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Q601--Health Care Clearinghouse 1 - HIPAA Electronic Transactions and Insurance Discovery (VA-27-00018291) | Maxel/Svendsen
In plain English
The Veterans Health Administration intends to sole-source a second health care clearinghouse to process HIPAA insurance eligibility transactions and find patient insurance. Responses are due November 3, 2026. Details are in the attachments.
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Description
SPECIAL NOTICE NOTICE OF INTENT TO SOLE SOURCE Electronic Insurance Transactions and Insurance Discovery HCCH I RFI eCMS ACTION NUMBER 36C24C27Q0007 October 29, 2026 Introduction: The Veteran s Health Administration (VHA) Office of Community Care (OCC), Revenue Operations (RO), eBusiness Solutions Office is looking to establish a Contract with a second Health Care Clearinghouse (HCCH) to continue to increase connectivity and further decrease processing time for VHA revenue operations. The Contractor shall conduct Health Insurance Portability and Accountability Act (HIPAA) Health Care Eligibility/Benefit Inquiry and Response 270/271 electronic transactions received from our Austin Financial Services Center (FSC) from across the United States and its territories. The Contractor shall conduct customized electronic transactions to search for patient insurance when VHA does not already have information on file. The Contractor shall assist the VHA in continuing its mission to implement electronic transactions. At no time shall the Contractor direct, change, or engage in the formulation of VHA policy. The VHA is solely responsible to review the Contractor s recommendations and to make decisions concerning the formulation of policy. Background: As a Health Care Provider, VHA has initiated several projects to increase the number of transactions that are completed electronically to comply with legislation and to facilitate administrative simplification. The VHA currently utilizes a Contractor to transmit its incoming and outgoing electronic transactions to the national Payer community. Various transaction formats are utilized, such as HIPAA Health Care Claim 837 (X12N-5010) and National Council for Prescription Drug Program (NCPDP) transactions. VHA transactions are completed as batch and real-time transfers. This secondary Contract will transmit only HIPAA Health Care Eligibility/Benefit Inquiry and Response 270/271 transactions for various Payers. VHA intends to use this secondary HCCH to expand its access to significant payers not provided by our primary HCCH contract. In January 2018, VHA implemented an insurance coverage discovery process to identify patient insurance information when VA does not already have billable insurance information already on file. This new system provides a standard, automated method for obtaining patient s third-party insurance information by utilizing customized HIPAA transactions. VHA intends to continue utilizing a secondary HCCH to transmit these customized electronic transactions to identify patient insurance information. eBusiness Solutions, as a proponent of administrative simplification, currently exchanges transactions from health care entities to third-party carriers. VHA has a fully developed and robust system to generate insurance eligibility inquiries for all places of care throughout VHA and route the transactions through (FSC) prior to transfer to the HCCH. This system and processes are referred to as Veterans…
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