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Federal Health Claims Processing Services (FHCPS)

Solicitation number 51019-072007/K

Publication date

Closing date and time 2013/05/14 14:00 EDT

Last amendment date


    Description
    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.

    Contract duration

    Refer to the description above for full details.

    Trade agreements

    • No trade agreements are applicable to this solicitation process

    Partner with another business

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    Contact information

    Contracting organization

    Organization
    Public Works and Government Services Canada
    Address
    11 Laurier St, Phase III, Place du Portage
    Gatineau, Quebec, K1A 0S5
    Canada
    Contracting authority
    Keith, Allan B.
    Phone
    (506) 636-4416 ( ) )
    Fax
    (506) 636-4376
    Address
    189 Prince William Street
    Room 421
    Saint John, New Bruns, E2L 2B9

    Buying organization(s)

    Organization
    Veterans Affairs Canada
    Address
    Jean Canfield Building, 1st Floor, 191 Great George Street
    Charlottetown, Prince Edward Island, C1A 4L2
    Canada
    Bidding details

    Full details regarding this tender opportunity are available in the documents below. Click on the document name to download the file. Contact the contracting officer if you have any questions regarding these documents.

    Access the Getting started page for details on how to bid, and more.

    Eligibility and terms and conditions

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    Summary information

    Notice type
    Request for Proposal
    Language(s)
    English, French
    Region(s) of delivery
    Alberta
    ,
    British Columbia
    ,
    Manitoba
    ,
    New Brunswick
    ,
    Newfoundland and Labrador
    ,
    Nova Scotia
    ,
    Northwest Territories
    ,
    Nunavut Territory
    ,
    Ontario (except NCR)
    ,
    Prince Edward Island
    ,
    Quebec (except NCR)
    ,
    Saskatchewan
    ,
    Yukon
    ,
    Foreign
    ,
    National Capital Region (NCR)

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