The Department of Veterans Affairs (VA) has issued a solicitation (36C10G26R0004) for a Community Care Network (CCN) Next Generation (Gen) - Dental Network. This single-award Indefinite Delivery/Indefinite Quantity (IDIQ) contract, with a maximum value of $30 billion and a guaranteed minimum of $670,008,794, aims to establish a comprehensive dental network for Veterans. The solicitation details payment structures, including reimbursement based on the Dental VA Fee Schedule (DVAFS), provisions for waivers in rural/scarce areas, and compensation for non-DVAFS services. It outlines specific Contract Line-Item Numbers (CLINs) for dental services, administrative services, implementation, and optional services like appointment scheduling and software development. The document also emphasizes stringent IT contract security requirements, data privacy (HIPAA, Privacy Act, FISMA), and incident reporting protocols for contractors handling sensitive VA information and systems.

The U.S. Department of Veterans Affairs (VA) is issuing a combined synopsis/solicitation (36C10G26R0004) for the Community Care Network (CCN) Next Generation (Next Gen) Dental program. This solicitation, in accordance with FAR Part 12.6, seeks to establish a dental network for veterans. The response deadline is March 16, 2026, at 14:00 Eastern Time. The VA, through its Strategic Acquisition Center in Fredericksburg, VA, is the contracting office, with Jessica Portillo as the point of contact. Numerous attachments provide comprehensive details, including the Performance Work Statement, contractor manual, pricing template, stakeholder lists, risk registers, performance requirement summaries, and various data exchange and guide documents. These attachments cover everything from project risks and performance requirements to specific EDI companion guides and templates for network waiver requests and provider information, ensuring a thorough framework for the dental network.

This Performance Work Statement (PWS) outlines the requirements for the Department of Veterans Affairs (VA) Community Care Network (CCN) Next Generation Dental Network. The contractor will establish, maintain, and administer a network of licensed dental providers, ensuring quality services, efficiencies, and a positive Veteran experience. Key areas include project management, dental network development and maintenance with specific adequacy standards for drive times and appointment timeliness, eligibility data management, customer service, referrals, medical documentation, claims processing, and program integrity to combat fraud, waste, and abuse. The PWS also covers clinical quality and patient safety, technology requirements, and training for network providers, contractor personnel, and VA staff. The deployment will occur in two phases, with the first achieving full healthcare delivery within six months and the second within twelve months of contract award. The document emphasizes compliance with federal, state, and local laws, and outlines various deliverables and reporting requirements.

The Department of Veteran Affairs (VA) Community Care Network (CCN) Next Generation Dental Network Contractor Manual outlines comprehensive guidelines for the contractor managing dental care for Veterans. This manual details administrative invoicing, dental network development, accreditation, credentialing, and eligibility data management, including the use of Veteran Community Care Eligibility (VCE) codes. A significant portion covers referral processes, including VA-Approved Referrals and Requests for Services (RFS), and claims processing and adjudication. The document emphasizes timely filing, clean claim edits, and various validation procedures to ensure accurate and efficient payment for dental services. It also addresses program integrity to combat fraud, waste, and abuse. The manual serves as a critical resource for contractors to configure their systems and processes to align with VA requirements for providing high-quality dental care to Veterans.

The document outlines a comprehensive set of contract line item numbers (CLINs) for dental and administrative services, likely part of a federal government Request for Proposal (RFP) or grant. It details various services, including routine dental care (CLIN X001), waivers of payment rates (CLIN X002), and non-DVAFS dental services (CLIN X003). Administrative services are covered under CLIN X004, with implementation as a fixed-price lump sum under CLIN X005. Optional services include appointment scheduling (CLIN X006), with separate implementation costs for VA facilities and contractor sites, and administration. Software, process, and proof of concept development are also optional (CLIN X007), broken down by task size with corresponding dollar amounts per task. The contract concludes with a fixed-price lump sum for transition out services (CLIN X008). Each CLIN includes details on unit/directions, base period, and multiple option periods, indicating a long-term contractual agreement. The document also lists

The Phase I – Questionnaire Attachment is a crucial component of a government solicitation, likely an RFP, designed to assess an offeror's qualifications and experience in providing dental network and claims processing services. The questionnaire asks three key questions: whether the company has established and maintained a dental provider network for the past five years, if all components of their network are nationally accredited (requiring evidence), and if they have experience receiving, processing, and adjudicating claims for medical and ancillary services. The document concludes with an attestation section, where an authorized individual from the offeror must confirm the accuracy and completeness of their responses and submitted accreditation evidence. This attachment serves to pre-qualify potential vendors based on their operational history and adherence to industry standards.

The Department of Veterans Affairs utilizes a Past Performance Questionnaire (PPQ) to evaluate contractors for competitive service contracts. This questionnaire serves as a reference check, gathering information on an offeror's past performance under a specific contract. The PPQ requests details about the person completing the evaluation and asks for ratings across several key areas, including overall quality, delivery, service quality, problem resolution, and contractor personnel quality. It also includes yes/no questions regarding cure notices, contract terminations, willingness to re-award contracts, discussions of adverse performance, and the existence of past performance databases. Additionally, it asks for the contract's period of performance, dollar value, and a brief description of services provided. The form is designed to provide a comprehensive assessment of a contractor's historical performance to aid in the contract award process.

The document outlines the Community Care Network (CCN) Stakeholder List, categorizing both internal and external stakeholders crucial for the effective delivery of healthcare services to Veterans, their families, and caregivers. Internal stakeholders include national-level entities such as VA and VHA Executive Leadership, the VHA Central Office (specifically the Office of Integrated Veteran Care (IVC) and its directorates like Integrated External Networks (IEN) and Integrated Access (IA)), as well as Contracting Officers and Representatives. Regional and local internal stakeholders include IVC Integrated Field Operations (IFO), Veterans Integrated Services Network (VISN) and VA Medical Center (VAMC) Leadership, VISN Business Implementation Managers (BIMs), and VAMC Transition Leads. External stakeholders encompass Veterans, Family Members, & Caregivers, Community Providers, Congress, Media, Veteran Service Organizations (VSOs), other CCN Region Contractors, and Outgoing Contractors. Each stakeholder group has a defined role in managing, overseeing, delivering, or advocating for community care programs, ensuring timely, high-quality healthcare, network development, contract management, and overall program compliance.

The DRAFT VHA Enterprise Risk Management (ERM) Templates workbook provides an all-inclusive system for identifying, analyzing, reporting, and recording risk and control information to facilitate actionable decisions. It includes various templates and scales, such as Risk Scoring Scales to assign likelihood and impact scores, and a Risk Tolerance Template to define performance ranges and an organization's risk appetite. The workbook also features a Risk Register for listing risks, scores, and responses, a Heat Map for visualizing risks based on likelihood, impact, and resourcing, and a Control Register and Monitor Log to document control activities and their effectiveness. These tools are designed to systematically manage and monitor risks across different domains like operational, patient safety, human capital, technology, financial/fraud, legal/regulatory, strategic, and hazard, ensuring alignment with VHA's risk appetite and objectives.

The document outlines performance requirements and standards for a federal government dental program, focusing on network adequacy, customer service, claims processing, and medical documentation. Key performance objectives include ensuring 90% veteran travel time compliance, maintaining a call abandonment rate of less than 5%, processing 98% of claims within 30 days, and resolving various tiers of VA-provided ticketing tool tickets within specific business or calendar day limits (e.g., Tier 1 in 5 business days, Tier 4 in 180 calendar days). Surveillance methods involve random sampling and using contractor-developed, government-approved methodologies for calculation. The document also lists specific exclusions for performance objective calculations, such as approved network deviations and referrals with veteran preference indicators. It provides a comprehensive list of VAMC Catchment Areas and associated pass rates, emphasizing that performance standards apply to each Catchment Area individually, not as a total average.

This Quality Assurance Surveillance Plan (QASP) outlines the Department of Veterans Affairs – Veteran Health Administration’s (VHA) procedures for monitoring the performance of a contractor providing dental services to eligible U.S. Veterans under the Community Care Network (CCN) Medical Performance Work Statement (PWS). The plan details a structured, outcomes-focused surveillance approach, emphasizing measurable results and continuous quality improvement. Key aspects include the roles and responsibilities of the Contracting Officer, Contract Specialist, and Contracting Officer's Representative (COR), along with various surveillance techniques such as audits, direct observation, and data analysis. Performance will be evaluated against Acceptable Quality Levels (AQLs) outlined in the Performance Requirement Summary (PRS), with specific calculations provided for network adequacy, appointment timeliness, contact center performance, and claims processing. The QASP also addresses documentation, performance determination, reporting, resolution of issues, and the process for making changes to the plan.

The Department of Veterans Affairs (VA) Community Care Network (CCN) utilizes a Monthly Progress Report Template (Attachment D) for its Third Party Administrators (TPAs). This template outlines key performance areas, including contractor information, a summary of objectives and activities supporting the CCN, external communication efforts, and updates on network adequacy meetings. It also details financial performance through high-level cost and expenditure summaries, tracks project schedules and milestones, and records actual and planned activities. Furthermore, the report requires the identification and mitigation of risks and issues, along with documentation of corrective actions requested by the VA and internal improvements made by the contractor. This comprehensive reporting structure ensures accountability, transparency, and continuous improvement in providing timely, accessible, and high-quality care to Veterans within the CCN.

The Integrated Veteran Care program outlines a comprehensive framework for managing and reviewing healthcare services for veterans. This document, intended for Program Management Review (PMR) meetings, details key areas of focus including work and progress summaries, risk status, operations support, network adequacy, customer service, and claims processing outcomes. It specifies the information to be presented in each section, such as task and schedule summaries, planned activities, corrective actions, medical documentation compliance, patient safety reports, and referral trends. The document also highlights the importance of attachments like the Integrated Master Schedule and Project Risk Register for both dental and medical networks. The overarching goal is to ensure efficient, high-quality, and compliant healthcare delivery for veterans, addressing both operational performance and patient safety.

The “Dental Network Waiver Request” is a pre-decisional draft form for contractors to request deviations from standard network adequacy requirements for specialized dental services. Contractors must complete parts I-VII of the form, providing detailed information such as county, PO/PE, associated code/cost set, specialty, and region. A mandatory accompanying CSV file with the form's responses is also required. Contractors must attest to having verified provider accessibility and recruitment efforts within the preceding six months, justifying the need for the deviation. The form also requires a resolution plan outlining how veterans will access services, including anticipated timelines and proposed changes to Network Adequacy QASP Standards. Deviations are limited to one year, with reevaluation. The final sections are for internal VA review, outlining the approval decision, start and expiration dates, and next review dates.

The document, "Required Dental Provider Information," outlines the comprehensive data points necessary for dental providers seeking to be included in a directory, likely for a government-affiliated healthcare program such as those related to federal grants or RFPs. It details required information across several categories, including provider identification (name, NPI, TIN), physical and virtual care site addresses, contact information, hours of operation, and mailing/billing addresses. The document also specifies the need for professional details like educational background, specialty, available services (including FMCSA certifications for Veterans), licensure, and any high-performing provider designations. Furthermore, it requests demographic data (gender, race, date of birth, languages), affiliated facilities, and special identifiers for emergency care, patient acceptance status, care type, and clinical quality metrics. Contract effective and termination dates are also required. This extensive data collection aims to ensure a comprehensive, accurate, and transparent provider directory for beneficiaries, emphasizing compliance and detailed service offerings.

The document outlines the eligibility verification and enrollment data exchange process for Veterans within the VA health system. It details the initial load of existing Veteran enrollment and eligibility records, ongoing updates for newly enrolled Veterans, changes in personal information, and updates to enrollment status, including those no longer enrolled or deceased. The Contractor integrates with VA's Data Access Service (DAS) to receive this data and to respond to real-time eligibility verification requests for community care. All data exchanged is ASCII-verified, with one record per Veteran, containing basic information like internal VA identifiers, SSN, name, DOB, address, and contact details. It also includes eligibility information such as Veteran Choice eligibility, NLE_ES flag, and distance-eligible information with associated VISN and station details. The document provides a data dictionary specifying field types, maximum lengths, and descriptions, along with sample record structures for different eligibility scenarios.

The Department of Veterans Affairs (VA) Community Care Network (CCN) Explanation of Payment/Benefit (EOB/P) is a record for veterans detailing claims paid or denied for services received within the CCN. This document clarifies that it is not a bill and instructs veterans to retain it for their records. It outlines eligibility requirements, including a VA identification card, enrollment in the VA's patient enrollment system, and an approved referral for community care services. The EOB/P also explains authorization requirements for providers, timely filing guidelines, and processes for disputes, appeals, and grievances. Key contact information for VA Customer Service and reporting fraud or abuse is provided. Veterans have 90 days to request a review if they disagree with a claim decision, and can file a claim with the VA if a community provider bills them for non-covered services not resolved with the CCN NG Contractor. The document provides a detailed breakdown of services, billed charges, and paid amounts for each claim.

The document outlines data specifications for various reports crucial for government contract oversight, including Cost Avoidance and Recovery/Recoupment Reports, Clinical Quality and Patient Safety Issues Reports, and Continuity of Operations Plan (COOP) Reports. The Cost Avoidance and Recovery/Recoupment Reports require detailed error summaries, overpayment/underpayment calculations with specific reasons and amounts, and variance analysis for changes exceeding 15%. Clinical Quality and Patient Safety Issues Reports focus on identifying, tracking, and resolving patient quality issues (PQI) and internal quality issues (IQI), including severity levels and peer review recommendations. COOP Reports track system downtime, its impact on functional capabilities, and corrective actions taken. Each section provides specific data descriptions, formatting requirements, and deliverable expectations, ensuring comprehensive and standardized reporting for federal government RFPs, grants, and state/local RFPs.

This document outlines a Memorandum of Understanding and Interconnection Security Agreement (MOU/ISA) between a VA Organization and a non-VA Organization, detailing the terms for secure data exchange between their respective IT systems. The agreement establishes a framework for managing, operating, and securing system interconnections, defining responsibilities, communication protocols for security incidents, disasters, and system changes, and cost-sharing. It incorporates federal and VA-specific authorities, including FISMA and HIPAA. The ISA section provides technical details on system security considerations, hardware/software requirements, data descriptions, security assessments, and audit trail responsibilities. It also specifies security measures like identification, authentication, logical access controls, physical security, firewalls, and encryption. The agreement emphasizes continuous monitoring, annual reviews, and the importance of FIPS 140-2 compliance for sensitive information. A topological drawing is required to illustrate the interconnection visually. The MOU/ISA ensures the confidentiality, integrity, and availability of information exchanged between the interconnected systems, with provisions for termination and reauthorization.

The Interface Control Document (ICD) details software interface requirements between the HealthShare Referral Manager (HSRM) and a Standard Integration Partner (SIP) within the U.S. Department of Veterans Affairs' (VA) Community Care Referral and Authorization (CCRA) solution. The Data Access Service (DAS) acts as a proxy, facilitating the exchange of referral data using Fast Healthcare Interoperability Resources (FHIR) messaging over secure HTTPS POST. The document outlines operational agreements, data transfer protocols, transaction types, security measures (two-way SSL/TLS 1.2+), and performance requirements, ensuring referral documents are transmitted to SIPs within 30 seconds. It also details required data fields, connectivity error handling, support contacts, and schema changes across various HSRM builds, including updates to patient demographics, program authorities, and patient preferences. This ICD is crucial for developers and testers implementing the interface, ensuring seamless and secure data flow for Veteran community care.

The Department of Veterans Affairs (VA) Office of Community Care Companion Guide, updated in July 2025, outlines procedures for electronic data interchange (EDI) of healthcare benefits. This guide supplements the v005010x220A1 ASC X12N TR3 and associated errata, clarifying data content for electronic exchanges with the VA Office of Integrated Veteran Care (IVC) health care programs. It details business and technical processes, including certification, testing, connectivity, and specific EDI transaction rules for the 834 and 999 transactions. The document emphasizes HIPAA compliance and provides contact information for EDI technical and business assistance, aiming to improve the facilitation of EDI transmissions for trading partners.

The Department of Veterans Affairs (VA) Integrated Veteran Care (IVC) program has released a HIPAA Transaction - Standard Companion Guide for Health Care Claims: Dental (837D). This August 2025 pre-decisional document clarifies data content for electronic exchanges with VA IVC healthcare programs, supplementing v5010 ASC X12N Implementation Guides. It outlines business and technical processes for Third-Party Administrators (TPAs) within the Community Care Network (CCN) to submit Coordination of Benefits (COB) claims to IVC for reimbursement. The guide details steps for claim submission, VA's acknowledgment process (999 acknowledgments), and specific business rules and limitations for data elements within the 837D transaction, including requirements for original and corrected/resubmitted claims. It also provides contact information for EDI customer service and relevant websites, emphasizing coordination with contracted healthcare clearinghouses for connectivity, testing, and technical assistance.

The Department of Veterans Affairs (VA) Integrated Veteran Care (IVC) program has released a pre-decisional Companion Guide for HIPAA Transaction - Standard Health Care Claim: Institutional (837I) based on ASC X12 version 005010x223A3. This guide clarifies data content for electronic exchanges with VA IVC healthcare programs, ensuring compliance with ASC X12 syntax and HIPAA. It outlines business and technical processes for Coordination of Benefits (COB) claims submitted by Community Care Network Third-Party Administrators (CCN TPAs) to IVC for reimbursement. The document details steps for initiating EDI exchange, testing with the payer, connectivity protocols, contact information for EDI customer service, control segments, and payer-specific business rules and limitations. It also specifies requirements for acknowledgments (999s) and emphasizes the shift in VA's payment model to reimbursement for accurate and timely claims processing by contractors, audited by a third party.

The Department of Veterans Affairs (VA) Integrated Veteran Care (IVC) program has released a HIPAA Transaction Standard Companion Guide for Health Care Claim: Professional, specifically for Coordination of Benefits (COB) Invoicing X12 837P. This guide, dated August 2025, clarifies data content requirements for electronic exchanges with VA IVC health care programs, supplementing existing ASC X12N Implementation Guides. It outlines business and technical processes for Third-Party Administrators (TPAs) within the Community Care Network (CCN) to submit 837 COB claims to the VA for reimbursement. The document details trading partner registration, testing procedures, connectivity protocols, contact information, control segments, and payer-specific business rules and limitations. It also specifies requirements for original and corrected/resubmitted claims, including the incrementing of claim control numbers. The VA IVC will return 999 acknowledgements for received 837 Professional batches, and emphasizes that payment is a reimbursement to the contractor, with VA enforcing accuracy through audits rather than re-adjudication.

The Department of Veterans Affairs (VA) Integrated Veteran Care (IVC) program has released a pre-decisional HIPAA Transaction Standard Companion Guide for Health Care Information Status Notification (277CA). This guide, based on ASC X12 version 005010X214, clarifies data content for electronic exchanges with VA IVC healthcare programs, particularly for pre-adjudication 277CA transactions from the Community Care Network (CCN) Third-Party Administrator (TPA) to the VA IVC. It outlines business and technical processes for transmitting pre-adjudication healthcare information status notifications to support the IVC CCN, supplementing the EDI 277CA TR3 and ensuring HIPAA compliance. The document details connectivity, communication process flows, testing procedures, contact information, and specific business rules, emphasizing a one-to-one ratio of X12 837 transactions to X12 277CA transactions to avoid HIPAA violations. The guide is crucial for developing and deploying pre-adjudication health care information status notifications within the VA IVC framework.

The Department of Veterans Affairs (VA) Integrated Veteran Care (IVC) program has released a HIPAA Transaction - Standard Companion Guide for Health Care Claim Payment Advice, dated August 2025. This pre-decisional document clarifies data content for electronic exchanges between the VA IVC health care programs and community care providers, based on the ASC X12 version 005010x221A1 (835 Electronic Remittance Advice). It outlines business and technical processes for the VA IVC Third Party Administrator (TPA) in handling post-adjudication claim payments and denials within the Community Care Network (CCN). The guide details procedures for claim adjudication, reimbursement, denial, batching, and transmission of 835 transactions, ensuring HIPAA compliance by separating CCN claims from other contracts. It also covers trading partner registration, testing with the payer, communication protocols, and specific business rules for 835 envelope formats and claim payment information. Contact information for EDI technical assistance and customer service is provided, along with relevant websites and key personnel. The document emphasizes adherence to ASC X12N/005010X221A1 guidelines and CAQH CORE rules for claim processing.

The document outlines 26 valid reason codes for returning a VA referral for community care scheduling by CCN Next Generation contractors. These reasons cover various scenarios, including the unavailability of network providers, incorrect appointments, veterans declining care due to geographic or timeliness standards, missing VA data, duplicate referrals, excluded healthcare services, and situations where care is already scheduled. Other reasons include veterans declining care despite meeting standards, no-shows, VA-requested returns, veteran cancellations, self-scheduling issues, providers not accepting new patients, and veterans requesting non-CCN network providers. Additional codes address situations where veterans are deceased or incapacitated, unaware of referrals, prefer VA care, face transportation challenges, or where the contractor is unable to schedule within timeliness standards or contact the veteran. The list also includes reasons related to an inability to review referrals within timelines and when the SEOC on the referral does not provide needed services.

The Dental Network Build Report requires a contractor to provide the VA with ongoing updates on network build issues, resolution plans, provider recruitment, and status. The report must include a summary of issues needing action plans, organized by VAMC catchment area, and an overview of the contractor's plan to address these issues with timelines and resources. Additionally, it requires a full listing of providers currently in recruitment, detailing provider name, specialty, services, care site locations, and key dates such as initial contact, contracting completion, credentialing application/completion, and the date the provider is loaded into the Provider Directory. This report ensures transparency and progress in expanding the dental network for veterans.

The Waiver of Payment Rates Request form is a critical document for contractors seeking to adjust payment rates for services provided to veterans. This form requires detailed information, including NPI/Tax ID, provider details, the number of providers in practice, and the number of veterans served. Contractors must justify the need for a rate waiver, explaining the potential impact on veterans if the provider leaves the network, and indicating if the provider is a scarce or rural resource. The form also necessitates a justification of existing providers within the same catchment area. Additionally, contractors must list non-contracted providers, outlining reasons for not contracting with them. The document includes sections for internal VA review, covering recommendations from the Rate Waiver Committee, decisions from the Contracting Officer, and expiration dates for approved waivers. This process ensures thorough evaluation and coordination to maintain adequate network services for veterans.

The Provider Satisfaction Survey is a comprehensive tool designed to gather feedback from community care providers participating in the VA's Community Care program. The survey covers several key areas: practice demographics, communication with VA staff and referring providers, coordination mechanisms, data transfer processes, professional relationships with VA providers, and roles and responsibilities. It also includes questions about the overall experience and likelihood of continuing participation in the program. Questions delve into the frequency of VA referrals, professional discipline, demographics of the respondent, and the number of Veterans seen. Specific inquiries address the helpfulness and timeliness of communication with VA personnel and referring offices, the processing of requests for additional services, and the impact of administrative delays on willingness to see Veterans. The survey assesses the effectiveness of various coordination methods, the ease and timeliness of data transfer, access to patient information, and the clarity of referral reasons and clinical history. It also explores provider confidence in recommendations, understanding of medication prescribing protocols, and satisfaction with the VA community care program.

The Department of Veterans Affairs (VA) has issued a combined synopsis/solicitation for the Community Care Network (CCN) Next Generation (Next Gen) Dental IDIQ contract. This unrestricted solicitation encourages companies of all sizes to develop and maintain a national network of community dental providers for Veterans, encompassing medical, surgical, complementary, integrative health services, durable medical equipment, pharmacy, and claims processing. The VA plans to award a Firm-Fixed Price plus Incentives, Multiyear, Multiple Award, Indefinite Delivery Indefinite Quantity contract. Proposals will be evaluated based on Technical, Veteran’s Involvement/Subcontracting Plan, and Price factors. Questions are due by January 6, 2026, with a pre-proposal conference on January 21, 2026, and proposals due by March 16, 2026. Offerors are encouraged to propose alternative NAICS and PSC codes if they better align with their proposed solution.