RFI #2 Veteran Affairs Code Sets Requirement

The Department of Veterans Affairs (VA) Enterprise Procurement Office has issued a Request for Information (RFI #2, Solicitation Number 36C10G26Q0088) to assess market interest and technical capabilities of qualified sources to develop, maintain, and regularly deliver comprehensive billing code sets. This Sources Sought Notice is for market research and planning purposes only and does not constitute a formal solicitation or a binding contract. Interested vendors must submit their capability statements and responses via email to the designated contacts, Contracting Officer Terri Duenas and Contract Specialists Justin Sink and Sidney Pennington, by September 21, 2026, at 3:00 PM Eastern Time. Submissions must reference the RFI number and project title ("Code Sets") in the subject line. The notice includes several attachments, including a Draft Performance Work Statement, RFI questions, and sample code sets for procedures and specialties, to help prospective sources understand the requirement's technical scope.

This Performance Work Statement (PWS) outlines a requirement by the Department of Veterans Affairs (VA) Office of Veterans Community Care for professional services to develop, refine, validate, maintain, and deliver VA-approved, Community Care Referral Guideline (CCRG) aligned Code Sets. CCRGs define the clinical scope of community care referrals, and the associated Code Sets map these guidelines to billable codes (such as CPT, HCPCS Level II, ICD-10, and NDCs) and linked adjudication-rule metadata. The contractor must provide the personnel, tools, and subject matter expertise to technical-map clinical guidelines to structured, version-controlled, adjudication-ready files. Key tasks include Task 1: Project Kickoff and Transition-In; Task 2: Initial Code Set Development (including a pilot package and delivery groups for approximately 373 CCRGs); Task 3: Routine Maintenance and Updates (structured around quarterly baseline releases, monthly monitoring, and prioritized urgent or off-cycle releases); and Task 4: Quality Assurance and Validation Support. While the contractor may optionally use automation or artificial intelligence to support mapping, human clinical and coding expertise is required to validate all deliverables. The contractor must also maintain a rigorous change log and version-control system to ensure historical reproducibility based on specific dates of service. Crucially, all contractor analyses, benchmark data, and recommendations remain strictly advisory; the VA retains sole authority over clinical scope, coverage, and payment policy. Deliverables must be submitted via secure transmission in approved machine-readable formats.

This Request for Information (RFI) is issued by the U.S. Department of Veterans Affairs (VA) to obtain industry feedback on a draft Performance Work Statement (PWS) for Community Care Referral Guidelines (CCRG) Code Set Development and Maintenance. The VA seeks actionable market research to refine its approach to developing, validating, and maintaining clinical-to-billing code maps (incorporating CPT, HCPCS, and ICD-10-CM/PCS) for approximately 373 active CCRGs. The document requests detailed narrative responses from capable vendors across twelve comprehensive categories (A through L). Key areas of inquiry include: - **Capabilities & Experience:** Vendor expertise in healthcare coding, data-handling accreditations (HIPAA, FedRAMP), and source tracking. - **Technical & Clinical Approach:** Methodologies for mapping clinical scope to billable codes, structured layer separation, quality assurance (QA), regression testing, and the use of automation/AI. - **Operations & Delivery:** Feedback on the proposed quarterly release cadence, 120-day backward-planned schedule, delta file delivery, and staffing models. - **Systems & Interoperability:** Tools for version control, delivery mechanisms (APIs, SFTP), and optional HL7 FHIR R4 integration. - **Governance & Pricing:** Recommended division of responsibilities, risk mitigations, and pricing structures (e.g., per CCRG or per release) to optimize competition and outcomes. The feedback gathered will help the VA reduce schedule risks, clarify the scope of work, and establish realistic timelines for transitioning industry-standard code sets to VA-specific categories of care.

This document outlines the Cardiology Community Care Referral Guideline (CCRG) for the Department of Veterans Affairs (VA), detailing the allowable outpatient services and physician-administered medications that do not require prior authorization. Under an active VA referral, community providers can deliver medically necessary, evidence-based specialty care aligned with the referred condition. Specifically, the guideline permits up to 5 diagnostic imaging tests, 15 diagnostic labs, 10 diagnostic studies (such as stress tests and echocardiograms), and 6 device interrogations or programming procedures within specified VA code sets. Additionally, for physician-administered medications not listed on the Preferred Active List (PAL), providers must adhere to the VA's Clinician Designee Instructions (CDI) or the VA Formulary Advisor criteria; if neither is available, a Request for Service (RFS) must be submitted prior to administration.

This is a federal Sources Sought Notice / Request for Information (RFI #2) issued by the U.S. Department of Veterans Affairs (VA) for a "Veteran Affairs Code Sets Requirement." Administered by the VA’s Strategic Acquisition Center (SAC) in Fredericksburg, VA, under solicitation number 36C10G26Q0088 0001, the initiative is categorized under Product Service Code (PSC) Q601 (Medical- General/Health Care) and NAICS code 541219 (Other Accounting Services). The primary point of contact is Contract Specialist Justin Sink. Responses to this market research notice are due by September 29, 2026, at 3:00 PM Eastern Time to help the VA assess industry capabilities for this upcoming requirement.

This document outlines the Community Care Referral Guideline (CCRG) for Cardiac Catheterization under the Department of Veterans Affairs (VA). It specifies allowable services related to this specialty that do not require prior authorization, provided they are clinically necessary and completed within the authorized duration. Key allowable services include: - Up to two outpatient evaluation and management (E/M) visits (initial and follow-up) with an interventional cardiologist. - Pre-procedure medical and basic cardiac clearance, including history and physicals, standard labs, electrocardiograms (EKGs), chest X-rays (CXRs), and echocardiograms (if not recently performed at the VA). Additional cardiac testing requires a separate Request for Service (RFS). - Associated anesthesia services. - One primary cardiac catheterization procedure with percutaneous interventions. Additionally, the guideline details protocols for physician-administered medications. Community providers must review the VA’s clinically designed indications (CDI) or VA Formulary Advisor criteria for medications not on the Approved Drug List (PAL). If a medication is unlisted in these resources, providers must submit an RFS prior to administration.