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Health Information and Claims Processing Services

Solicitation number HT426-144642/A

Publication date

Closing date and time 2015/07/14 14:00 EDT

Last amendment date


    Description
    Trade Agreement: Agreement on Internal Trade (AIT)
    Tendering Procedures: All interested suppliers may submit a bid
    Competitive Procurement Strategy: N/A - P&A/LOI Only
    Comprehensive Land Claim Agreement: No
    Nature of Requirements: 
    Health Information and Claims Processing Services
    
    Purpose
    
    The purpose of this notice is to advise the industry of the
    Health Information and Claims Processing Services (HICPS)
    requirement for Health Canada (HC), the Request for Information
    (RFI) #1 publication, and the subsequent Engagement activities.
    
    1. NIHB Program Background
    
    The Non-Insured Health Benefits (NIHB) Program of the First
    Nations and Inuit Health Branch (FNIHB) at Health Canada (HC)
    provides eligible registered First Nations and recognized Inuit
    with a range of medically-necessary goods and services not
    provided through private insurance plans, provincial/territorial
    health and social programs or other publicly funded programs.
    These medically necessary benefits are: 
    
    * Pharmacy (certain prescription and over-the-counter drugs); 
    * Medical supplies and equipment;  
    * Dental care; 
    * Vision care; 
    * Other health care services such as short-term crisis
    intervention mental health counselling; and
    * Medical transportation to access medically required health
    services not available on reserve or in the community of
    residence. 
    
    NIHB is the largest program of HC, representing approximately
    31% of the department's total budget and 46% of FNIHB's budget
    in 2013-14. Total annual expenditures for all NIHB benefit areas
    amounted to $1,026.4 million in fiscal year 2013-14.
    
    As with other public and private plans, the NIHB Program does
    not provide direct services to clients. It relies mainly on
    pharmacists, dentists and other health providers to deliver
    services to clients. Through the Health Information and Claims
    Processing Services, the NIHB Program reimburses providers for
    the cost of eligible services. These services are essential to
    the NIHB Program's ability to fulfill its mandate to ensure
    access by First Nations and Inuit clients to needed health
    benefits. 
    
    2.  HICPS Overview
    
    HICPS includes all services and supporting systems used to
    process Non-Insured Health Benefits claims, supporting Providers
    with the processing and settlement of their claims, ensuring
    compliance with NIHB Program policies including audit, reporting
    and financial control practices, automated information
    management systems used to process and pay claims in accordance
    with NIHB Program client/benefit eligibility and pricing
    policies.
    
    Since 1990, Canada has retained the services of a private sector
    contractor to administer the following core health information
    and claims processing services on its behalf:
    * Requests and claims processing, adjudication and settlement; 
    * Provider registration and communications;
    * Payment and Financial operations; 
    * Systems and services in support of the various NIHB operated
    Review, Prior-Approval, and Predetermination Centres. 
    * Provider Audit program and audit recoveries; and
    * Data retention, collection, analysis and reporting
    
    NIHB Program uses this third party claims processor to review
    and process claims for the Pharmacy, Dental Care, and Medical
    Supplies and Equipment. In addition to ensuring claims are
    processed in a timely manner and in keeping with NIHB Program
    policies and rules, HICPS includes a range of pre-payment and
    post-payment controls (including a provider audit program that
    covers Provider Profiling, Next Day Claim Verification, Client
    Confirmation Program, On-Site and Desk audit), which help to
    ensure the accountability of the NIHB Program. In 2013-14, HICPS
    processed 21.2 million claim lines of nationally administered
    pharmacy and dental benefits which accounted for approximately
    55.4% of all NIHB expenditures (or over $570 million).
    
    3. Aboriginal Participation Component
    
    The HICPS requirement will include an Aboriginal Participation
    Component (APC), which is a mechanism designed to meet the
    Government of Canada's objectives of encouraging Aboriginal
    socio-economic development through federal contracting
    opportunities that are not subject to International Trade
    Agreements. The APC is designed to develop long-term sustainable
    and meaningful socio-economic benefits for Aboriginal people,
    businesses and communities and compliments the objectives of the
    Procurement Strategy for Aboriginal Businesses (PSAB). 
    
    4. Request for Information #1
    
    The purpose of this RFI is to inform industry of HC's
    requirement for HICPS and to provide industry an opportunity to
    provide feedback on the requirement and subsequent engagement
    activities. This feedback will assist Canada initiating a
    dialogue about the requirements and possible solutions. 
    
    This RFI also contains specific questions addressed to the
    industry to identify future technologies, best practices and
    innovative business or service models.  Detailed written
    responses will enable Canada to consider industry perspectives
    in the development of HICPS requirement and the eventual RFP.
    
    4.1 Nature of this Request for Information
    
    This is not a bid solicitation. This RFI will not result in the
    award of any contract. Potential suppliers of any goods or
    services described in this RFI should not reserve stock or
    facilities, nor allocate resources, as a result of any
    information contained in this RFI. Nor will this RFI result in
    the creation of any source list. Therefore, whether or not any
    potential supplier responds to this RFI, it will not preclude
    that supplier from participating in any future procurement.
    Also, the procurement of any of the goods and services described
    in this RFI will not necessarily follow this RFI. This RFI is
    simply intended to solicit feedback from industry with respect
    to the subject matter described in this RFI.
    
    4.2 Response Costs
    
    Canada will not reimburse any organization for expenses incurred
    in responding to this RFI including, but not limited to,
    expenses incurred for participating in subsequent Engagement
    Activities.
    
    4.3	Follow-up Activity
    
    This RFI #1 is part of Engagement Phase 1, and will be followed
    by a one-day Industry Engagement Information Session #1 and
    separate One-on-One Sessions #1.
    
    4.4 Communication with Industry
    
    During the Engagement Activities subsequent to this RFI, the
    Contracting Authority may communicate with registered Industry
    Participants through direct email rather than by posting
    additional notices on the GETS.
    
    5. Proposed Procurement Approach 
    
    5.1 Engagement Strategy
    
    Three phases are planned for the Industry Engagement process. 
    However, as the process evolves, additional activities could be
    incorporated into the engagement schedule or engagement phases
    may be combined, modified, or eliminated depending on timelines
    and feedback from industry.
    
    Please note that participation in any of the Engagement
    activities is not a mandatory requirement for eventual
    submission of a bid; industry representatives that do not
    participate in the Engagement process will remain eligible to
    submit a bid in response to any future RFP relating to the HICPS
    procurement.
    
    
    5.2 HICPS Engagement Milestones and Associated Timeline
    
    The following milestones and their associated target delivery
    dates are estimates which have been provided for information
    purposes only. Canada reserves the sole option to delete or
    change each of the individual named milestones and their
    associated delivery dates as Canada sees fit.
    
    Engagement Phase 1
    1 Industry Engagement Information Session #1 - September 21, 2015
    2 One-on-One Sessions #1 - September 21 - 23, 2015
    
    Engagement Phase 2	
    3 RFI #2 - Spring 2016
    4 Industry Engagement Information Session #2 - Summer 2016
    5 Working Group Sessions #2 - Summer 2016
    6 One-on-One Sessions #2 - Summer 2016
    
    Engagement Phase 3
    7 RFI #3 - Autumn 2016
    
    5.3 Enquiries
    
    All enquiries and other communications related to this RFI and
    associated Industry Engagement activities shall be directed
    exclusively to the Public Works and Government Services Canada
    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 RFI may direct their enquiries to:
    
    Contracting Authority: Aaron Wong-Sing
    Public Works and Government Services Canada
    Place du Portage III, 12C1 11 Laurier Street Gatineau, Quebec
    K1A 0S5
    
    Email Address:	TPSGC.DGASTRDPSS-AQCBHICPS.PWGSC@tpsgc-pwgsc.gc.ca
    Telephone:	819-956-2219
    Facsimile:	819-934-1235
    
    Alternate:
    Delegate Contracting Authority: Betty Cole
    Telephone:	819-956-1360
    
    The use of e-mail to communicate is preferred.
    
    
    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

    • Agreement on Internal Trade (AIT)

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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
    Wong-Sing, Aaron
    Phone
    (819) 956-2219 ( )
    Fax
    (819) 934-1235
    Address
    Place du Portage, Phase III, 12C1
    11 Laurier St./11 rue, Laurier
    Gatineau
    Gatineau, Gatineau, K1A 0S5

    Buying organization(s)

    Organization
    Health Canada
    Address
    Address Locator 0900C2
    Ottawa, Ontario, K1A 0K9
    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.

    Tender documents
    Document title Amendment no. Language Unique downloads Date added
    002
    English
    53
    002
    French
    13
    001
    English
    54
    001
    French
    6
    000
    English
    165
    000
    French
    27

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

    Eligibility and terms and conditions

    Government of Canada tender and awards notices, solicitation documents, and other attachments are fully accessible and available free of charge and without having to register on CanadaBuys.

    Information may be available on another source prior to being available on CanadaBuys. You may have received this information through a third-party distributor. The Government of Canada is not responsible for any tender notices and/or related documents and attachments not accessed directly from CanadaBuys.canada.ca.

    Government of Canada tender or award notices carry an OpenGovernment License - Canada that governs its use. Related solicitation documents and/or tender attachments are copyright protected. Please refer to our terms and conditions page for more information.

    Summary information

    Notice type
    Request for Information
    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
    ,
    National Capital Region (NCR)
    Procurement method
    Competitive – Open Bidding
    Selection criteria
    Not applicable

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