R710--Third Party Billing

This Performance Work Statement (PWS) outlines the requirements for a contractor to provide outpatient medical billing services for the Department of Veterans Affairs (VA) Consolidated Patient Account Centers (CPAC) nationwide. The contractor is responsible for generating, authorizing, and releasing outpatient medical claims to third-party healthcare insurers for both VA Care and VA Care in the Community, utilizing the VA’s legacy, DOS-based Veterans Health Information Systems and Technology Architecture (VistA) system. Key tasks include processing claims within the month of receipt, resolving rejected or denied claims, canceling non-billable claims with correct reasons, and maintaining active system access. Because the legacy system does not interface with modern billing software, billers must manually process 16 to 25 VA Care claims or 12 to 18 Community Care claims per hour without utilizing proprietary automation tools. Deliverables include monthly itemized statements, monthly staffing reports, and weekly pending workload reports. The contract is structured as an Indefinite Delivery Indefinite Quantity (IDIQ) with a 60-month ordering period. The contractor must perform work remotely in a secure environment that complies with HIPAA, PII, and PHI standards. Key personnel, including managers and supervisors, must possess extensive experience in outpatient third-party medical billing and will undergo initial training by the VA. Performance will be monitored via a Quality Assurance Surveillance Plan (QASP), requiring a minimum 95% individual biller accuracy rate and a 93% timely completion rate.

The Department of Veterans Affairs (VA), Regional Procurement Office Central Supplies and Services Division, has issued a Sources Sought Notice (Solicitation Number: 36C24C27Q0001) for market research and planning purposes. The VA is seeking information from qualified sources, particularly small and veteran-owned businesses, capable of providing Third Party Billing services through the Consolidated Patient Account Center (CPAC) Revenue Operations. The scope of work includes authorizing and releasing outpatient medical claims, including VA Care in the Community, using the legacy VISTA Disk Operating System (DOS). Key requirements involve manually processing 16–25 VA Care claims and 12–18 Community Care claims per hour per biller, with an estimated monthly volume of 250,000 to 350,000 claim encounters. Under NAICS code 524292 (Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds), interested parties must submit a capability statement of no more than 10 pages by July 20, 2026, at 2:00 PM Eastern Time. Submissions must address company designations, industry experience in medical billing (including DME and Dental), technical staff qualifications, transition timelines, and claims processing strategies, alongside feedback on the draft Performance Work Statement.