Secure Data Exchange Software for Cheyenne River Health Center

The Indian Health Service (IHS) requires a secure data exchange software solution for the Cheyenne River Health Center to facilitate connectivity with Medicare DDE/FISS, provide automated claims status reporting, and manage payment floor details. The solution will also include eligibility verification for third-party payers, with an anticipated monthly volume of 100 checks, and the capability to search for third-party coverage for patients who do not present insurance information (anticipated volume of 1000 searches per month). Additionally, it will handle third-party insurance medical claims validation, approval, and processing services via a clearinghouse for Medicare, Medicaid, VA, and Commercial Payers, with an anticipated submission volume of 2,500 claims per month. The software must support rigorous claims rules, custom business rules, and self-monitoring of service usage. Training and support will be provided either on-site or via teleconference. The service must be workstation independent, support an unlimited number of users, and not require installation within the Cheyenne River Health Center or IHS network. Data exchange will be enabled via Secure File Transfer Protocol (SFTP), and the solution must support Electronic Data Interchange (EDI) transactions and interactive Telnet sessions. A Business Associate Agreement will be established between the Cheyenne River Health Center and the Contractor.