Indian Health Service (IHS) Sources Sought: Pharmacy Claims Switching and Benefit Eligibility Verification Services

Notice ID: 75H709-BAIHS-25-010

OBJECTIVE: The Billings Area Office in Billings, Montana works in conjunction with six (6) Health Service Units to provide health care to more than 70,000 American Indian and Alaska Native people in Montana. The service units include two (2) hospitals, one (1) critical access hospital, three (3) health centers, and several smaller health stations and satellite clinics.   Each facility incorporates a comprehensive healthcare delivery system. The hospitals, health centers and satellite clinics provide inpatient and outpatient care. Switching Services are required when BAIHS health care facilities submit pharmaceutical claims electronically from the IHS Resource and Patient Management System (RPMS) computer system to third party Drug Plans for reimbursement. Pharmacy Benefit Eligibility Verification Services are web-based programs utilized to verify pharmacy insurance processing information and patient benefit eligibility status that is critical for Pharmacy Point-of-Sale (POS).

Switching Services Contractor shall perform the following activities:

1. Operate the Switching Services in accordance with the applicable Specifications.
2. Provide BAIHS facility with a local telephone number or alternative toll-free number for access on a dial-up telecommunication basis to the central processing facility for use of the services.
3. Be available to BAIHS health care facilities according to customer service hours (refer to Customer Service section).
4. Provide ongoing support through telephone consultations and provide a local or toll free number for access to technical support …

Pharmacy Benefit Eligibility Verification Services:

1. Obtain information provided by the pharmacy benefit managers (PBMs) to determine pharmacy benefit eligibility information in real-time and reduce time spent researching benefit information to automate the task of determining patient eligibility and coverage, providing time savings and an enhanced level of service to patients …

Billings Area Indian Health Service (BAIHS) Health Care Facilities will:

1. Obtain an agreement with designated Drug Plans so the Switching Service can submit prescription claims for electronic adjudication and or eligibility on behalf of BAIHS health care facilities transmitting claims …

Base Period of 12 months plus 4 Option Periods of 12 months each.

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