Federal Health Claims Processing Services

Trade Agreement: NONE
Tendering Procedures: The bidder must supply Canadian goods and/or services
Competitive Procurement Strategy: N/A - P&A/LOI Only
Comprehensive Land Claim Agreement: No
Nature of Requirements: 

51019-211004/A

Federal Health Claims Processing Services

Purpose of Letter of Interest (LOI) and Industry Engagement

On behalf of Veterans Affairs Canada (VAC), the Royal Canadian Mounted Police (RCMP) and the Department of National Defence (DND), Public Services and Procurement Canada (PSPC) is requesting industry feedback regarding an upcoming requirement for Federal Health Claims Processing Services (FHCPS). 

The purpose of the LOI and Industry Engagement process is to inform industry of the requirement for FHCPS and to provide industry an opportunity to provide feedback on the requirement and subsequent engagement activities.  Industry feedback will assist the three organizations in initiating a conversation about the requirements and possible solutions.

Canada as part of the Industry Engagement process to follow will be seeking feedback regarding the appropriateness of existing services being included in a single procurement or if Canada would be better served with these services being provided through more than one contract or through other delivery solutions 

Requirement Description

Currently all three federal departments provide a wide range of health benefits and services to eligible participants 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 16 POC’s:

• Aids to Daily Living
• Ambulance Services (includes Health Related Travel)
• Audio (Hearing) Services
• Dental Services
• Hospital Services
• Long Term Care (VAC only)
• Medical Services
• Medical Supplies
• Nursing Services
• Oxygen Therapy 
• Prescription Drugs and Cannabis for Medical Purposes (VAC only)
• Prosthetics and Orthotics
• Related Health Services
• Special Equipment
• Vision (Eye) Care
• Veterans Independence Program (VAC only)

The successful Contractor(s) would be required to provide health authorization and claim processing services for the 16 Programs of Choice outlined above along with the following:

• client registration and generation of the applicable level of eligibility based on the adjudication data transmitted from the departments;
• multi-channel communication services for the Canadian Armed Forces (CAF), RCMP members, VAC clients, service providers and staff of Departments. Communication encompasses written communication products, Websites which provide information services including claim status and call centers with Canadian and International toll-free access.  Communication includes a secure messaging services and secure data exchange;
• provider registration, provider relations and provider audit services;
• treatment authorization services including special authorization services for pharmacy and Cannabis for Medical Purposes, dental pre-determination using Canadian Dental Association Network and authorization for other medical services and benefits;
• manual and electronic processing of claims from members, clients and third-party providers.  Claims processing services encompass claims capture, claims tracking, claims adjudication, claims payment and productions and distribution of claims statements;
• pharmacy services for the electronic adjudication and processing of benefits dispensed at both retail and CAF 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 the services and systems meet the performance standards; and
• system design, development/customization, testing and implementation which supports the delivery of FHCPS systems and interfaces with departments’ systems.

Business Management to ensure the following:

• services comply with departments’ policies and standards;
• business solution conforms to laws and regulations and is adaptive to accommodate any change in laws and regulations; 
• adoption of leading-edge technology for health authorization and claim processing services;
• data is correct and secure at all times; and
• planning and analysis are conducted to identify opportunities to improve efficiency and effectiveness of the services.

Business Services include change management, training, system maintenance and management reporting and records retention.

The contract(s) period is tentatively planned for nine (9) years with options to extend for two (2) additional, two (2) year periods.

Nature of the Letter of Interest

This LOI is neither a call for tender nor a Request for Proposal (RFP).  No agreement or contract will be entered into based on this LOI.  The issuance of this LOI is not to be considered in any way a commitment by the Government of Canada, nor as authority to potential respondents to undertake any work that could be charged to Canada.  This LOI is not to be considered as a commitment to issue a subsequent solicitation or award contract(s) for the work described herein.

Although the information collected may be provided as commercial-in-confidence (and, if identified as such, will be treated accordingly by Canada), Canada may use the information to assist in drafting RFP documents (which are subject to change) and for estimating purposes.

Respondents are encouraged to identify, in the information they share with Canada, any information that they feel is proprietary, third party or personal information. Please note that Canada may be obligated by law (e.g. in response to a request under the Access of Information and Privacy Act) to disclose proprietary or commercially-sensitive information concerning a respondent (for more information: http://laws-lois.justice.gc.ca/eng/acts/a-1/).

Participation in this is encouraged, but is not mandatory.  There will be no short-listing of potential suppliers for the purposes of undertaking any future work as a result of this LOI.  Similarly, participation in this LOI is not a condition or prerequisite for the participation in any potential subsequent solicitation.

Respondents will not be reimbursed for any cost incurred by participating in this LOI or subsequent Industry Engagement. 

The LOI closing date published herein is not the deadline for comments or input. Comments and input will be accepted any time up to the time when/if a follow-on solicitation is published.


Enquiries

All enquiries and other communications related to this LOI shall be directed exclusively to the PSPC 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 LOI may direct their enquiries the Contracting Authority.

Contracting Authority: Sandra Lomax
Public Services and Procurement Canada
126 Prince William St., Suite 14B, Saint John, NB, E2L 2B6

Email Address: sandra.lomax@pwgsc-tpsgc.gc.ca
Telephone: 506-639-8503

The use of email communication is preferred.

Language

This PWGSC office provides procurement services to the public in both official languages.

Responses may be submitted in either official language.

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.