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Other Health Insurance (OHI) Discovery

Solicitation Number: HT0003-14-RFI-0030
Agency: Other Defense Agencies
Office: Defense Health Agency
Location: Contract Operations Division - Falls Church
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Sources Sought
Added: Mar 18, 2014 6:24 am
**no questions will be accepted for this RFI**

1.0 Purpose of this RFI
This Request for Information (RFI) is to identify potential sources of services for Other Health Insurance (OHI) discovery in support of the Department of Defense (DoD) Military Healthcare System. Responses to this RFI will be used to assess the capability of business interests in various socioeconomic categories to perform this work.

2.0 Background

The DoD records commercial other health insurance (OHI) in the Defense Enrollment Eligibility Reporting System (DEERS). When complete, this information identifies treatment for which TRICARE is a secondary payer to any applicable third party insurance. It also allows military treatment facilities (MTFs) operated by the Uniformed Services bill to and collect from commercial insurance companies for medical treatment provided to non-active duty service member beneficiaries. Studies indicate that a significantpercentage of records in DEERS lack complete or accurate OHI. DoD is currently conducting small-scale pilot programs in MTF benefit recovery that include OHI discovery as part of the process. The Defense Health Agency intends to award a contract focused primarily on proactive OHI discovery to support the existing billing and collection processes for healthcare services provided by the MTFs and purchased from TRICARE providers. The intended concept is to provide the performer with a data file sourced from DEERS and containing identities and OHI information for some number of TRICARE beneficiaries. The performer will search for updated OHI information, verify it with a commercial health insurer or employer, and return a data file containing updated OHI information. The expected terms of the contract will include a fixed-price payment for each record containing new or updated OHI information that has been verified with the insurer and can be loaded back into DEERS within a set number of days.

3.0 Required Capabilities
Respondents shall provide company information. At a minimum, this should include business name, business address, name of company representative, contact information, and business qualification for socio-economic categories (e.g., Small Business, Small Disadvantaged Business, Service Disabled-Veteran Owned Small Business, Women-owned Small Businesses, HUBZone Small Businesses, etc.)

Respondents shall identify expected teaming arrangements with other business interests and the percentage of work to be performed by each. For team members, identify business name, business address, and business qualification for socio-economic categories (e.g., Small Business, Small Disadvantaged Business, Service Disabled-Veteran Owned Small Business, Women-owned Small Businesses, HUBZone Small Businesses, etc.)

Respondents shall describe their overall ability to perform discovery of new OHI information to include but not limited to the following:

a) Ability to identify and validate billable health insurance for Uniformed Services beneficiaries that have no health insurance information on file as well as identify and validate other health insurance information that may have policy information missing and provide said information to update the OHI repository in the DEERS database.

b) Ability to establish and maintain a productive cost-effective Insurance ID system; incorporate industry standard performance metrics; monitor and validate the accuracy, and timeliness of DEERS OHI information; and establish a reporting mechanism that measures return on investment that is in line with negotiated performance metrics.

c) Ability to query commercial health insurance carriers to include Blue Cross/Blue Shield, Aetna, Mailhandlers, United, and other OHI providers as well as pharmaceutical insurance providers. Identify current access to or the anticipated time to enter into Data Sharing Agreements with commercial health insurance carriers. Describe any business-owned OHI search engine(s)

d) Ability to store, safeguard, and safely transmit all personal identifying information and protected health insurance data.

4.0 How to Respond
THIS IS A REQUEST FOR INFORMATION (RFI) ONLY. This RFI is issued solely for information and planning purposes - it does not constitute a solicitation nor does it restrict the Government as to the ultimate acquisition approach. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Any contract that might be awarded based on information received or derived from this market research will be the outcome of a competitive process. Responders are advised that the U.S. Government will not pay for any information or administrative costs incurred in response to this RFI. All costs associated with responding to this RFI will be solely at the interested vendor's expense. Not responding to this RFI does not preclude participation in any future RFP, if any is issued. The formal closing date for this RFI and for the submission of responses is March 27, 2014. All responses should be submitted electronically using PDF, HTML, MS Word or PowerPoint formats with subject "Identification and Validation of Other Health Insurance" to the following Email addresses:
*Total e-mail file limit size is restricted to 5MB. Files exceeding this threshold shall be submitted over multiple messages, and be identified as "Message #x of #x".


7700 Arlington Blvd.
Suite 1M401
Falls Church, Virginia 22042
United States
Nicolas Sanchez