Health Information and Claims Processing Services

Trade Agreement: Canadian Free Trade Agreement (CFTA)
Tendering Procedures: All interested suppliers may submit a bid
Competitive Procurement Strategy: Best Overall  Proposal
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) and the Request for Proposal (RFP) publication.

1. NIHB Program Background

The Non Insured Health Benefits (NIHB) Program of HC's First Nations and Inuit Health Branch (FNIHB) provides eligible registered First Nations and recognized Inuit with a range of medically-necessary health-related goods and services not provided through private insurance plans, provincial/territorial health and social programs or other publicly funded programs. These benefit categories are:
* Dental care;
* Eye and vision care;
* Medical supplies and equipment;
* Drugs and pharmacy products;
* Mental health counselling;
* Medical transportation to access medically necessary services not available in the community of residence (out-of-scope for this Contract).

2.  The Health Information and Claims Processing Services

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 HICPS contract, the NIHB Program reimburses providers or clients for the cost of eligible services up to the NIHB maximum allowable. 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. 

The Contractor must provide the health information and claims processing services and supporting systems detailed in the Statement of Work of the RFP, which include:
* Requests and claims processing, and settlement;
* Provider enrolment and communications;
* Payment and financial operations;
* Systems and services in support of the NIHB review centres;
* Provider claim verification and financial recoveries; and 
* Data retention, collection, and reporting. 

3. Volumeterics

In 2015/16 a total of 23,156,419 claim lines were processed for services rendered to 839,129 clients through a network of a 27,903 active providers enrolled into the Program. Total Program expenditures for this same year were $1,100.5 million. 

4. Contract Period

The period of the Contract is from date of award and includes an Implementation Phase, a 5-year Operation Phase with options to extend for up to an additional 6 years, and a Phase-Out Period.

5. Aboriginal Participation Component (APC)

The HICPS requirement includes 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).

6. Enquiries

All enquiries and other communications related to this RFP must be directed exclusively to the Public Works and Government Services Canada Contracting Authority:

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.

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.