Summary: This RFQ is in reference to GSA eBUY Request For Information (RFI) “RFQ1499504” posted on 6/21/2021 and GSA eBUY DRAFT RFQ “RFQ1507587” posted on 7/23/2021. NOTE1: Submit all questions related the this RFQ no later than 12:00PM EST on August 12, 2021 in accordance with the instructions in the solicitation. NOTE2: The Government is requesting quote for the underlying BPA and also requesting quote for Order #1 against the BPA. Attached to this RFQ posting are both the BPA RFQ (with BPA PWS and BPA Attachments) and the Call#1 PWS and Pricing Schedule. The Office of Network Management (ONM) is responsible for the oversight, monitoring and governance of third-party organizations offering network-based private fee-for-service healthcare benefits and claims processing of healthcare services for all eligible Veterans across all 50 states and specific US Territories. ONM must maintain a network of appropriate providers that is sufficient to provide adequate access to covered services to meet the needs of the Veteran population. ONM must provide the oversight, monitoring and governance of the organizations providing Veterans health care services through a contracted network of providers and claims processing for healthcare services that is consistent with the prevailing community pattern of health care delivery in the network service area. The Contractor shall provide subject matter expertise sufficient to support ONM in program and project design, development, implementation, governance, oversight and monitoring of all ONM operating processes. Specifically, the Contractor shall support ONM with detailed evaluation of existing processes in the network development strategy; evaluating prevailing community patterns of health care delivery for each provider and facility specialty type in each county in a service area; development and evaluation of healthcare strategy and best practices; specific healthcare subject matter expertise in business, technical, and financial support; industry standards and best practices in claims processing, including monitoring and oversight of third party administrators claims processing programs; industry standards and best practices on healthcare electronic data interchange (EDI) standards including statistic on industry adoption rates; development of communication artifacts; administrative support services; establishing and implementing contracting strategies for provider networks, including specialized networks; managing and improving network access and adequacy while monitoring cost and quality performance; future state expansion planning to include robust data modeling and predicative analysis of future health care trends; designing and implementing improvements to provider experience support and services; and pre and post-acquisition support to ONM including each of the following seven departments: 1. Office of the Executive Director 2. Operations and Administration 3. Contracts Administration 4. Contract Support 5. Provider Experience 6. Network Support 7. Acquisition
Vehicle: PSS
RFP release date: 8/6/2021
Proposal due date: 8/20/2021
Related Attachments: