Revenue Cycle Management for Quentin N Burdick Memorial Health Care Facility in Belcourt, ND

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Contract Opportunity

Sources Sought: Revenue Cycle Management for Quentin N Burdick Memorial Health Care Facility

Sources Sought Notice Number: IHS-SS-25-1516621

This Sources Sought Notice is for informational and planning purposes only and shall not be construed as a solicitation, an obligation or commitment by the Indian Health Service.

This notice is intended strictly for market research to determine the availability of Indian Economic Enterprises (IEE).

Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. The anticipated applicable NAICS code for this acquisition is 524292, Third Party Administration of Insurance and Pension Funds- other relevant NAICS codes will be considered based on responses received (such as conference centers, etc.)

1. BACKGROUND

The IHS is an agency within the Department of Health & Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The Indian Health Service provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 567 federally recognized tribes, in 35 states. The Indian Health Service Headquarters is located in Rockville, MD and then divided into twelve (12) physical areas: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson.

The Great Plains Area Office (GPAO) works in conjunction with 19 Indian Health Service Units and Tribal Managed Service Units to provide health care to approximately 130,000 Native American located in North Dakota, South Dakota, Nebraska, and Iowa.

QNBMHCF falls under the GPAO and provides medical care to approximately 14,550 tribal members living on the Turtle Mountain Indian Reservation. The Service Unit was built in 1967 with renovation and clinic expansion completed in 1992, to provide an expanded level of outpatient health care services specifically designed to meet the needs of our population. Services include: 24 Hour Emergency Services, Laboratory, Radiology (CAT Scan & Mobile MRI) and 24-Hour Pharmacy Services, Optometry, Dental, Clinic, Emergency, Podiatry, Same Day Clinic, and Behavioral Health.

1. OBJECTIVE

The primary objective of this project is to provide four components; Claims management (billing electronic claims), Remittance, Payment Management (Collections/Accounts Receivable) and software hands-on training; an overall Clearinghouse, this service is to support the mission of the Indian Health Service (IHS).

1. SCOPE

Contractor is to provide a Revenue Cycle Management to Quentin N Burdick Memorial Health Care Facility a Revenue Cycle Process to being automating for the following areas; Third Party Billing (Claims Management & Patient Billing), Account Receivable (Remittance & Payment Management). Contractor will offer solutions to improve the revenue cycle process and achieve assisting in accelerating Medicare, Medicaid, and Private Health Insurance(s) reimbursement, from front-end eligibility verification to reimbursement posting. Specific task includes the following:

6.1 Major Duties:

Contractor shall will provide a web-based, HIPAA compliant billing management solution, saving time and money by providing a single claim management interface, tailors distinctive tools to aid decision support, view dashboard snapshots of claims inventory, manage workflow, and prioritize resources, resulting in improved efficiency and increased revenue.

Contractor shall provide a solution for acquiring real-time throughout the third-party billing and accounts receivable process. Real-time EDI transactions, including claims status, interfaces with the existing RPMS (Resource Patient Management System), inquiry and response data is electronically transferred between the third-party billing systems and accounts receivable system and offered through a Clearinghouse.

Contractor shall provide denial management by determining root causes, patterns and process breakdowns responsible for denials and establish corrective steps to prevent future revenue loss or delay by organizing remittance inventory, arrange, prioritize and monitor denials and underpayments; report and view net denied amounts. The denial management process is streamlined since providers are able to quickly determine cause and patterns of denials. This will allow for immediate action to prevent future revenue loss or delay. Included is the Medicare Manager providing overall management of suspended, rejected, return-to-provider, paid and denied Medicare Part A claims. DDE plus which allows easy correction of claims within the Medicare DDE system via internet

Contractor shall provide a browser-based web application that interprets Electronic Remittance Advice (ERA) expediting the patient billing process and resulting in faster payments of accounts receivable. Added function, electronic notes in claims to ensure status of claims involving secondary payments. Payment Manager gathers remittances from all enrolled payers; faster and easy secure payments, accelerated cash flow, simple enrollment. Provides a reporting system detailed to track trends, reconciles with reduced errors that slow down posting process. Accounts Receivable posting done in real time.

Contractor shall for launching transactions for available payers based off a crosswalk between facilities plan codes and the clearing house payers; plan networks, by defaulting plan networks for those payer identified; System messages for non-payer specific, notify user if patient is inactive; Posting input/response data comparison for post back i.e. policy number, group name, group number, historical database with reporting tool, monthly checker/payer availability; Project steps/Milestones providing technical calls, IHS requirements, mapping, customer service help desk.

Contractor shall provide onsite training for QNBMHCF Business Office staff in the work queue design set-up, use, claim billing functionality, management oversight, payment manager reports to build workflow plans, program development for improvement with billing, accounts receivable process and denial management.

Communication: The contractor and QNBMHCF Business Office Department will maintain frequent communications on any issues or problems with the work performed, workload status, deadlines, or to assign work priority, via email or by telephone. Weekly conference calls will be established to provide updates or address issues/problems.

1. CONTRACT REQUIREMENTS/ AND PERSONNEL QUALIFICATIONS

Contractor shall have a minimum of ten (10) years of experience working with Indian Health Services facilities in developing revenue enhancement initiatives. Contractor shall have experience with billing Inpatient, Ambulatory Surgery (ASC) and Outpatient encounters.

Contractor shall have knowledge of revenue enhancement cycle processes, private insurance carriers and must be familiar with the third-party billing RPMS. Contractor shall have basic knowledge of North Dakota and other related Medicaid programs.

Contractor shall have an ICD-10 Implementation Readiness by October 2025.

1. TYPE OF ORDER

This is a firm fixed price purchase order.

1. ANTICIPATED PERIOD OF PERFORMANCE

The anticipated period of performance will consist of a base year of twelve (12) months, followed by four (4) twelve-month option periods, for a potential total period of performance of five (5) years, contingent upon continued need, contractor performance, and availability of funds.

1. PLACE OF PERFORMANCE

Quentin N Burdick Memorial Health Care Facility

1300 Hospital Loop

Belcourt, ND 58316

1. REPORT(S)/DELIVERABLES AND DELIVERY SCHEDULE

N/A

1. PAYMENT

Payment will be rendered once all supplies are shipped and accounted for and invoice is uploaded into IPP to be paid.

10.0 Capability Statement/Information:

Interested parties are expected to review this notice to familiarize itself with the requirements of this project. Failure to do so will be at your firm’s own risk. The following information shall be included in the capability statement:

1. A general overview of the respondent’s opinions about the difficulty and/or feasibility of the potential requirement, and any information regarding innovative ideas or concepts.

2. Information in sufficient detail of the respondent’s (a) current capability and capacity to perform the work; (b) prior completed events of similar nature/size; (c) organizational experience and management capability; and (d) examples of prior completed Government contracts and other related information.

3. The respondents’ UEI number, organization name, address, point of contact, and size and type of business (e.g., 8(a), HUBZone, etc.) Pursuant to the North American Industry Classification System (NAICS) code: 524292, Third Party Administration of Insurance and Pension Funds, or comparable NAICS

4. Any other information that may be helpful in developing or finalizing the requirements of the potential acquisition.

5. The capability statement shall not exceed 10 single-sided pages (including all attachments, resumes, charts, etc.) presented in single-space and using a 12-point font size minimum, in either Microsoft Word or Adobe Portable Document Format (PDF), with 8-1/2 by 11-inch paper size, and 1 inch top, bottom, left and right margins.

6. All proprietary information should be marked as such. Statements should also include an indication of current certified small business status; this indication should be clearly marked on the first page of your capability statement (preferably placed under the eligible small business concern’s name and address). Responses will be reviewed only by IHS personnel and will be held in a confidential manner.

11.0 Closing Statement

Point of Contact: Farrah Azure, Purchasing Agent, at Farrah.Azure@ihs.gov

Submission Instructions:

Interested parties shall submit capability via email to Farrah Azure, at Farrah.Azure@ihs.gov . Must include Sources Sought Number IHS1516621 in the Subject line. The due date for receipt of statements is August 26, 2025, 12:00 p.m. Central Time.

All responses must be received by the specified due date and time in order to be considered.

This notice is for information and planning purposes only and shall not be construed as a solicitation or as an obligation on the part of IHS.

IHS does not intend to award a contract on the basis of responses nor otherwise pay for the preparation of any information submitted. As a result of this notice, IHS may issue a Request for Quote (RFQ).

THERE IS NO SOLICITATION AVAILABLE AT THIS TIME. However, should such a requirement materialize, no basis for claims against IHS shall arise as a result of a response to this notice or IHS’s use of such information as either part of our evaluation process or in developing specifications for any subsequent requirement.

Disclaimer and Important Notes. This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in SAM.gov. However, responses to this notice will not be considered adequate responses to a solicitation.

Confidentiality. No proprietary, classified, confidential, or sensitive information should be included in your response.

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