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HIPAA 270/271 Transaction Processing Services

Active
Federal

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

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This subcontract for the Department of Veterans Affairs, managed by Rpo Central, involves providing HIPAA 270/271 Transaction Processing Services to support VHA revenue operations. The selected provider will be responsible for the receipt, processing, and transmission of Health Care Eligibility and Benefit Inquiry and Response transactions. A critical component of the work includes using X12 processing engines to translate proprietary data formats into HIPAA compliant transactions. To ensure regulatory adherence, the contractor must maintain CAQH CORE and HIPAA X12 standards compliance and execute a Business Associate Agreement. The scope of work focuses on the delivery of processed real-time transactions and electronic acknowledgements under NAICS code 518210.

General Info

NAICS

518210 - Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services

Place of Performance

TN

Set-Aside

NONE

Documents

This scope was carved out of 36C24C27Q0007.

The full solicitation package (16 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

Q601--Health Care Clearinghouse 1 - HIPAA Electronic Transactions and Insurance Discovery (VA-27-00018291) | Maxel/Svendsen

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Response Deadline

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Organization & Contact Information

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AgencyDepartment Of Veterans Affairs → Rpo Central (36C24C)
ContactsNo contacts available
OfficeN/A
Office AddressN/A
ContactsNo contact information available

Full Description

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Performs the receipt, processing, and transmission of CAQH CORE Operating Rules compliant HIPAA Health Care Eligibility/Benefit Inquiry and Response (270/271) transactions for prime contractors on VHA revenue operations projects. Translates proprietary formats to HIPAA compliant transactions using X12 processing engines. Requires CAQH CORE and HIPAA X12 standards compliance and BAA execution. Delivers processed real-time transactions and electronic acknowledgements.

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More opportunities from Department Of Veterans Affairs → Rpo Central (36C24C)

Same awarding agency

NAICS: 518210
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Q601--Health Care Clearinghouse 1 - HIPAA Electronic Transactions and Insurance Discovery (VA-27-00018291) | Maxel/Svendsen
Solicitation # 36C24C27Q0007
The Department of Veterans Affairs, through the Veterans Health Administration Office of Community Care, intends to establish a Firm Fixed Price contract with a second Health Care Clearinghouse to enhance connectivity and reduce processing times for revenue operations. The primary objective is to conduct HIPAA Health Care Eligibility/Benefit Inquiry and Response 270/271 electronic transactions and perform customized insurance coverage discovery to identify patient insurance information when the VHA does not have it on file. This effort supports administrative simplification and ensures maximum healthcare claim generation by utilizing the VistA electronic Insurance Verification and Electronic Insurance Coverage Discovery systems. The procurement is identified under NAICS code 518210 and is intended as a sole source procurement with PNT Data Corporation, utilizing statutory authority for certified service-disabled veteran owned small businesses. The contractor must maintain CAQH CORE certification and comply with FISMA 2014 and NIST standards for information security. Key deliverables include real-time HIPAA transactions for standard, participating, and non-participating payers, as well as customized discovery transactions for found and not-found insurance. Performance is measured via a Quality Assurance Surveillance Plan, and the contractor must provide minimum payer connectivity and validation testing within 30 business days of the award or effective date. The contract includes a potential six-month extension and requires monthly electronic invoicing. All participating organizations must meet strict accreditation requirements by November 1, 2026, to be considered acceptable.
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