Sources Sought: Pharmacy Claims Switching and Benefit Eligibility Verification Services for the Billings Area Indian Health Service (BAIHS) locations.
ID: 75H709-BAIHS-25-010Type: Sources Sought
Overview

Buyer

HEALTH AND HUMAN SERVICES, DEPARTMENT OFINDIAN HEALTH SERVICEBILLINGS AREA INDIAN HEALTH SVCBILLINGS, MT, 59107, USA

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518210)

PSC

IT AND TELECOM - SERVICE DELIVERY SUPPORT SERVICES: ITSM, OPERATIONS CENTER, PROJECT/PM (LABOR) (DD01)

Set Aside

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

Original Source

https://sam.gov/opp/a39f5c961a38428abfa3b4440ed329c9/view
Timeline
    Description

    The Department of Health and Human Services, specifically the Indian Health Service (IHS), is seeking sources for Pharmacy Claims Switching and Benefit Eligibility Verification Services for the Billings Area Indian Health Service (BAIHS) locations in Montana. The objective is to identify potential providers capable of delivering non-personal services that facilitate the electronic submission of pharmaceutical claims and verify pharmacy benefit eligibility for over 70,000 American Indian and Alaska Native individuals served by BAIHS. These services are critical for ensuring timely reimbursement from third-party drug plans and enhancing the efficiency of pharmacy operations within the healthcare facilities. Interested parties must respond to the Sources Sought Notice (75H709-BAIHS-25-010) by providing a capability statement and relevant documentation, with the anticipated contract period being twelve months and four option periods thereafter. For further inquiries, contact Prudence Yellow Owl at prudence.yellowowl@ihs.gov or (406) 247-7252.

    Point(s) of Contact
    Prudence Yellow Owl
    (406) 247-7252
    prudence.yellowowl@ihs.gov
    Files
    Title
    Posted
    IEE Representation.pdf
    The document from the Indian Health Service outlines the requirements for self-certification under the Buy Indian Act, specifically related to the definition of an "Indian Economic Enterprise." Offerors must confirm their compliance at three key milestones: at the time of the offer, at contract award, and throughout the contract performance period. If an enterprise's eligibility changes, it must promptly notify the Contracting Officer. The document states that while self-certification is essential, individual Contracting Officers may request proof of eligibility before awarding contracts. Any false information can lead to legal ramifications. The representation section requires the Offeror to declare whether they meet the definition of an “Indian Economic Enterprise” and provides spaces for the necessary signatures and business information. This solicitation is part of the federal government's efforts to engage and support Indian-owned businesses within the framework of federal grants and RFPs, reinforcing statutory compliance and promoting economic development in Indian communities.
    Pharmacy Claims Switching Draft SOW.pdf
    The document outlines a draft statement of work for Pharmacy Claims Switching and Benefit Eligibility Verification Services for the Billings Area Indian Health Service (BAIHS). The services are essential for the electronic submission of pharmaceutical claims from BAIHS healthcare facilities to third-party drug plans for reimbursement, as well as for verifying pharmacy benefit eligibility in a timely and efficient manner. It specifies the locations of the healthcare facilities involved, outlines compliance with federal regulations, and highlights the contractor's responsibilities, including operational support and technical assistance. The contractor must ensure the Switching Services provide accurate and timely data on patient eligibility, significantly reducing the time spent handling claims rejections. The agreement includes a base performance period of 12 months with options for four additional one-year periods. The document emphasizes privacy and security requirements, adherence to existing healthcare guidelines, and the necessity of seamless integration with the Resource and Patient Management System (RPMS). Overall, the statement serves as a foundation for ensuring BAIHS healthcare facilities can efficiently manage pharmacy claims and eligibility verifications, enhancing service delivery for patients.
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