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Dental Pricing Data


Colorado, United States
Government : Federal
RFP
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Purpose
Veterans Health Administration (VHA) Dental Program provides community dental treatment via private licensed dental providers to eligible Veterans when VA medical facilities are not capable of providing economical care due to geographical inaccessibility or when the needed care is not available at VA, federal, or affiliated health care facility.

The purpose of this VHA solicitation is to obtain necessary data via Current Dental Terminology (CDT) codes to support VA s standardization of local reimbursement rates for VAMCs to use in determination of current market dental procedure payment and reimbursement rates.

Background
In such cases, dental care can be provided through a formal contract with the dental provider or an individual authorization authorized in advance of treatment. VA s Office of Community Care seeks regionally adjusted dental procedural cost data for this purpose.

Reference: Veterans Health Administration Dental Program, Section 10, b. Procedure for Development of the Schedule of Maximum Allowances for Non-VA Dental Care. VHA Handbook 1130.01 and VA Community Care Desk Procedure Guide. These reports are published on the VHA Dental Reporting and Analytics System for use by all VAMC facilities to aid in standardizing the determination of local reimbursement rates.

The VA schedule of Maximum Allowances for community dental service is considered confidential, and will be distributed by the Chief, Dental Service, or designee. It is prohibited to provide a copy of this schedule to outside parties.

Scope of Work
Areas of coverage for Dental Data are required for the United States, District of Columbia, and Puerto Rico.

Number of line items will be dependent upon number of current dental codes and zip codes returned.

Schedule of Services
The VA Denver Acquisition and Logistics Center (VA DALC) in support of the Veterans Health Administration (VHA) is seeking current market dental procedure payment and reimbursement rates data via Current Dental Terminology (CDT) codes for dental procedures provided on a bi-annual basis.

Performance Period: June 1, 2017 May 31, 2018 with four (1) year options.

Implementation and Use of Data Subscription
The VA intends to use the data subscription as follows:
Data will be housed on one server location on VA s closed network for the use of VA employees only conducting or overseeing dental program operations. A non-operational backup copy will be housed on a second server in case of failure.

Data will be provided using an interactive report format for authorized users of the data to conduct VA internal operations including administration and oversight.

While access to data for all regions is a requirement, it is anticipated that between 1-3 individuals at approximately 150 parent VAMCs will routinely access information pertinent to their facility. A limited number of VA Centralized Business Office and VA Office of Dentistry personnel will also routinely access the information as required.

General Requirements
Data shall be provided to VA in an ASCII, or flat file format, database for integration into existing business information systems. No reporting functionality is required.

Data shall be provided for all current and active CDT code level for dental procedures as described by the American Dental Association.

Data shall be provided by the first 5 or first 3 level zip code region.

Data shall be provided at varying percentile levels for each region, at the 25th, 50th , 60th , 70th , 80th , 90th and 100th percentile ranges at a minimum.

Submission of Dental Data Documentation
The data provided must be current, based on claim or survey data obtained within the previous 2 months, with updates of not less than a semi-annual basis for all active CDT codes.

The Contractor shall submit the deliverable in draft form to this contract s VHA COR (Contract Officer s Representative) and Office of Dentistry s designated Stakeholder(s) for review in accordance with mutually-agreed upon required schedule of due dates determined upon award.

VA will have five (5) business days after receipt to review draft deliverables, note deficiencies, or make other comments. The VA Stakeholder(s) will verify the accuracy of the submitted data and provide their written inputs with specific areas requiring rework or acceptability to the COR prior to five (5) business days of receipt. The VHA COR will forward prepare a consolidated list of comments to Contractor. In the event of any rejected deliverable, the Contractor shall be notified in writing by the COR of the specific reasons for rejection. The Contractor shall have five business days to correct the rejected deliverable and return it per delivery instructions within five (5) business days.
The Contractor shall receive written acceptance by VA of all final deliverables prior to acceptance or provided documented reasons for rejection for failure to comply with contract requirements.

The Contractor shall describe the methodology and source for each data type.

Any changes to the schedule must be coordinated and approved by the Office of Dentistry s Stakeholder and VHA COR prior to implementation.

The data provided must be based on a number of claim or survey data points occurring during the sample time period, and of sufficient quantity to result in a 95%, or better, statistical accuracy.

Electronic Submission of Payment Requests for Billing
The contractor and VHA process for submission of invoices after receipt of approval for submitted
data is as follows:

The invoice is submitted to the assigned VA COR for initial review.
Discrepancies on invoice are returned to contractor to fix prior to final COR approval.
Written approval is returned to contractor from the COR to file with Financial Service Center (FSC) for certification and payment.
Contractor uploads its invoice (without PII) into OB10 where it will be processed by FMS and then sent to the certifying official (COR) through IPPS (formerly OLCS).
The COR approves and certifies the submitted invoices for payment.

The Contractor shall not bill both VA and any patient 3rd party insurance, nor Medicare for services delivered.
The Contractor shall ensure that no Veteran is billed by them for contracted services under this contract.
Rejected invoices Invoices considered incomplete, that require additional information for processing, shall be rejected for correction and re-submission. Reasons for return may include, but are not limited to: missing VA required data, the need for additional supporting documentation, or correction and explanation of coding discrepancies on the claims. Invoices may require specific documentation prior to processing.

Denied Invoices/Resubmissions for reconsideration of payment must be done within 12 months from date of denial.

Deliverables Contractor must be prepared to comply with requests for information, including those originating from Congress, using company letterhead, complete sentences, and professional English. Contractor shall comply with the requests of Government and independent auditors during audits of this contract and all associated contract documentation, including but not limited to invoices.

Sheila Kiker
sheila.kiker@va.gov
303-273-6209

sheila.kiker2@va.gov

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