Indian Health Service (IHS) Sources Sought: Clearinghouse Services in Multiple Locations

Notice ID:  75H71324R00002

Indian Small Business Economic Enterprises (ISBEEs) and other small business are highly encouraged to respond to this notice.

The scope includes, but no limited to:

• Clearinghouse will provide a single, unified user experience which means user log-on to one system.
• Clearinghouse will provide real-time point-of-service eligibility data from third party insurance databases to include commercial payers, Medicare intermediaries, and state Medicaid plans. Queries will be conducted pre-encounter.  This may occur in either batches the day before or in real-time.
• Clearinghouse will provide secure data transmission of all electronic claims. Payer enrollment and ability to transmit electronic VA claims is required.
• Clearinghouse will provide initial data checks, initial data scrubbing to ensure clean claim submission to the end payer and claim status inquiry and response.
• Clearinghouse will ensure HIPAA Compliant transactions and password protected access and meet IHS security requirements.
• Clearinghouse will have capabilities to drop an electronic claim to paper.
• All claims with errors will be rejected to a site within the portal where rework can occur. Portal should have simple response rejections messages and intuitive interactive decision support through use of ‘help tiles’ within the portal.  Claim attachment functionality is necessary.   The denial workflow allows direct resubmission.
• All inquiries and responses will provide accurate and up-to-date eligibility information available to the end user. All information will be uploaded for electronic claims transmissions in order for clean claim billing and third-party revenue activities.
• Summary integrated dashboard reports with top tile metrics are needed for ongoing performance tracking, tracking aging receivables, and employee assignments.
• Adherence to Federal and State regulatory requirements…

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