Pharmacy Claims Switching and Benefit Eligibility Verification Services - IHS Phoenix Indian Medical Center
ID: SS-25-PHX-003Type: Sources Sought
Overview

Buyer

HEALTH AND HUMAN SERVICES, DEPARTMENT OFINDIAN HEALTH SERVICEPHOENIX AREA INDIAN HEALTH SVCPHOENIX, AZ, 85004, USA

NAICS

Software Publishers (513210)

Set Aside

Buy Indian Set-Aside (specific to Department of Health and Human Services, Indian Health Services) (BICiv)

Original Source

https://sam.gov/opp/75c60ef9d305419d96639cc7e8b16fcd/view
Timeline
    Description

    The Department of Health and Human Services, specifically the Indian Health Service, is seeking qualified vendors to provide Pharmacy Claims Switching and Benefit Eligibility Verification Services for the Phoenix Indian Medical Center (PIMC). The objective of this procurement is to enhance the electronic processing of pharmaceutical claims and verify patient benefit eligibility, ensuring compliance with relevant specifications and standards. These services are critical for streamlining claims submissions to third-party Drug Plans and the Arizona Health Care Cost Containment System (AHCCCS), ultimately improving healthcare service delivery for Indigenous populations. Interested parties must self-certify as an Indian Economic Enterprise and are required to submit their qualifications by contacting Dekovan Cook at Dekovan.Cook@ihs.gov or by phone at 602-364-5018. The contract is set to span five years, from March 18, 2025, to March 17, 2030.

    Point(s) of Contact
    Dekovan Cook
    (602) 364-5018
    Dekovan.Cook@ihs.gov
    Files
    Title
    Posted
    IEE Representation Form.pdf
    The document from the Indian Health Service outlines the requirements for the Buy Indian Act under which an enterprise must self-certify as an “Indian Economic Enterprise” when responding to a solicitation, sources sought notice, or request for information (RFI). This certification must be valid at three key points: at the time of the offer, at contract award, and throughout the contract's duration. Should the contractor fail to meet eligibility criteria during these periods, they are required to inform the Contracting Officer. Furthermore, successful Offerors need to be registered with the System of Award Management (SAM). The form also stresses the legal implications of providing false information, including penalties for violations of federal law. Additionally, the document gathers essential representational data from the Offeror, such as the name of the business owner and their Tribal affiliation, while confirming their status as an Indian Economic Enterprise. This form serves as a critical mechanism for ensuring compliance with the Buy Indian Act, supporting Indigenous economic participation in federal contracting processes.
    SOW - Switching and Eligibility.pdf
    The Phoenix Indian Medical Center (PIMC) seeks Pharmacy Claims Switching and Benefit Eligibility Verification Services to enhance its electronic pharmaceutical claims processing and benefit verification. The Switching Services aim to streamline claims submissions to third-party Drug Plans and the Arizona Health Care Cost Containment System (AHCCCS) while ensuring compliance with specifications. Key tasks include providing telecommunication support, automated data checks, and the option for additional services such as Pre Post Editing and Rx Reconciliation. PIMC is responsible for establishing agreements with Drug Plans, adhering to data standards for claims transmission, and covering any needed modifications to the RPMS system. The software must communicate effectively to verify Medicare Part D eligibility. Customer service support will be available Monday to Friday from 7:00 am to 7:00 pm CST. The contract duration is five years, from March 18, 2025, to March 17, 2030. Additionally, the document outlines requirements for HHS digital accessibility compliance per Section 508 of the Rehabilitation Act, ensuring all technology developed is accessible to individuals with disabilities. It also addresses the handling of confidential information related to patient records while establishing invoicing and payment protocols to ensure prompt contractor payment. The request highlights PIMC's commitment to improving healthcare service delivery and compliance with legal standards.
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