Notice ID: 36C10D24Q0109
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.
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:
- 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.
- Assist VA with automated hospitalization reporting capabilities and associated benefit entitlement reviews and decisions.
- 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.
- Assist VA with modernizing Hospitalization Decision Ready Claims by leveraging hospitalization reports data to automate administrative activities leading up the claim decision.
- Assist VA with modernizing Disability Benefits Questionnaires (DBQs) intake portal.
The scope of work provides a brief overview of the work that shall be accomplished under this contract. Specific tasks and deliverables can be found in section 5.0. The contractor shall provide services under the following work areas and tasks:
- Assist VA in modernizing the disability compensation claims process by using data and human-centered design to develop insights into the current adjudication process in order to identify opportunities for business process improvement. The current processes required by adjudicators involve significant amounts of manual data entry which is both time consuming, prone to error, and takes time away from higher value decision-making activities. This work shall enable the implementation of approved solutions; however, the scope of this work is specific to the services provided, not the implementation of an information technology solution.
- Assist VA with automated hospitalization reporting based on medical database queries against the Veterans Health Administration’s (VHA’s) Corporate Data Warehouse (CDW) and VBA’s datasources. The primary focus of this enhanced reporting capability is to support the automated process(es) for claims establishment associated with hospitalization adjustments, which impact benefit entitlements. Additional operational improvements associated with the interoperability of computable medical data shall also be explored using similar methodologies, including data integration of clinical, laboratory, and 3rd party data.
- Assist VA with the mapping of medical data codes to related VASRD criteria and identifying Health Data Repository (HDR) records, and potentially to records contained in other record repositories or systems, containing those medical data codes. The medical code mapping outputs of this task shall be used by Automated Decision Support (ADS) in developing business logics to prepare information leading up the claim decision for claims processors.
- Assist VA with modernizing Hospitalization Decision Ready Claims by leveraging hospitalization reports data to automate administrative activities leading up the claim decision.
- Assist VA with modernizing Disability Benefits Questionnaires (DBQs) intake portal. The effort aims to eliminate the need for Medical Disability Examination Office’s (MDEO) contract exam vendors to create proprietary systems and eliminate non-compliance DBQ information.
The Contract Period of Performance (PoP) shall be a 12-month base period + three (3) option years.
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