IFHP Claims Processing Services

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

IFHP Claims Processing Services

B8304-180008/B
Chalmers, Brianna
Telephone No.: (613) 204-9545 

THE INTERIM FEDERAL HEALTH PROGRAM (IFHP)
 
The IFHP provides in-Canada limited, temporary coverage of health-care benefits to protected persons, refugee claimants, and other specified groups who aren’t eligible for provincial or territorial health insurance.  It also provides certain Pre-Departure Medical Services (PDMS) to refugees destined to Canada for resettlement prior to their arrival in Canada.

The IFHP is funded by the Government of Canada (GoC) and managed by the Migration Health Branch (MHB) at the Department of Citizenship and Immigration Canada (CIC). MHB sets policy, provides program oversight and has overall responsibility for program management.

As MHB is responsible for the management and delivery of the program, its service delivery roles encompass, among others, overseeing Claims Administration services. It is important to note that the provision of health-care services is not part of the MHB mandate. Health-care service is provided to IFHP Beneficiaries by IFHP Providers who register with IFHP and submit claims and are reimbursed directly by a third-party.

This bid solicitation is for the provision of Claims Processing Services for the IFHP.

The following services are required for the IFHP contract: 

Start-up Phase (refer to SOW Section B: Start-up Phase) outlines the milestones and deliverables to design, develop, implement, test and validate the Claims Processing Services prior to Implementation Date.

Business Management Documents (refer to SOW Section 6: Business Management) consist of but may not be limited to preparing the following documents:

a. IFHP Operations Management Strategy;
b. Annual Operations Plan and report; and
c. Operational management teleconferences and meetings schedule;
d. Disaster recovery Plan and Business Continuity Plan;
e. Quality Assurance Program;
f. Audit Program;
g. Privacy operations; and
h. Financial operations policies and procedures.

Claims Processing Services (refer to Statement of Work (SOW) Section 7: Claims Processing Services) consist of but may not be limited to providing the following services:

a. Support services for existing and new IFHP Providers (e.g. Registration of Providers, verification of Beneficiary eligibility and Benefits, various modes of communication, access to Benefit Grids);
b. Support Services for Beneficiary (e.g. Registration of Beneficiaries, verification of eligibility for IFHP and Benefits, various modes of communication, access to Benefit Grids);
c. IFHP public-facing website and three secure web portals;
d. Provision of a Contact Center;
e. Claims Processing Services; 
f. Claims Settlement services;
g. Claims Statements;
h. Financial Operations that include, but not limited to, requesting, reconciling and recovering amounts owed, financial controls, audits and Fraud Prevention and Detection; and
i. Reporting services that include, but not limited to, incorporation of a Business Intelligence Tool and/or Artificial Intelligence, data extracts, and Standard and Ad-Hoc reporting.

Technical specifications (refer to SOW Section 8: Technical Specifications) outline the technical requirements of the Contract.

Operations support (refer to SOW Section 9: Operational Support) outline the operation deliverables to be provided by the Contractor.

IFHP Manuals (refer to SOW Section 10: IFHP Manuals) lists the various manuals to be drafted, approved and published under the Contract.

Training and support (refer to SOW Section 11: IFHP User Training and Support) outlines the requirements for training by the Contractor.

Close-out Phase (refer to SOW Section D: Close-out Phase) outlines the requirements to close-out the Contract and transition to the next contract, if applicable.

A complete description of the Work is detailed in Part 7, Annex A - SOW.

There are security requirements associated with this requirement. For additional information,
consult PART 6 - Security, Financial and Other Requirements, and PART 7 - Resulting Contract
Clauses. For more information on personnel and organization security screening or security
clauses, Bidders should refer to the Industrial Security Program (ISP) of Public Works and
Government Services Canada (http://ssi-iss.tpsgc-pwgsc.gc.ca/index-eng.html) website.

The requirement is not subject to the provisions of any trade agreements. 

The resulting contract will not include deliveries of services within locations within Yukon, 
Northwest Territorites, Nunavut, British Columbia, Quebec, or Labrador that are subject to Comprehensive Land Claims Agreements (CLCAs).  Any requirements for deliveries of services within locations within Yukon, Northwest Territorites, Nunavut, British Columbia, Quebec, or Labrador that are subject to CLCAs will have to be treated as a separate procurement not forming part of the bid solicitation.

The requirement is subject to a preference for Canadian services.

The Federal Contractors Program (FCP) for employment equity applies to this procurement; see
PART 5 - Certifications and Additional Information, PART 7 - Resulting Contract Clauses and the
attachment titled Federal Contractors Program for Employment Equity - Certification.



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.