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Home » Health Information and Claims Processing Services
Health Information and Claims Processing Services
|Name||Public Works & Government Services Canada|
|Category||Health and Social Services|
Date closing 2015/07/07 14:00 Eastern Daylight Time (EDT)
Reference number PW-$$XF-008-28919
Solicitation number HT426-144642/A
Region of delivery Alberta, British Columbia, Manitoba, National Capital Region, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Quebec, Saskatchewan, Yukon
Notice type Letter of Interest (LOI)/Request for Information (RFI)
GSIN L004CV: Claims Administration/Processing (insurance plans)
Trade agreement Agreement on Internal Trade (AIT)
Tendering procedure All interested suppliers may submit a bid
Competitive procurement strategy N/A – P&A/LOI Only
Procurement entity Public Works & Government Services Canada
End user entity Health Canada
Trade Agreement: Agreement on Internal Trade (AIT)
Tendering Procedures: All interested suppliers may submit a bid
Competitive Procurement Strategy: N/A – P&A/LOI Only
Comprehensive Land Claim Agreement: No
Nature of Requirements:
Health Information and Claims Processing Services
The purpose of this notice is to advise the industry of the Health Information and Claims Processing Services (HICPS) requirement for Health Canada (HC), the Request for Information (RFI) #1 publication, and the subsequent Engagement activities.
1. NIHB Program Background
The Non-Insured Health Benefits (NIHB) Program of the First Nations and Inuit Health Branch (FNIHB) at Health Canada (HC) provides eligible registered First Nations and recognized Inuit with a range of medically-necessary goods and services not provided through private insurance plans, provincial/territorial health and social programs or other publicly funded programs.
These medically necessary benefits are:
* Pharmacy (certain prescription and over-the-counter drugs);
* Medical supplies and equipment;
* Dental care;
* Vision care;
* Other health care services such as short-term crisis
intervention mental health counselling; and
* Medical transportation to access medically required health services not available on reserve or in the community of
NIHB is the largest program of HC, representing approximately 31% of the department’s total budget and 46% of FNIHB’s budget in 2013-14. Total annual expenditures for all NIHB benefit areas amounted to $1,026.4 million in fiscal year 2013-14.
As with other public and private plans, the NIHB Program does not provide direct services to clients. It relies mainly on pharmacists, dentists and other health providers to deliver services to clients. Through the Health Information and Claims Processing Services, the NIHB Program reimburses providers for the cost of eligible services. These services are essential to the NIHB Program’s ability to fulfill its mandate to ensure access by First Nations and Inuit clients to needed health benefits.
2. HICPS Overview
HICPS includes all services and supporting systems used to process Non-Insured Health Benefits claims, supporting Providers with the processing and settlement of their claims, ensuring compliance with NIHB Program policies including audit, reporting and financial control practices, automated information management systems used to process and pay claims in accordance with NIHB Program client/benefit eligibility and pricing policies.
Since 1990, Canada has retained the services of a private sector contractor to administer the following core health information and claims processing services on its behalf:
* Requests and claims processing, adjudication and settlement;
* Provider registration and communications;
* Payment and Financial operations;
* Systems and services in support of the various NIHB operated
Review, Prior-Approval, and Predetermination Centres.
* Provider Audit program and audit recoveries; and
* Data retention, collection, analysis and reporting
NIHB Program uses this third party claims processor to review and process claims for the Pharmacy, Dental Care, and Medical Supplies and Equipment. In addition to ensuring claims are processed in a timely manner and in keeping with NIHB Program policies and rules, HICPS includes a range of pre-payment and post-payment controls (including a provider audit program that covers Provider Profiling, Next Day Claim Verification, Client Confirmation Program, On-Site and Desk audit), which help to ensure the accountability of the NIHB Program. In 2013-14, HICPS processed 21.2 million claim lines of nationally administered pharmacy and dental benefits which accounted for approximately 55.4% of all NIHB expenditures (or over $570 million).
3. Aboriginal Participation Component
The HICPS requirement will include an Aboriginal Participation Component (APC), which is a mechanism designed to meet the Government of Canada’s objectives of encouraging Aboriginal socio-economic development through federal contracting opportunities that are not subject to International Trade Agreements. The APC is designed to develop long-term sustainable and meaningful socio-economic benefits for Aboriginal people, businesses and communities and compliments the objectives of the Procurement Strategy for Aboriginal Businesses (PSAB).
4. Request for Information #1
The purpose of this RFI is to inform industry of HC’s requirement for HICPS and to provide industry an opportunity to provide feedback on the requirement and subsequent engagement activities. This feedback will assist Canada initiating a dialogue about the requirements and possible solutions.
This RFI also contains specific questions addressed to the industry to identify future technologies, best practices and innovative business or service models. Detailed written responses will enable Canada to consider industry perspectives in the development of HICPS requirement and the eventual RFP.
4.1 Nature of this Request for Information
This is not a bid solicitation. This RFI will not result in the award of any contract. Potential suppliers of any goods or services described in this RFI should not reserve stock or facilities, nor allocate resources, as a result of any information contained in this RFI. Nor will this RFI result in the creation of any source list. Therefore, whether or not any potential supplier responds to this RFI, it will not preclude that supplier from participating in any future procurement. Also, the procurement of any of the goods and services described in this RFI will not necessarily follow this RFI. This RFI is simply intended to solicit feedback from industry with respect to the subject matter described in this RFI.
4.2 Response Costs
Canada will not reimburse any organization for expenses incurred in responding to this RFI including, but not limited to, expenses incurred for participating in subsequent Engagement Activities.
4.3 Follow-up Activity
This RFI #1 is part of Engagement Phase 1, and will be followed by a one-day Industry Engagement Information Session #1 and separate One-on-One Sessions #1.
4.4 Communication with Industry
During the Engagement Activities subsequent to this RFI, the Contracting Authority may communicate with registered Industry Participants through direct email rather than by posting additional notices on the GETS.
5. Proposed Procurement Approach
5.1 Engagement Strategy
Three phases are planned for the Industry Engagement process. However, as the process evolves, additional activities could be incorporated into the engagement schedule or engagement phases may be combined, modified, or eliminated depending on timelines and feedback from industry.
Please note that participation in any of the Engagement activities is not a mandatory requirement for eventual submission of a bid; industry representatives that do not participate in the Engagement process will remain eligible to submit a bid in response to any future RFP relating to the HICPS procurement.
5.2 HICPS Engagement Milestones and Associated Timeline
The following milestones and their associated target delivery dates are estimates which have been provided for information purposes only. Canada reserves the sole option to delete or change each of the individual named milestones and their associated delivery dates as Canada sees fit.
Engagement Phase 1
1 Industry Engagement Information Session #1 – September 21, 2015
2 One-on-One Sessions #1 – September 21 – 23, 2015
Engagement Phase 2
3 RFI #2 – Spring 2016
4 Industry Engagement Information Session #2 – Summer 2016
5 Working Group Sessions #2 – Summer 2016
6 One-on-One Sessions #2 – Summer 2016
Engagement Phase 3
7 RFI #3 – Autumn 2016
All enquiries and other communications related to this RFI and associated Industry Engagement activities shall be directed exclusively to the Public Works and Government Services Canada Contracting Authority. Since this is not a bid solicitation, Canada will not necessarily respond to enquiries in writing or by circulating answers to all respondents; however, respondents with questions regarding this RFI may direct their enquiries to:
Contracting Authority: Aaron Wong-Sing
Public Works and Government Services Canada
Place du Portage III, 12C1 11 Laurier Street Gatineau, Quebec
Email Address: TPSGC.DGASTRDPSS-AQCBHICPS.PWGSC@tpsgc-pwgsc.gc.ca
Delegate Contracting Authority: Betty Cole
The use of e-mail to communicate is preferred.
Delivery Date: Above-mentioned
The Crown retains the right to negotiate with suppliers on any
Documents may be submitted in either official language of Canada.
Government of Canada (GC) tender notices and awards, solicitation documents and tender attachments are available free of charge and without registration on Buyandsell.gc.ca/tenders, the authoritative location for GC tenders.
You may have received this tender notice or award through a third-party distributor. The Government of Canada is not responsible for any tender notices and/or related documents and attachments not accessed directly through Buyandsell.gc.ca/tenders.
This Government of Canada tender notice or tender award carries an Open Government Licence – Canada that governs its use. Related solicitation documents and/or tender attachments are copyright protected. Please refer to the section about Commercial Reproduction in the Buyandsell.gc.ca Terms and Conditions for more information.
Contact name Wong-Sing, Aaron
Contact phone (819) 956-2219 ( )
Contact fax (819) 934-1235
Place du Portage, Phase III, 12C1
11 Laurier St./11 rue, Laurier
For more information buyandsell.gc.ca
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