Federal Health Claims Processing Services (FHCPS)

Trade Agreement: NONE
Tendering Procedures: All interested suppliers may submit a bid
Attachment: YES (MERX) Electronic
Competitive Procurement Strategy: Best Overall  Proposal
Comprehensive Land Claim Agreement: No
Nature of Requirements: 

Federal Health Claims Processing Services (FHCPS)

51019-072007/K
Keith, Allan B.
Telephone No. - (506) 636-4416 (  ) )
Fax No. - (506) 636-4376
E-mail: allan.keith@pwgsc.gc.ca

Canada has a government-wide requirement for Federal Health
Claims Processing Services (FHCPS) which includes providing 
services and systems, for the processing and settlement of
health claims, and to ensure compliance with applicable (and
specified) Program policies including audit, reporting and
financial control practices used by various departments of the
federal government. The relevant departments involved in this
solicitation include Veterans Affairs Canada (VAC), Canadian
Forces (CF), and Royal Canadian Mounted Police (RCMP).

	Canada retains the option to extend the provision of the
Federal Health Claims Processing Services (FHCPS) to other
eligible departments and Programs provided that the total
estimated increase in claim lines (refer to Annex E for
definition) for all additional health care plans and/or programs
does not exceed 4,500,000 claim lines annually.  As such, the
successful Bidder may also be required to provide health claims
processing goods and/or services to support health care plans
and/or programs for other Government Department, Departmental
Corporation and Agency, and other Crown entities described in
the Financial Administration Act (as amended from time to time),
and any other party for which the Department of Public Works and
Government Services may be authorized to act from time to time
under section 16 of the Department of Public Works and
Government Services Act. Prior to exercising this option, Canada
will assess the estimated annual claim line volume of the health
care plan and/or program to be added, as well as the estimated
annual claim line volume  of previously added health care plans
and/or programs (based on estimates available at the time that
they were added). Once the option has been exercised, Canada
will have no obligation to remove a health care plan and/or
program should the increase in claim line volumes, from the
extension of the Federal Health Claims Processing Services
(FHCPS) to other eligible departments and Programs, exceed
4,500,000 claim lines annually. 
	
Additionally, should a health care plan and/or program forming
part of FHCPS no longer require the services listed in Appendix
A - Statement of Work, Canada retains the option to remove goods
and/or services that are to be provided by the successful Bidder.
	
	All three federal departments combined provide a wide range of
health benefits and services to eligible clients, members,
Veterans and other persons as specified under their respective
regulations.  The benefits and services available for the three
partner Departments are consolidated under Programs of Choice
(POC).  FHCPS is used by the Departments in the administration
of the following POC:

1.	Aids to Daily Living
2.	Ambulance (Includes Health Related Travel) 
3.	Audio Services
4.	Dental Services
5.	Hospital Services
6.	Medical Services
7.	Medical Supplies 
8.	Nursing Services
9.	Oxygen Therapy
10.	Prescription Drugs
11.	Prosthetics and Orthotics 
12.	Related Health Services
13.	Special Equipment
14.	Vision Care
15.	Veterans Independence Program (VAC only)
16.	Long Term Care (VAC only)

The successful Contractor would be required to provide a health
claim processing system to enable the Departments to provide a
wide range of health benefits and services to eligible Clients,
Veterans and other persons as specified under their respective
Regulations. The Contractor must provide the Health Claims
services and systems to support FHCPS and the delivery of the
programs.  The successful Contractor would also be required to
provide   supplementary services for the 16 POC with the
following components:

Client registration and generation of the applicable level of
eligibility based on the adjudication data transmitted from the
Departments.     

Multi-channel communication services for members/clients,
providers and staff of Departments.   Communication encompasses
written communication products, Websites which provide
information services including claim status and Call Centres
with Canadian and International toll-free access.  Communication
with Departmental staff includes a secure messaging service and
secure data exchange.

Provider Registration, Provider Relations and Provider Audit
Services.   

Treatment Authorization Services including Special Authorization
Services for Pharmacy requests, Dental pre-determination
requests using CDAnet (Canadian Dental Association network) and
authorization requests for other medical services and benefits.

Manual and Electronic Claims Processing of claims from clients,
third-party and providers.   Claims Processing Services
encompass Claims capture, Claims Tracking, Claims adjudication,
Claims Payment and production and distribution of Claims
Statements.

Pharmacy Services for the electronic adjudication and processing
of benefits dispensed at both retail and CF Pharmacies. 

Drug Utilization Evaluation Service to evaluate, analyze and
interpret utilization by clients/members, prescribing by
physicians and dispensing by pharmacies.

Financial Operations which encompass the financial practices to
request, reconcile and process claims payment and recovery
amounts with the Departments.

Quality Assurance and Performance Reporting to ensure that the
services and systems meet the performance standards.

System design, development/customization, testing and
implementation which supports the delivery of FHCPS and
interface with Departments' systems.

Business Management to ensure that:
	services comply with Departments' policies and standards, 
	the business solution conforms to Laws and Regulations and is
adaptive to accommodate 		any change in laws and regulations
	data is correct, secure and private at all times, and
	planning and analysis is conducted to identify opportunities to
improve efficiency and		effectiveness of the services. 

Business Services including Change Management, Training, System
Maintenance and Management, Reporting and Records Retention.

b. Contract Period and Options
A single Contractor will be selected from this RFP.  The
proposed length of the contract is 8 years 6 months inclusive of
an 18 month system development, testing, and Transition-In to
FHCPS and 7 years operations and maintenance with options to
extend the period of the Contract by up to 2 separate 2 year
periods.
	
c. Security Requirements 
There is a security requirement associated with this
requirement.  For additional information, see Part 6 - Security,
Financial and Other Requirements, and Part 7 - Resulting
Contract Clauses.
	
Bidders should consult the "Security Requirements for PWGSC Bid
Solicitations - Instructions for Bidders"
(http://www.tpsgc-pwgsc.gc.ca/app-acq/lc-pl/lc-pl-eng.html#a31)
document on the Departmental Standard Procurement Documents Web
site.

Information on personnel and organization security screening is
available on the Canadian Industrial Security (CISD)
(http://ssi-iss.tpsgc-pwgsc.gc.ca/index-eng.html).   For any
enquiries, bidders should contact CISD at 1-866-368-4646 or
613-948-4176 in the National Capital Region.
	
For information purposes, Bidders are hereby informed that the
amount of time to obtain required security clearance levels may
be lengthy and is contingent upon the specific clearance levels
required.  Bidders are solely responsible for obtaining such
clearances. 
	
d. Code of Conflict and Certifications
Pursuant to section 01 of Standard Instructions 2003, Bidders
must submit a complete list of names of all individuals who are
currently directors of the Bidder.  Furthermore, as determined
by the Special Investigations Directorate, Departmental
Oversight Branch, each individual named on the list may be
requested to complete a consent to a Criminal Record
Verification form and related documentation.

e. Trade Agreements
The national security exceptions provided for in the trade
agreements have been invoked;       therefore, this procurement
is excluded from all of the obligations of all the trade
agreements.

g. Canadian Content
This requirement is limited to Canadian goods and/or services.
	
1.3	Debriefings
After contract award, bidders may request a debriefing on the
results of the bid solicitation process.  Bidders should make
the request to the Contracting Authority within 15 working days
of receipt of the results of the bid solicitation process. The
debriefing may be in writing, by telephone or in person.
Delivery Date: Above-mentioned

The Crown retains the right to negotiate with suppliers on any
procurement.

Documents may be submitted in either official language of Canada.