Owcp - Pharmacy Bill Processing Services

THIS IS NOT A REQUEST FOR PROPOSAL - THIS IS A NOTICE OF THE GOVERNMENT'S INTENT TO ISSUE A SOLE SOURCE AWARD CONTRACT TO CONDUENT FEDERAL SOLUTIONS PHARMACY BILL PROCESSING SERVICES TO ASSIST THE U.S. DEPARTMENT OF LABOR'S (DOL) OFFICE OF WORKERS' COMPENSATION PROGRAMS (OWCP).

The Department (DOL) intends to negotiate and award a firm-fixed price contract with Conduent Federal Solutions for Pharmacy Billing Services on behalf of OWCP.

The Contractor shall interface with the OWCP District Offices and OWCP National Office staff for each program in the performance of these activities.

In addition to processing bills, the Contractor shall be responsible for all inquiries regarding bills and appeals, authorization of services, suspense resolution, pharmacy enrollment and appeals processing.

The primary goals of the OWCP bill processing strategy are as follows:

To ensure efficient, accurate and timely bill processing for OWCP providers and claimants. Accurate processing refers to the correct implementation and maintenance of business rules and practices for each program, and the application of industry standards for pharmacy bill processing.

To ensure claimants' timely authorization for covered benefits.

To ensure that appropriate medications/drugs for claimants is identified and approved.

To incur and report cost savings from the standardization of functions across programs and the application of state-of-the-art capabilities, including but not limited to utilization limits, fee schedules, and other industry standards.

To assure responsiveness to customer inquiries and requests.

To incorporate state-of-the-art Contractor capabilities, including but not limited to, clinical guidelines for medical treatment and prescriptions, and fraud and abuse protection programs.

To provide standard reports for contract management, production, and trend analysis.

To provide OWCP management access to raw data to enable tracking and analysis of data necessary for identification of program trends, utilization review, etc.

To provide a user interface for case management functions.

To establish a framework for continuous improvement.

To comply with Federal requirements for financial and benefit systems.

OWCP Imaging and indexing services will be implemented to support the DEEOIC, and DCMWC imaging effort to provide a more efficient way of doing business.

The purpose of the Pharmacy Mailroom and Imaging is to establish a pharmacy mailroom and imaging capability that will achieve the following OWCP technical, management, cost, and risk mitigation objectives:

Improved mailroom, imaging, and data entry throughput and efficiency

Reduced mailroom, imaging, and data entry costs

Common workflow methodologies and process controls

Established management and technical expertise

Common processing platform

Robust facility and equipment capacities in support of current and future requirements

Ready availability of back-up facilities, equipment and personnel

Established telecommunications capabilities

Implementation of uniform, established quality control procedure

The anticipated period of performance is one (1) 12-month base period and two (2) 12-month option periods, plus an optional 6-month extension period using FAR clause 52.217-8.

The associated North American Industry Classification System (NAICS) Code 524298 -All Other Insurance Related Activities, which has a size standard of $30.5 million. The statutory authority for this non-competitive action is Federal Acquisition Regulation FAR 6.302-1 Only one responsible source and no other supplies or services will satisfy agency requirements.

This is a sole source notice published for informational purposes only and not a request for competitive proposals. Therefore, no solicitation document exists for this requirement. However, all responsible parties interested in responding to this notice are invited to submit a capability statement by 3:00 p.m. EDT, October 24, 2023, that provides sufficient details for consideration by the Government, via email to: Pyatigorsky.Emily@dol.gov and Colbert.Elvis.R@dol.gov. The determination not to compete the contract based on the responses to this notice is solely within the discretion of the Government.

Phone calls will not be accepted in response to this notice. All information submitted should support the offeror's capability to provide the items required and shall be furnished at no cost or obligation to the Government. Responses must be in writing and must provide clear and concise documentation indicating an offeror's bona fide capability to provide these services. Verbal responses are not acceptable and will not be considered. The Government reserves the right to cancel this requirement.