Non-Personal Healthcare Services-Physicians & Other Professional Ambulatory Services for PRC Program

The Albuquerque Area Indian Health Service (AAIHS) is soliciting proposals under solicitation 75H70726R00002 for professional physician and other ambulatory healthcare services. The contract provides medically necessary inpatient and outpatient services for Purchase/Referred Care (PRC) eligible American Indians and Alaskan Natives. All services must be performed at the contractor's facility rather than at IHS clinics or hospitals. The award is a Buy Indian Set-Aside, with a total performance period not to exceed 60 months, including a base year and subsequent options. Reimbursement is based on the Medicare Like Rate (MLR) pricing model, where contractors propose a percentage discount or an offer above the Medicare rate. The contract is awarded based on a 50/50 split between price and a combination of technical and past performance. Eligible providers must maintain Joint Commission accreditation or a CMS equivalent, hold active and unrestricted state licenses, and possess medical liability insurance including tail coverage. Key administrative requirements include the use of the IHS-843-1A Order for Health Services and the submission of claims via CMS-1500, CMS-1450, or ADA forms to the fiscal intermediary, Blue Cross Blue Shield of NM. Providers are prohibited from billing patients for authorized services and must adhere to strict prior authorization requirements for non-emergency surgeries, organ transplantations, and specific therapeutic services. Proposals are due by February 3, 2027, and must include a completed Provider Contract Summary Sheet, Provider Certification, and a Business Associate Agreement.