US-FED-00000398443 - Q601--Health Care Clearinghouse 1 - HIPAA Electronic Transactions and Insurance Discovery (VA-27-00018291) | Maxel/Svendsen - Deadline November 3,2026

SPECIAL NOTICE NOTICE OF INTENT TO SOLE SOURCE Electronic Insurance Transactions and Insurance Discovery HCCH I RFI eCMS ACTION NUMBER 36C24C27Q0007 October 29, 2026 Introduction: The Veteran s Health Administration (VHA) Office of Community Care (OCC), Revenue Operations (RO), eBusiness Solutions Office is looking to establish a Contract with a second Health Care Clearinghouse (HCCH) to continue to increase connectivity and further decrease processing time for VHA revenue operations. The Contractor shall conduct Health Insurance Portability and Accountability Act (HIPAA) Health Care Eligibility/Benefit Inquiry and Response 270/271 electronic transactions received from our Austin Financial Services Center (FSC) from across the United States and its territories. The Contractor shall conduct customized electronic transactions to search for patient insurance when VHA does not already have information on file. The Contractor shall assist the VHA in continuing its mission to implement electronic transactions. At no time shall the Contractor direct, change, or engage in the formulation of VHA policy. The VHA is solely responsible to review the Contractor s recommendations and to make decisions concerning the formulation of policy. Background: As a Health Care Provider, VHA has initiated several projects to increase the number of transactions that are completed electronically to comply with legislation and to facilitate administrative simplification. The VHA currently utilizes a Contractor to transmit its incoming and outgoing electronic transactions to the national Payer community. Various transaction formats are utilized, such as HIPAA Health Care Claim 837 (X12N–5010) and National Council for Prescription Drug Program (NCPDP) transactions. VHA transactions are completed as batch and real–time transfers. This secondary Contract will transmit only HIPAA Health Care Eligibility/Benefit Inquiry and Response 270/271 transactions for various Payers. VHA intends to use this secondary HCCH to expand its access to significant payers not provided by our primary HCCH contract. In January 2018, VHA implemented an insurance coverage discovery process to identify patient insurance information when VA does not already have billable insurance information already on file. This new system provides a standard, automated method for obtaining patient s third–party insurance information by utilizing customized HIPAA transactions. VHA intends to continue utilizing a secondary HCCH to transmit these customized electronic transactions to identify patient insurance information. eBusiness Solutions, as a proponent of administrative simplification, currently exchanges transactions from health care entities to third–party carriers. VHA has a fully developed and robust system to generate insurance eligibility inquiries for all places of care throughout VHA and route the transactions through (FSC) prior to transfer to the HCCH. This system and processes are referred to as Veterans Health Information Systems and Technology Architecture (VistA) electronic Insurance Verification (eIV) module. While required by law, at times VHA finds that patients are sometimes reluctant or remiss in sharing their third–party insurance information with VHA. To comply with federal regulations and to ensure revenue operations are generating health care claims to the maximum extent possible, VHA has engaged in efforts to seek patient s third–party insurance information from contracted sources. VHA has a fully developed a robust system of data extracts that provide basic patient demographics routed through FSC prior to transfer to the HCCH for which the Contractor can use to search for patient insurance information. This system and processes are referred to as Electronic Insurance Coverage Discovery (EICD). Notice of Intent to Sole Source: The Regional Procurement Office – Central Supplies & Services Team 2 intends to enter into a sole source procurement for the purchase of Electronic Insurance Transactions and Insurance Discovery HCCH I with: PNT Data Corporation Statutory Authority Permitting Other than Full and Open Competition: 41 USC §3304(a)(5), 38 U.S. Code § 8127(c), as implemented by FAR 6.302–5 (Authorized or Required by Statute). COs may use the non–competitive (sole source) procedures authorized in VAAR 819.7008, Sole Source Awards to a certified service–disabled veteran owned small business. The NAICS code for this procurement is 518210 (Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services) and the Small Business Administration Size Standard is $40 million Submittal Information: This notice of intent to is not a request for competitive quotes. No solicitation document is available and telephone requests will not be accepted. However, any responsible source who believes it is capable of meeting the requirements may submit a capability statement, proposal, or quotation, which may be considered by the agency, only i