Health Information and Claims Processing Services

Trade Agreement: Agreement on Internal Trade (AIT)
Tendering Procedures: All interested suppliers may submit a bid
Competitive Procurement Strategy: 
Comprehensive Land Claim Agreement: No
Nature of Requirements: 

Health Information and Claims Processing Services

Purpose

This is an Information Notice #2 pertaining to the Health Information and Claims Processing Services (HICPS) requirement for Health Canada (HC). The purpose of this notice is to update industry on the status of the 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 (not part of the HICPS requirement). 

NIHB is the largest program of HC, representing approximately 31% of the department's total budget and 46% of FNIHB's budget in 2014-15. Total annual expenditures for all NIHB benefit areas amounted to $1,029.1 million in fiscal year 2014-15.

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 ProviderProfiling, Next Day Claim Verification, Client Confirmation Program, On-Site and Desk audit), which help to ensure the accountability of the NIHB Program. In 2014-15, a total of 21.4 million claim lines were processed through HICPS.

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. 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. Proposed Engagement Approach 

4.1 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.


4.2 HICPS Engagement Milestones and Associated Timeline

The following milestones and theirassociated 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 RFI #1 - May 21 - July 14, 2015 - Completed
2 Industry Engagement Information Session #1 - September 21, 2015 - Completed
3 One-on-One Sessions #1 - September 21 - 28, 2015 - Completed

Engagement Phase 2 
4 RFI #2 - May 16 - July 20, 2016 - Completed
5 Working Group Sessions #2 - July 5 - 6, 2016 - Completed

Engagement Phase 3
6 RFI #3 - Autumn 2016

5. HICPS Status Update
An initial Request for Information No. HT426-144642/A was published in May 2015 seeking feedback from industry on the requirement and subsequent engagement activities. It also included specific questions to the industry which responses will enable Canada to consider in the development of HICPS requirement and the future RFP. 
A second Request forInformation No. HT426-144642/C was published in May 2016 with a summary of results and findings from RFI #1.  It also included further details of the NIHB Program, anticipated HICPS requirements, and options/examples for the Aboriginal Participation Component.  Canada is reviewing the feedback received in response to the RFI process and, where applicable, will include this feedback in the engagement activities.   

6. 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: 819-420-2213
Facsimile: 819-934-1235

Alternate:
Delegate Contracting Authority: Betty Cole
Telephone: 819-420-2214

The use of e-mail to communicate is preferred.

7. Previous RFI

Copies of the previously published HICPS RFI #1 (HT426-144642/A published May 20, 2015) can be downloaded from GETS https://buyandsell.gc.ca/procurement-data/tender-notice/PW-XF-008-28919 and the previously published HICPS RFI #2 (HT426-144642/C published May 16, 2015) can be downloaded from GETS https://buyandsell.gc.ca/procurement-data/tender-notice/PW-XF-008-30198 .


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.