MEDICAL CLAIMS TRANSMISSION AND REMITTANCE SERVICES FOR PINE RIDGE IHS HOSPITAL

Sources Sought: Medical Claims Transmission & Remittance Services for the Pine Ridge Indian Health Service (IHS) Hospital

Sources Sought Notice Number: IHS1521149

This Sources Sought Notice is for informational and planning purposes only and shall not be construed as a solicitation, an obligation or commitment by the Indian Health Service.

This notice is intended strictly for market research to determine the availability of Indian Small Businesses Economic Enterprise (ISBEE) and Indian Economic Enterprises (IEE).

Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. The anticipated applicable NAICS code for this acquisition is 518210-Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services

1.0 BACKGROUND

The Pine Ridge Indian Health Hospital requires a secure exchange data software solution that provides connectivity to the Medicare Fiscal Intermediary Standard System and Direct Data entry Service, Private Insurance verification and discovery, and preform third-party insurance processing claims for Medicare, Medicaid, Veteran Administration, and Commercial Payers. 

The electronic service allows quicker revenue turnaround time, with few or no errors of claim rejections maximizing revenue with the electronic claims’ analyzer.      

2.0       OBJECTIVE

The primary objective of this project is to secure a company that will provide the Pine Ridge IHS Hospital with a secure exchange data software solution to provide connectivity to the Medicare Fiscal Intermediary Standard System (FISS) and direct data entry (DDE) service. Insurance verification/discovery, perform third-party insurance claims processing for Medicare, Medicaid, VA and commercial payers. IHS is looking to keep software as a service that confidentiality and authentication and ability to check eligibility of claims to reduce the rejection rates using less manpower to follow up on payment denials.

3.0      CONTRACT REQUIREMENTS/ AND PERSONNEL QUALIFICATIONS

The Contractor will provide IHS with a secure exchange data software solution to provide required services. The Government seeks industry input on commercially available solutions capable of meeting the described objectives.

4.0       TYPE OF ORDER

The Government anticipates a commercial acquisition; contract type has not yet been determined and will be informed by market research results.

5.0  ANTICIPATED PERIOD OF PERFORMANCE

Period of Performance: Date of Award plus 365 calendar days.

6.0  PLACE OF PERFORMANCE

Services will be provided online to the Pine Ridge IHS – Business Office.   

7.0      Capability Statement/Information:

Interested parties are requested to submit a capability statement for market research purposes only, in accordance with FAR Part 10 and the FAR Revolutionary Overhaul (RFO) emphasis on commercial-first acquisition strategies.

Responses shall address the following areas to assist the Government in assessing the availability of commercially available medical claims transmission and remittance solutions:

1. Commercial Capability Overview

Describe your company’s commercially available secure exchange or clearinghouse solution that is capable of supporting electronic medical claims transmission, eligibility verification, remittance advice, and related services for Federal healthcare environments. Identify whether the solution is provided as Software-as-a-Service (SaaS) or another commercial delivery model.

2. Alignment with Government Objectives

Provide a high-level description of how your commercial solution could support the objectives described in this Sources Sought Notice. A draft Statement of Work (SOW) is provided for reference only to illustrate the Government’s anticipated operational environment and scope; respondents are not required to meet all draft SOW elements at this stage.

3. Relevant Experience

Describe recent and relevant experience providing similar commercial services to Federal, Tribal, State, or private healthcare organizations, including claims processing, clearinghouse connectivity, eligibility verification, or secure data exchange services.

4. Security and Compliance

Identify applicable industry standards, certifications, or compliance frameworks supported by your commercial solution (e.g., HIPAA, CMS transaction standards, secure data exchange protocols).

5. Small Business Status

Provide business size and socioeconomic status (e.g., ISBEE, IEE, Small Business, 8(a), HUBZone), along with your UEI, organization name, address, and point of contact. The anticipated NAICS code for this requirement is 518210 – Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services.

6. Commercial Pricing Models (High-Level)

Describe typical commercial pricing structures used for similar services (e.g., transaction-based, subscription-based), without providing pricing quotes.

7. Additional Information

Provide any additional information that may assist the Government in refining its acquisition strategy or determining whether a competitive set-aside or other RFO-aligned commercial approach is appropriate.

Submission Format:

Capability statements shall not exceed 10 single-sided pages, single-spaced, minimum 12-point font, submitted in Microsoft Word or PDF format.

8.0.        Closing Statement

Point of Contact: Mary Sarenana, Purchasing Agent, at contact@example.gov

Submission Instructions:

Interested parties shall submit capability via email to contact@example.gov. Must include Sources Sought Number IHS1521149 in the Subject line. The due date for receipt of statements is December 29, 2025, 12:00 p.m. Mountain Standard Time.

All responses must be received by the specified due date and time in order to be considered.

This notice is for information and planning purposes only and shall not be construed as a solicitation or as an obligation on the part of IHS.

IHS does not intend to award a contract on the basis of responses nor otherwise pay for the preparation of any information submitted. As a result of this notice, IHS may issue a Request for Quote (RFQ).

THERE IS NO SOLICITATION AVAILABLE AT THIS TIME. However, should such a requirement materialize, no basis for claims against IHS shall arise as a result of a response to this notice or IHS’s use of such information as either part of our evaluation process or in developing specifications for any subsequent requirement.

Disclaimer and Important Notes. This notice does not obligate the Government to award a contract or pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in SAM.gov. However, responses to this notice will not be considered adequate responses to a solicitation.

Confidentiality. No proprietary, classified, confidential, or sensitive information should be included in your response.