VA VBA Sources Sought: Automated Benefits Delivery (ABD) Modern Claims Processing Support Services

Notice ID:  36C10D24Q0129

The Modern Claims Processing (MCP) program is intended to provide transformative services to Veterans Benefits Administration’s (VBA) claims processing.  The program is leveraging computable benefits data from VBA and medical data from the Veterans Health Administration (VHA) to conduct analysis and identify administrative tasks and workflows for automation.  The goal is to assist claims processors in making fast, accurate, consistent, and equitable claim decisions for Veterans and beneficiaries.

Through automation the efficiency of compiling and indexing evidence data are improving the effectiveness of compiling relevant evidence into more intuitive information for claim processors to review and adjudicate. Hence, claim processors are making faster, well-informed decisions while maintaining full adjudicative discretion in accordance with statutes and regulations.

Overall, VBA’s modernization effort is aimed at addressing the growing claims inventory.  The MCP program is assisting the effort by providing business process improvement services aimed at automating tasks and workflows aimed to reduce claim processing time, establish data standardization, and improve accuracy of claims decisions, for examples standardization of Disability Benefits Questionnaires (DBQ), Automated Data Ingestion (ADI), Hospitalization Reports Automation, and Automated Decision Support (ADS).

MCP focuses on assisting the Department of Veterans Affairs (VA) with the following objectives to accomplish the program’s mission:

• Deliver integrated, interoperable, and secure systems to modernize delivery of benefits, enabling VBA to work with partners to improve Veterans’ and other beneficiaries’ quality of life and outcomes.
• Automate administrative tasks and workflows that will assist claims processors in making fast, accurate, consistent, and equitable claim decisions for Veterans.
• Partner with OIT to provide continuous user-driven system enhancements to improve claims processing speed and accuracy.
• Improve governance, management practices and make evidence-based decisions to ensure quality outcomes and experiences and efficient use of resources.
• Implement IT enhancement processes, priorities, and follow-through projects, aimed at developing and delivering high quality system capabilities and efficiencies to support disability claims processing.
• Prototype automation services as proofs of concept and then assist VBA in operationalizing them nationally.

This contract seeks specifically to:

1. Assist VA in modernizing the claims process by using data analytics and human-centered design to develop insights into current business process strengths and inefficiencies.
2. Assist VA with automated hospitalization reporting capabilities and associated benefit entitlement reviews and decisions.
3. Assist VA with the mapping of medical data codes to related VA Schedule for Rating Disabilities (VASRD) criteria and identifying Health Data Repository (HDR) records containing those medical data codes.
4. Assist VA with modernizing Hospitalization Decision Ready Claims by leveraging hospitalization reports data to automate administrative activities leading up the claim decision.
5. Assist VA with modernizing DBQs intake portal.

The Contract Period of Performance (PoP) shall be a 12-month base period + three (3) option years.

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