Solicitation Notice for Workers' Compensation Medical Bill Processing (WCMBP)

The United States Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) is seeking a contractor to provide Workers' Compensation Medical Bill Processing and Mailroom services. DOL intends to award a single firm fixed price contract with other direct cost (OCD) pass-throughs. The NAICS code for this requirement is 524298 and the size standard is $6.5 million. The period of performance of the proposed contract is anticipated to be one year with four one-year options, and up to two one-year award terms for outstanding performance - for a total potential performance period of seven years. PURPOSE The U.S. Department of Labor's (DOL) OWCP administers workers' compensation medical bill processing programs that mitigate the impact of work-related injury for certain workers and their families. OWCP is seeking a single Contractor to build and operate a centralized workers' compensation medical bill processing (WCMBP) solution for three OWCP programs: the Division of Federal Employees' Compensation (DFEC), the Division of Coal Mine Workers' Compensation (DCMWC) and the Division of Energy Employees Occupational Illness Compensation (DEEOIC). OWCP's medical bill processing function is currently performed as a contracted service. The Government does not own an information system that can be transferred to a follow-on Contractor. Only historical data will be transferred. This centralized solution will include the processes associated with receipt of the medical bills and attachments, review of medical bills and attachments against program-specific authorizations, handling of inquiries related to medical services from claimants and providers, and utilization of business rules established by each OWCP program for the adjudication and pricing of medical bills. Specifically, the integrated system will support the following capabilities: - Receipt and accounting for medical bills, attachments and other documents, in both hardcopy and electronic formats - Scanning and data entry of bills, attachments and other documents received. - Processing of bills to payment or denial (the Contractor will not make benefit payments, but will transfer payment files to Treasury for certification and payment) - Processing of requests for adjustment, authorization of services, suspense resolution, and appeals processing - Processing and responding to submitted correspondence received from medical providers and claimants, when applicable, and storing the responses to the correspondence in an imaging system from which the Government can retrieve for review - Enrolling new providers and managing information about existing providers - Providing claimant and provider support via a call center and self-service applications (such as user access portals and IVR) - Processing Point of Sale (POS) pharmacy bills - Providing secure on-line access, available to authorized users, to view images of bills, correspondence, and other documents. PROGRAM OBJECTIVES The goal of the WCMBP program is to acquire a standards-based medical bill processing system and processes that implement the following: - Improved mailroom, imaging, and data entry throughput, accuracy, and efficiency - Ensure a smooth and timely transition from the incumbent service provider - Ensure efficient, accurate and timely processing of medical and pharmacy bills - Ensure timely and correctly processed authorizations for covered benefits. - Provide accurate and timely responses to customer inquiries and requests. - Implement advanced medical bill processing technologies and processes - Develop robust fraud and abuse and error detection/protection processes - Use of industry-standard hosting and programming techniques to support portability among platforms - Implement robust change and configuration management process - Establish a framework for continuous improvement