SAM #36C10G26D0030

Award for VA community-care claims processing and customer-service support

The U.S. Department of Veterans Affairs awarded SIGNATURE CHOICE III, LLC a $517 million contract for Veterans Health Administration claims processing and customer-service support. - Government buyer: U.S. Department of Veterans Affairs, Veterans Health Administration, through the OPAL Strategic Acquisition Center. - Awardee: SIGNATURE CHOICE III, LLC. - Services: Verify eligibility and authorizations; adjudicate claims for community-provided care; provide billing guidance; support claims-processing IT systems; and operate customer-service call centers for billing, claims, and eligibility inquiries. - Includes a 24/7 emergency care notification line. - Products, part numbers, and quantities: None specified. - OEMs: No product manufacturers are identified.

Description

VHA VCC claims processing and customer service functions are critical to ensuring uninterrupted access to healthcare services for Veterans and their families. VHA s existing resources are inadequate to manage the workload required to fulfill mission requirements. These services include verifying eligibility and authorizations, adjudicating claims for community-provided care, and issuing billing guidance to prevent improper payments and minimize reimbursement delays. These functions also support the complex IT systems that enable accurate claims processing and continuity of care. Customer service needs include the operation of customer service call centers to address billing, claims, and eligibility inquiries, including a 24/7 emergency care notification line that serves Veterans in crisis, helps VHA meet reimbursement timelines and ensures Veterans can report urgent care episodes promptly for payment authorization. Timely adjudication of medical claims for services performed by community-based providers guarantees that Veterans and family members of permanent and total service-connected disabled Veterans receive uninterrupted care.

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