R499--Bridge - Health Care Clearing House (HCCH) HIPAA Insurance Identification and Verification (VA-20-00036170)

Page 2 of 10 Date: April 29, 2020 The following Synopsis is to inform of the Sole Source bridge contract that was set-aside and awarded to the incumbent Contractor Gi4, LLC a Service Disabled Veteran Owned Small Business (SDVOSB) for the continued services received for the Healthcare Cash House (HCH) to Support Eligibility Transactions (EDI) requirement currently being provided under contract 36C77618C0004. The Contracting Agency address is: PCAC-St, Louis 4401-D Meramec Bottom Road St. Louis, Missouri 63129 Contracting Officer: Mr. Charles Hampton Jr. Proposed Solicitation Number: 36C77620R0009 Closing Response date: April 13, 2020 Contract Award: 36C77620C0026 Award Amount: $450,964.44 Award Date: April 29, 2020 Effective Date: May 1, 2020 Contractor: Gi4, LLC Place of Performance: Virginia Product Service Code: R499 Please see the attached documents for added information regarding this synopsis. Page 10 of 10 Justification and Approval (J&A) For Other Than Full and Open Competition

(>SAT) Acquisition Plan Action ID:___________________________________________ Contracting Activity: Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Office of Community Care (OCC), Revenue Operations (RO), eBusiness Solutions office. Nature and/or Description of the Action Being Processed: A Bridge Contract to be awarded to the incumbent contractor (Gi4) as a direct award. These services are currently provided under contract 36C77718C0004 by contractor Gi4. The bridge contract will allow work to continue so there are no breaks in service while the Contracting Officer (CO) works to complete the new procurement under full and open competition. The Bridge Contract will be in accordance with FAR Part 6.302-2(d)(B) Unusual and Compelling and be a Firm Fixed Price Service Contract. Description of Supplies/Services Required to Meet the Agency s Needs: The VA requires a contractor to provide Health Insurance Portability and Accountability Act (HIPAA) Health Care Eligibility/Benefit Inquiry and Response 270/271 (HIPAA X12N 270/271) electronic transactions received from our internal clearinghouse service from across the United States and its territories. The Contractor shall also conduct customized electronic transactions to search for patient insurance when VA does not already have information on file. Estimated Value: $451,813.46 (3 Month base period) + $150,604.49 (1 month option period) = $602,417.95. Period of Performance: The Period of Performance shall be for three months May 1, 2020 to July 31, 2020, with a 1 month option period. Tasks and Deliverables Task 1: Expand VA s electronic reach to payers extraction, transformation and loading of data. Deliverable 1.1 - The Contractor shall provide, in one month or less, electronic data exchange access to approximately 250 payers, including, but not limited to the following top payers: Colonial Penn Cigna Behavioral Health Bankers Life Independent Health Task 2: Supply and maintain a master payer list and provide access to payers. Deliverable 2.1 - The Contractor shall provide an appropriate transmission vehicle to ensure the delivery of HIPAA 270 inquiries from the Contractor's site to each responsible Payer or their contracted representative. VA shall provide the Contractor with a list of payers VA deems most important to access for initial implementation. The Contractor shall initiate a dialog with each responsible Payer to establish an understanding of the requirements associated with and to fulfill the obligation of relaying VA inquiries to and from Payers. Deliverable 2.2 - The Contractor shall maintain an accurate master list of payers with their associated identification numbers available to VA through either direct connections or through other clearinghouses. The Contractor shall assist in establishment of a mechanism to keep VA's Payer list synchronized with the Contractor's list. The Contractor shall maintain the accuracy of its lists and update the Contractor's payer dictionary, website, companion guide, and any other form used for communication about requirements/specifications within 5 business days of receiving a change from a payer. Task 3: Provide Real-Time data exchange services Deliverable 3.1 - The Contractor shall respond to each HIPAA 270 real-time inquiry in less than one minute. The response to the HIPAA 270 shall be either a HIPAA 271 or an acknowledgement from the Payer. The acknowledgement shall be either a TA1 (ISA/IEA interchange rejection) or a 997 (functional group or transaction set rejection). Deliverable 3.2 - The Contractor shall develop a mutually agreed upon resubmission policy with VA. In cases where the Payer does not send a timely HIPAA 271 response or times out, the Contractor shall invoke the resubmission methodology. Task 4: Monitor transactions for compliance Deliverable 4.1 - The Contractor shall monitor (i.e. at a minimum, every other week) all inbound transactions for HIPAA compliance and notify VA of payers which are sending non-compliant transactions. The Contractor shall also work with the payer to submit compliant transactions. Task 5: Provide enrollment support. Deliverable 5.1 - The Contractor shall conduct and publish enrollment requirements for all payers it has access to as well as facilitate and coordinate enrollment with payers. This may include, but is not limited to, completion of appropriate authorization forms and letters as required by Payer specific guidelines. Task 6: Provide Routine Reports. Deliverable 6.1 - The Contractor shall provide a proposal for reports to be used in monitoring the transmission and success/failure of the HIPAA 270/271 transaction. The Contractor and VA shall decide on mutually agreed upon reports, formats and reporting frequencies, which shall include, at a minimum those reports listed below. The reports outlined in this document should be itemized by payer and by VA Medical Center. To the extent possible, reporting shall be electronic data sets and provided to CFD for disbursement. VA periodic and/or monthly reporting minimum for payer entities: Total number of inquiries processed by the Contractor Total number and percentage of inquiries accepted, rejected and timed-out by each payer Provide report(s) on inbound and outbound data exchanges to identify exceptions in timing and content Provide management reporting to support audit trail and reconciliation Other reports and technical documents may be developed as required throughout the project Task 7: Offer capability to test and supply edit messages. Deliverable 7.1 - The Contractor shall partner with VA to test capability to ensure that the HIPAA 270/271 transactions are processed in accordance with the terms and conditions of this Performance Work Statement. The Contractor shall have the ability to test inquiries for completeness and create a set of edit conditions with corresponding edit messages to be returned with rejected inquiries in compliance with HIPAA and VA requirements. Task 8: Provide implementation support and documentation. Deliverable 8.1 - The Contractor shall: Coordinate with VA for delivery of system documentation Provide documentation on proposed system and/or process changes prior to implementation Modify the processes for any VA-specific anomalies related to implementation for a payer Add other transaction sets as deemed appropriate by VA Creation of a unique PAYERID for health care payers that shall eventually be converted to the national PAYERID Task 9: Provide operational support. Deliverable 9.1 - The Contractor shall provide services, including, but not limited to: Dedicated staff contact that shall provide technical and help desk support for day-to-day operational activities. Technical support during normal business hours covering Eastern, Central, Mountain and Pacific Time Zones. Monitoring of inbound and outbound data exchanges to identify exceptions (total unknown) in timing and content. Maintenance of ongoing Payer connections as necessary to support data exchange. Hardware and software maintenance as necessary to support ongoing delivery of consistent services with minimal interruption. Backups as necessary to support recovery for failed equipment within 24 hours or less and problem research. A secure environment that prevents access from unauthorized physical or electronic sources. Reformatting, routing and other data transaction management processes as may be necessary to help ensure proper application of data. Maintenance of production environment where all internal processes occur. Monitor Payer communications and industry developments to determine changes that are applicable to the scope of services. Deliverable 9.2 - The Contractor shall establish a schedule that allows unattended operations for the transmission and receipt of the data/transactions. The Contractor shall obtain VA approval of the operations schedule and any subsequent changes to the schedule. Additionally, the Contractor shall provide VA technical points of contact for coordination activities associated with the development and implementation phase. These contacts shall be provided to VA at no additional charge since those services shall be required to assure smooth implementation. Task 10: Archive, Retrieve and Manage transactional documents. Deliverable 10.1 - The Contractor shall: Capture and archive transactional documents as necessary to support document collation and routing Submit transactions by or for VA to Payers or other transaction switch organizations via electronic means with appropriate editing and tracking controls to help assure data integrity Demand retrieval of documents from archives Archive all correspondences between VA and the Contractor in a support database Task 11: Provide Customer Support. Deliverable 11.1 - The Contractor shall provide customer support services, including, but not limited to: Online problem and transaction submission/response tracking system. Published information on enhancement releases and systems changes. Task 12: Assist with Special Projects Deliverable 12.1 The contractor shall assist VA with enhancements or processes expansions, including but not limited to the following: Incorporation of new mandated standards, e.g. the Contractor shall assist VA with conversion from legacy IDs to NPIs Marketing/educational effort to convert non-electronic payers to electronic. Task 13: The contractor will be asked to perform insurance coverage discovery. For insurance coverage discovery VA seeks to find 3rd party insurance information when VA does not already have the information on file. The contractor will receive Government furnished patient demographics in HIPAA standard formatting to perform insurance coverage discovery activities with results being sent back to VA in HIPAA standard formatting. Deliverable 13.1 Supply and maintain a payer list where insurance coverage may be searched by using patient demographics only. Deliverable 13.2 Provide the initial capability for real-time or batch services with transactions for insurance coverage discovery. Optional Task 14: Access to HIPAA ASC X12N 278x217 & HIPAA ASC X12N 278x217 payers. Deliverable 14.1 Supply and maintain a master payer list and provide access to payers. Deliverable 14.2 Provide Companion guides that detail the 278 transaction fields required for electronic transactions for each Payer. Deliverable 14.3 Submit Payer sheet to the project lead and the Financial Services Center (FSC) in electronic machine-readable code, in electronic format for out 278 transactions and Payers. Optional Task 15: Provide real-time data exchange services for HIPAA ASC X12N 279x217 & HIPAA ASC X12N payers. Deliverable 15.1 The Contractor shall publish enrollment requirements for all payer s it has access to as well as facility and coordinate enrollment with payers. This may include, but is not limited to, completion of appropriate authorization forms and letters as required by Payer specific guidelines. Deliverable 15.2 The Contractor shall develop a mutually agreed upon submission policy with VA. Deliverable 15.3 The Contractor shall develop a mutually agreed upon resubmission policy with VA. In cases where the Payer does not send a timely HIPAA response or times out, the Contractor shall invoke the resubmission methodology. Deliverable 15.4 Provide ongoing support to ensure payers and utilization management organizations are supporting the use of the HIPAA X12 278 transactions. This includes establishing new payer and UMO connectivity, facilitating relationship b Task 16: Provide batch and/or real-time data exchange services for insurance coverage discovery. Deliverable 16.1 - The Contractor shall respond to each insurance coverage discovery inquiry within 20 business days. The response to the insurance coverage discovery inquiry shall be either a HIPAA 271 or an acknowledgement from the Payer. The acknowledgement shall be either a TA1 (ISA/IEA interchange rejection) or a 997 (functional group or transaction set rejection). Task 17: Additional Tasks. Deliverable 17.1 Perform Additional Tasks. The contractor will be asked to perform additional tasks related to healthcare EDI and its associated emerging technologies. In the event the contractor is required to perform tasks not included in the Performing Work Statement, the amount of each task shall be negotiated, and a task order issued. Statutory Authority Permitting Other than Full and Open Competition: ( ) (1) Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements per FAR 6.302-1; (X) (2) Unusual and Compelling Urgency per FAR 6.302-2; ( ) (3) Industrial Mobilization, Engineering, Developmental or Research Capability or Expert Services per FAR 6.302-3; ( ) (4) International Agreement per FAR 6.302-4 ( ) (5) Authorized or Required by Statute FAR 6.302-5; ( ) (6) National Security per FAR 6.302-6; ( ) (7) Public Interest per FAR 6.302-7; Demonstration that the Contractor s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above (applicability of authority): Gi4 is the incumbent Service-Disabled Veteran Owned Business currently processing HIPAA 270/271 transactions and all insurance coverage discovery transactions under contract 36C77718C0004. Gi4 working with a commercial clearinghouse has successfully performed the services stated in the PWS of this contract. Delay in award of a contract would result in serious injury, financial or other to the government. Gi4 is uniquely positioned to continue a Bridge contract through its developed communication and transfer data platform. Due to the VA s Information Security Measures a new vendor connection would take approximately 30 45 days to set up at additional cost to the Government. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable: N/A - This award is being made under FAR 6.302-2 (d) (B) Unusual and compelling. A synopsis will be posted on Federal Business Opportunities website to let industry know of the contract award. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable: The Contracting Officer anticipated cost will be considered fair and reasonable based on historical pricing data, the IGCE and working relationship with current contractor to assist with verifying cost. However, we do understand that there may be an increase in the cost for this short-term contract in relation to past payment for same type work. The pricing will be compared to the IGCE that has been developed for this contract. If pricing seems to be out of line, then we will enter negotiations with the contractor. The anticipated dollar value of this extension is below the dollar threshold for certified cost and pricing data. The proposal from the contractor will be reviewed through a technical evaluation to ensure that they meet the requirements of the contract. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted: Market Research was not conducted for this requirement, this award is being made under FAR 6.302-2 (d) (B) Unusual and compelling until the agency can enter into another contract for required services by competitive procedures. Because of time constraints regarding how long it would take to identify a new contractor, establish connections, and confirm that they would be able to provide the services required, the existing contract would be ended, and services would be lost. The bridge contract is to create a contract that will allow for services to continue while a new updated contract is being established. Any Other Facts Supporting the Use of Other than Full and Open Competition: Requesting and verifying insurance information is vital to the success of the VA revenue collection process because accurate information is required to effectively bill and collect reimbursements from third-party payers for services to Veterans and other beneficiaries. It is required to contact the third-party payer and verify the Veteran s or other beneficiary specific policy coverage and other information before submitting claims to the third-party payer(s). A stop-work and break-in-service without replacement would results in current electronic transactions being reverted to telephone and paper, which negatively affects time frames, potentially creating a backlog of actions before billing could occur. A stop work and break in service without replacement negatively impact VA s $4 billion-dollar Revenue Collections process mandated by Congress and United States Code. Without these collections, VA could be in danger of falling short in providing medical services to our Nation s Veteran population. Title 38 United States Code (U.S.C.) Section 1729 authorizes VA to recover or collect for care or services, reasonable charges, as determined by the Secretary of Veterans Affairs, for care and services, provided for a non-service connected disability in or through a VA medical facility to a Veteran who is also a beneficiary under a third-party payer s insurance plan. VA s right to recover or collect is limited to the extent that the Veteran or a Community care provider of the care or services would be eligible to receive reimbursement or indemnification from the third-party payer, if the care or services had not been furnished by a department or agency of the United States. VA implements this authority under Title 38 CFR Section 17.101 and 17.106. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition: Because there has been no request for other vendors to submit any interest statements, there has been no interest identified in this bridge contract by any other company. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to Competition before Making subsequent acquisitions for the supplies or services required: This Bridge contract allows the VA additional time to solicit and award a follow-on contract to 36C77718C004, in accordance with the Federal Acquisition Regulations and VA policy. Requirements Certification: I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief. _____________________________ ________________________ Daryl Claggett Date Director, eBusiness Solutions Office of Community Care, Revenue Operations Approvals in accordance with the VHAPM Part 806.3 OFOC SOP: Contracting Officer or Designee s Certification: I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief. _____________________________ ________________________ Name Charles Hampton Jr. Date Title Contracting Officer Facility PCAC- ST. Louis One Level Above the Contracting Officer (Required over SAT but not exceeding $700K): I certify the justification meets requirements for other than full and open competition. _____________________________ ________________________ Name: Terry W. Hester Date NCO/PCO Branch Chief Facility PCAC-St. Louis