Services des renseignements et de traitement des demandes de paiement pour les services de santé

Trade Agreement: Agreement on Internal Trade (AIT)
Tendering Procedures: All interested suppliers may submit a bid
Competitive Procurement Strategy: N/A - P&A/LOI Only
Comprehensive Land Claim Agreement: No
Nature of Requirements:
Health Information and Claims Processing Services

Purpose

The purpose of this notice is to advise the industry of the
Health Information and Claims Processing Services (HICPS)
requirement for Health Canada (HC), the Request for Information
(RFI) #1 publication, and the subsequent Engagement activities.

1. NIHB Program Background

The Non-Insured Health Benefits (NIHB) Program of the First
Nations and Inuit Health Branch (FNIHB) at Health Canada (HC)
provides eligible registered First Nations and recognized Inuit
with a range of medically-necessary goods and services not
provided through private insurance plans, provincial/territorial
health and social programs or other publicly funded programs.
These medically necessary benefits are:

• Pharmacy (certain prescription and over-the-counter drugs);
• Medical supplies and equipment;
• Dental care;
• Vision care;
• Other health care services such as short-term crisis

intervention mental health counselling; and

• Medical transportation to access medically required health

services not available on reserve or in the community of
residence.

NIHB is the largest program of HC, representing approximately
31% of the department's total budget and 46% of FNIHB's budget
in 2013-14. Total annual expenditures for all NIHB benefit areas
amounted to $1,026.4 million in fiscal year 2013-14.

As with other public and private plans, the NIHB Program does
not provide direct services to clients. It relies mainly on
pharmacists, dentists and other health providers to deliver
services to clients. Through the Health Information and Claims
Processing Services, the NIHB Program reimburses providers for
the cost of eligible services. These services are essential to
the NIHB Program's ability to fulfill its mandate to ensure
access by First Nations and Inuit clients to needed health
benefits.

2. HICPS Overview

HICPS includes all services and supporting systems used to
process Non-Insured Health Benefits claims, supporting Providers
with the processing and settlement of their claims, ensuring
compliance with NIHB Program policies including audit, reporting
and financial control practices, automated information
management systems used to process and pay claims in accordance
with NIHB Program client/benefit eligibility and pricing
policies.

Since 1990, Canada has retained the services of a private sector
contractor to administer the following core health information
and claims processing services on its behalf:

• Requests and claims processing, adjudication and settlement;
• Provider registration and communications;
• Payment and Financial operations;
• Systems and services in support of the various NIHB operated

Review, Prior-Approval, and Predetermination Centres.

• Provider Audit program and audit recoveries; and
• Data retention, collection, analysis and reporting

NIHB Program uses this third party claims processor to review
and process claims for the Pharmacy, Dental Care, and Medical
Supplies and Equipment. In addition to ensuring claims are
processed in a timely manner and in keeping with NIHB Program
policies and rules, HICPS includes a range of pre-payment and
post-payment controls (including a provider audit program that
covers Provider Profiling, Next Day Claim Verification, Client
Confirmation Program, On-Site and Desk audit), which help to
ensure the accountability of the NIHB Program. In 2013-14, HICPS
processed 21.2 million claim lines of nationally administered
pharmacy and dental benefits which accounted for approximately
55.4% of all NIHB expenditures (or over $570 million).

3. Aboriginal Participation Component

The HICPS requirement will include an Aboriginal Participation
Component (APC), which is a mechanism designed to meet the
Government of Canada's objectives of encouraging Aboriginal
socio-economic development through federal contracting
opportunities that are not subject to International Trade
Agreements. The APC is designed to develop long-term sustainable
and meaningful socio-economic benefits for Aboriginal people,
businesses and communities and compliments the objectives of the
Procurement Strategy for Aboriginal Businesses (PSAB).

4. Request for Information #1

The purpose of this RFI is to inform industry of HC's
requirement for HICPS and to provide industry an opportunity to
provide feedback on the requirement and subsequent engagement
activities. This feedback will assist Canada initiating a
dialogue about the requirements and possible solutions.

This RFI also contains specific questions addressed to the
industry to identify future technologies, best practices and
innovative business or service models. Detailed written
responses will enable Canada to consider industry perspectives
in the development of HICPS requirement and the eventual RFP.

4.1 Nature of this Request for Information

This is not a bid solicitation. This RFI will not result in the
award of any contract. Potential suppliers of any goods or
services described in this RFI should not reserve stock or
facilities, nor allocate resources, as a result of any
information contained in this RFI. Nor will this RFI result in
the creation of any source list. Therefore, whether or not any
potential supplier responds to this RFI, it will not preclude
that supplier from participating in any future procurement.
Also, the procurement of any of the goods and services described
in this RFI will not necessarily follow this RFI. This RFI is
simply intended to solicit feedback from industry with respect
to the subject matter described in this RFI.

4.2 Response Costs

Canada will not reimburse any organization for expenses incurred
in responding to this RFI including, but not limited to,
expenses incurred for participating in subsequent Engagement
Activities.

4.3 Follow-up Activity

This RFI #1 is part of Engagement Phase 1, and will be followed
by a one-day Industry Engagement Information Session #1 and
separate One-on-One Sessions #1.

4.4 Communication with Industry

During the Engagement Activities subsequent to this RFI, the
Contracting Authority may communicate with registered Industry
Participants through direct email rather than by posting
additional notices on the GETS.

5. Proposed Procurement Approach

5.1 Engagement Strategy

Three phases are planned for the Industry Engagement process.
However, as the process evolves, additional activities could be
incorporated into the engagement schedule or engagement phases
may be combined, modified, or eliminated depending on timelines
and feedback from industry.

Please note that participation in any of the Engagement
activities is not a mandatory requirement for eventual
submission of a bid; industry representatives that do not
participate in the Engagement process will remain eligible to
submit a bid in response to any future RFP relating to the HICPS
procurement.

5.2 HICPS Engagement Milestones and Associated Timeline

The following milestones and their associated target delivery
dates are estimates which have been provided for information
purposes only. Canada reserves the sole option to delete or
change each of the individual named milestones and their
associated delivery dates as Canada sees fit.

Engagement Phase 1
1 Industry Engagement Information Session #1 - September 21, 2015
2 One-on-One Sessions #1 - September 21 - 23, 2015

Engagement Phase 2
3 RFI #2 - Spring 2016
4 Industry Engagement Information Session #2 - Summer 2016
5 Working Group Sessions #2 - Summer 2016
6 One-on-One Sessions #2 - Summer 2016

Engagement Phase 3
7 RFI #3 - Autumn 2016

5.3 Enquiries

All enquiries and other communications related to this RFI and
associated Industry Engagement activities shall be directed
exclusively to the Public Works and Government Services Canada
Contracting Authority. Since this is not a bid solicitation,
Canada will not necessarily respond to enquiries in writing or
by circulating answers to all respondents; however, respondents
with questions regarding this RFI may direct their enquiries to:

Contracting Authority: Aaron Wong-Sing
Public Works and Government Services Canada
Place du Portage III, 12C1 11 Laurier Street Gatineau, Quebec
K1A 0S5

Email Address: T••••••••@••••••••.••.ca
Telephone: 819-956-2219
Facsimile: 819-934-1235

Alternate:
Delegate Contracting Authority: Betty Cole
Telephone: 819-956-1360

The use of e-mail to communicate is preferred.

Delivery Date: Above-mentioned

The Crown retains the right to negotiate with suppliers on any
procurement.

Documents may be submitted in either official language of Canada.