of DoD beneficiaries by the Air Force Judge Advocate. KNOWN REQUIREMENTS: 1. Must be Net-Ready; 2. Must provide CAC enabled sign-on capability; AND 3. Interface with DEAMS THE DATA REQUIRED FOR MHS BILLING FALL INTO FOUR MAJOR CATEGORIES: A. Beneficiary Data, e.g., other health insurance, patient category codes, patient demographic information B. Provider Data, e.g., provider specialty codes, national provider identifiers C. Financial Data, e.g., billing rates, revenue codes D. Clinical Data, e.g., diagnosis codes, procedure codes, ancillary data (such as prescriptions, lab results, radiology results), inpatient admission data including pre-admission information and information required to extend admissions (concurrent review information), and same day Surgery/procedure data including pre-operative information. DATA ELEMENTS ARE REQUIRED FOR PAPER CLAIM FORMS USED BY THE MHS SUCH AS: A. Centers for Medicare and Medicaid Services (CMS)-1500, Health Insurance Claim Form B. DD Form 7, Report of Treatment Furnished Pay Patients C. Invoice and Receipt (I&R) D. UB-04, Uniform Bill form UNIVERSAL CLAIM FORM (UCF). ELECTRONIC CLAIMS, SUBJECT TO HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) STANDARDS, REQUIRING DATA ELEMENTS INCLUDE: A. 837-I (Institutional) B. 837-P (Professional) NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP). THE TMA ORGANIZATION CURRENTLY PROVIDES THE FOLLOWING RATES, DATA, AND TABLES FOR USE BY THE SERVICES IN BILLING AND COLLECTIONS: A. Rates packages B. Inpatient Adjusted Standardized Amounts C. Outpatient Itemized Billing rates D. Cosmetic services rates E. Pharmacy rates F. Medical Affirmative Claim rates SUBMITTALS The information received shall be reviewed to conduct objective, comparative assessments and validation of commercial equipment and systems. This RFI is for information gathering and planning purposes only, and should not be construed as a Request for Proposal (RFP) or solicitation of an offer. The Government DOES NOT intend to award a contract on the basis of this RFI or otherwise pay for the information solicited. All information received will be treated as public knowledge; therefore, vendors should not submit proprietary information in response to this RFI. SPECIFIC INFORMATION SOUGHT INCLUDES: 1. Company information, including name, address, and URL. 2. Whether the company is a manufacturer or distributor. 3. A point of contact for follow-up information, to include a phone number and e-mail address. 4. A brief description (75 words or less) of capabilities and existing or related products. 5. Any relevant cost information such as purchase price and General Services Administration (GSA) schedule information. RESPONSES ARE DUE NLT COB on 3 November 2011 and may be sent directly to the technical POC and/or the Contract POC. The technical point of contact is Joe Schepisi at
[email protected]. E-mail your non-technical, contract related questions to the Contract Specialist at
[email protected].