Historical Medical Claims Data Analysis Services

Sources Sought Notice / Request for Information (RFI) Historical Medical Claims Data Analysis Services 1. Purpose This Sources Sought Notice/Request for Information (RFI) is issued solely for market research purposes in accordance with Revolutionary FAR Overhaul (RFO) Part 10 and RFO Subpart 8.4. This notice is not a solicitation and does not constitute a commitment by the Government to award a contract. The Government seeks information from contractors to determine the availability of qualified sources, evaluate the capabilities of small business concerns, identify commercially available solutions, obtain budgetary

pricing information, and assist in determining the appropriate acquisition strategy, including whether a socioeconomic set-aside is appropriate. The Government will not reimburse respondents for any costs incurred in responding. 2.

Background The Federal Bureau of Prisons (BOP) is conducting market research for professional analytical support services to evaluate approximately 2,000,000 historical medical claims. The effort is analytical in nature and will support evaluation of Medicare reimbursement methodologies and future acquisition planning. The contractor will not perform claims adjudication, claims processing, utilization management, provider network management, or payment administration. The analysis will be used to examine the data for fraud, waste, and abuse; as well as to identify trends within the claims data such as over-use or over-billing including duplicate charges. No current real-time data will be provided as this analysis is solely intended for historical evaluation. Additionally, no personally identifiable information (PII) will be provided in the dataset. 3. Draft Requirement The contractor shall furnish all personnel, management, commercial software, analytical tools, and other resources necessary to analyze approximately 2,000,000 historical medical claims. The analysis

deliverables shall include: Duplicate claims Inappropriate procedure code based on included diagnostic code Outliers (overuse) of specific procedure codes by specific providers and/or sites Comparison of billed rates to Medicare rates, reported as a percentage of Medicare rates Ranking of providers by amount billed Ranking of patients by amount billed Ranking of sites (facilities) by amount billed Ranking of procedure codes by amount billed Ranking of providers by procedure code The data provided by the Government will include: Claim gender BOP internal patient Authorization number Payor/institution information (name, city, state) Diagnostic codes Service Dates Procedure (CPT) codes Procedure description Charge amount Billing provider information (NPI, name) Providing facility information (name, NPI) 4. Commercial Artificial Intelligence (AI) The Government is interested in commercially available AI-enabled capabilities that could improve the efficiency, quality, and timeliness of the required analyses. The Government is not seeking development of a custom AI model. Respondents should describe proposed commercial AI tools, the analytical functions they support, human validation processes, protection of PHI/PII and other sensitive information, and whether the capabilities are available under the respondent's GSA MAS contract (if applicable). Please note that this needs to be a closed source AI model. 5. Performance Timeline The contractor shall complete the required analyses and provide all required reports and recommendations within sixty (60) calendar days after the Government provides the historical claims data. Respondents should identify any assumptions affecting their ability to meet this schedule. 6. Security The contractor may have access to Protected Health Information (PHI), Personally Identifiable Information (PII), and other sensitive Government information. Respondents should assume compliance with all applicable Federal privacy and cybersecurity

requirements. 7. Applicable s NAICS (under consideration): 541611 PSC (under consideration): R405 Respondents may recommend alternative s with supporting rationale. 8. Information Requested from Industry Please provide: Company name UEI Cage Code Business size and socioeconomic status GSA MAS contract number (if applicable) Applicable SIN(s) (if applicable) Confirmation that the required services are within the scope of your awarded SIN(s) (if applicable) Relevant experience involving large healthcare claims datasets, Medicare reimbursement methodologies, healthcare reimbursement analysis, healthcare financial analysis, or statistical analysis of healthcare claims. Include customer,

period of performance, scope, dollar value, and approximate number of claims analyzed. Describe your technical approach, analytical methodology, software platforms, quality assurance processes, and any commercially available AI capabilities proposed. If your organization qualifies as a small business, describe your ability to perform the entire requirement as the prime contractor and identify any anticipated subcontractors. 9. Budgetary Firm-Fixed-Price Estimate For market research purposes only, respondents are requested to provide one Budgetary Firm-Fixed-Price estimate for completing the analysis of approximately 2,000,000 historical medical claims. The estimate should include all labor, management, software, commercial AI tools (if proposed), licensing, reporting, quality assurance, and all other costs required to complete the effort. Do not provide labor category rates or labor-hour estimates. Identify: • One Budgetary Firm-Fixed-Price •