MEDICAL CLAIMS TRANSMISSION AND REMITTANCE SERVICES FOR PINE RIDGE IHS HOSPITAL

The Pine Ridge Indian Health Service (IHS) Hospital requires a secure exchange data software solution for medical claims processing. This solution must provide connectivity to Medicare systems, offer clearinghouse services for third-party insurance claims (Medicare, Medicaid, VA, and Commercial Payers), and facilitate eligibility verification. The service must support various claim types (inpatient, outpatient, day surgery, specialty clinics) and adhere to secure file transfer protocols and EDI transaction sets (X12 837, 835, 270, 271, 276, 277). Key requirements include no on-site software installation, support for up to 20 users, and compliance with HIPAA and other federal regulations regarding confidentiality. The contractor will provide end-to-end communication testing, daily operations support, routine technical assistance, and timely notifications for maintenance or disruptions. Customer support via phone and email is required during business hours. The contractor must process claims by the close of the next business day, perform routine editing for defects, and ensure electronic transmission. Rejected claims must be returned for correction without charge, and errors in processing are at the contractor's expense. The contractor must adhere to official coding and billing rules, maintain confidentiality, and provide weekly reports on claims approval and clearinghouse activities. Billing will be at a fixed rate, and the contract period is one year.

The Indian Health Service (IHS) requires potential contractors to self-certify as an “Indian Economic Enterprise” (IEE) under the Buy Indian Act (25 U.S.C. 47) for solicitations, sources sought, and RFIs. This form, IHS1521149, for Medical Claims Transmission & Remittance Services for Pine Ridge IHS Hospital, mandates that an enterprise meet the IEE definition at the time of offer, contract award, and throughout the contract's term. Contractors must notify the Contracting Officer immediately if they no longer meet eligibility. Successful offerors must also be registered with the System for Award Management (SAM). False information can lead to penalties under 18 U.S.C. 1001 and 31 U.S.C. 3729 to 3731. The form includes a representation section for the offeror to affirm their IEE status and provides fields for owner, tribal entity, business name, and DUNS number.