DA10 -- Payment Integrity Validation and Oversight Tool ( PIVOT ) ( VA - 26 - 00015670 ) RFI 3

2026-11-03

Request for Information Payment Integrity Validation and Oversight Tool ( PIVOT ) TAC RFI Number : 36C10B26Q0121 Please Note : All major revisions in the associated PWS 3 . 0 are indicated in Red Font Introduction This RFI is for planning and market research purposes only and shall not be considered an Invitation for Bid , Request for Task Execution Plan , Request for Quotation or a Request for Proposal . Additionally , there is no obligation on the part of the Government to acquire any products or services described in this RFI . Your response to this RFI will be treated only as information for the Government to consider . You will not be entitled to payment for direct or indirect costs that you incur in responding to this RFI . This request does not constitute a solicitation for proposals or the authority to enter into negotiations to award a contract . No funds have been authorized , appropriated or received for this effort . Interested parties are responsible for adequately marking proprietary , restricted or competition sensitive information contained in their response . The Government does not intend to pay for the information submitted in response to this RFI . The North American Industry Classification System ( NAICS ) for this requirement is DA10 . Be advised that set - aside decisions may be made based on the information provided in response to this RFI . Responses should be as complete and informative as possible . 2 . Background The Department of Veterans Affairs ( VA ), Office of Information & Technology ( OIT ), within the Veterans Health Administration ( VHA ), Office of Integrated Veteran Care ( IVC ), provides high - quality , effective , and efficient Information Technology ( IT ) services . These services are crucial for those responsible for delivering care to Veterans at the point of care and throughout all stages of the Veterans health care journey , ensuring care is effective , timely and compassionate . Â VA depends on Information Management / Information Technology ( IM / IT ) systems to meet its mission goals . VA s Office of Integrated Veteran Care ( IVC ) requires a Payment Integrity Validation and Oversight Tool ( PIVOT ) to proactively detect and prevent improper VA Community Care healthcare claims payments . Improper payments may result from inaccurate coding , billing , unauthorized services , or non - compliance with VA or CMS reimbursement policies , including fraud , waste , and abuse ( FWA ). Currently , VA relies on manual , retrospective processes that delay detection and recoupment efforts . PIVOT will modernize payment integrity capabilities through advanced analytics , automation , and integration with VA systems . The solution will enable systematic analysis of claims data , early detection of improper payments , and support cost containment strategies . 3 . Problem Statement : VA is seeking a SaaS based solution capable of supporting a minimum of 100 concurrent users that integrates with existing VA systems , ingests a wide variety of claims and healthcare data , and leverages advanced analytics and artificial intelligence / machine learning to identify improper payments , including fraud , waste , and abuse ( FWA ). The solution needs to support secure , scalable , and elastic deployment models , and integrate with VA s identity and access management infrastructure , including Personal Identity Verification ( PIV ) authentication and role - based access controls , be accessible via VA - approved remote access methods ( e . g ., Azure Virtual Desktop , Citrix Access Gateway ), and support high availability , disaster recovery , and secure multi - tenancy . VA would like potential vendors to provide a demonstration of their solution to be assessed for best value , technical effectiveness , implementation requirements , and potential scalability . VA will not be providing a dataset for solutions to be assessed against , and requests a live demonstration facilitated through Microsoft Teams with a description of the solution s technical functionality not to exceed two ( 2 ) pages . VA expects the demonstration to provide a clear , practical illustration of how the vendor s proposed solution meets technical and functional requirements outlined in the Performance Work Statement ( PWS ). Vendors should focus on showcasing core capabilities such as data ingestion and normalization , rules engine functionality , pattern recognition and anomaly detection , real - time analytics , workload modules , and user interface features . The demonstration should highlight the solutions effectiveness , scalability , security , and integration capabilities , as well as any unique features that enhance healthcare payment integrity and oversight . While VA will not provide a dataset , vendors are encouraged to use representative data to illustrate system performance and outputs . The goal is to allow VA to assess technical effectiveness , ease of implementation , and alignment with VA s mission objectives . Technical Requirements The technical requirements outlined in this document are not comprehensive of the Performance Work Statement ( PWS ). Consult and review the PWS in its entirety to ensure full understanding of the scope , requirements , and obligations . Summarization : Data Ingest & Management : Process 837P , 837I , 837D , NCPDP claims and remittance advice ( 835 ), aggregate and normalize data , maintain audit trails , and support real - time processing . Rules Engine : Execute VA and CMS compliance rules at scale , support configuration in sandbox , testing , pre - production , and production environments ; rules library , version control , rollback , and audit logging . Pattern Recognition Engine : Detect anomalies and suspicious billing behaviors using AI / ML , provide risk and confidence scoring and explainable AI outputs , enable continuous improvement through feedback loops , and AI - Recommended Rules . Workload Module : Centralized interface for VA staff to review flagged claims , validate rule outcomes , manage approvals , and disposition cases with audit logging and performance tracking . Dashboards & Reporting : Real - time dashboards , customizable reports , and export capabilities . Security & Compliance : FedRAMP High baseline , HIPAA , FISMA compliance , role - based access control , and audit logging . Virtual Technical Demonstration ( VTD ) The VTDs will be conducted via Microsoft Teams . All vendors participating in the demonstration will receive detailed VTD information regarding their scheduled demonstration date and time . Demonstrations should be no longer than 90 minutes . Requests to reschedule will be approved at the discretion of the Contracting Officer ( CO ). The objective of the VTD is to demonstrate the vendor ability to deliver the PIVOT solution as described in the Performance Work Statement ( PWS ). Additionally , VA seeks to assess the potential vendor s solution for best value , technical effectiveness , implementation requirements , and scalability potential . Vendors will need to create and provide their own scenarios demonstrating their solutions . During the VTD , vendors will showcase their solutions through a PowerPoint presentation and include a live demonstration facilitated through Microsoft Teams . VA requests a description of the solution s technical functionality not to exceed two ( 2 ) pages . Please note that VA will not be providing a dataset for solutions to be assessed against . Vendors may include up to ten ( 10 ) participants for the VTD . Participants may include prime members and teaming partners ( subcontractors ) expected to contribute actively to the demonstration . The team participating in the VTD should represent the personnel proposed to work on the solution . The prime contractor must be represented among the VTD participants . Only members of the virtual team can perform activities during the demonstration . Communication with individuals outside of the virtual team during the VTD is not permitted . VA will be present for the entire VTD . A list of VTD participants must be included with the RFI response submission and emailed to the Contracting Officer . The vendor must provide all resources and equipment required for the VTD , including internet access , software , and any necessary supplies . Vendors shall ensure their equipment and internet bundles are sufficient to support an uninterrupted virtual demonstration session . Vendors do not need to use the entire allotted time , but may not exceed it . Corrections or revisions to the PowerPoint presentations after submission are not allowed . Portions of the PowerPoint presentation not demonstrated within the allotted time will not be reviewed . VA reserves the right to hold a Government - only caucus and to ask questions during the demonstration . Vendors must answer questions on the spot without a separate period to caucus . These questions aim to clarify the Government s understanding of the demonstration and do not constitute formal discussions or exchanges . Vendors will not have the opportunity to revise their submissions or demonstrations post - questions , regardless of whether VA conducts exchanges with Vendors . VA personnel will not provide feedback during the VTD . All costs associated with the VTD shall be borne by the vendor and will not be reimbursed by the Government . Demonstration Content Requirements Vendors shall structure their demonstrations to showcase how their solution meets VA s core functional requirements . To meet VA s technical expectations , vendors should structure their demonstrations around the following components : Data Integration and Normalization : Vendors should demonstrate how their solution ingests and integrates multiple data sources , including historical and new claims in formats such as 837P , 837I , and 837D , as well as pharmacy transactions and reference datasets . The demonstration should show how the system normalizes this data into a unified schema , ensuring consistency and traceability across all elements . Vendors should highlight how claim - to - payment and claim - to - authorization relationships are maintained and how metadata such as source , timestamps , and transformation logic is captured to support auditability . User Interface and Usability Features : The demonstration should showcase the system s user interface and overall usability , emphasizing intuitive navigation that does not require coding knowledge . Vendors should illustrate dynamic search and filtering capabilities , drill - down functionality from dashboards to claim - level details , and hyperlinked navigation that allows seamless movement between related data views . The interface should comply with Section 508 accessibility standards and demonstrate responsiveness and ease of use for both novice and advanced users . Rules Engine : Vendors should demonstrate the Rules Engine s ability to execute VA - approved rules at both the claim and line - item level . The demo should show how rules can be configured without custom coding , and how version control and rollback capabilities are implemented . Vendors should highlight transparency features such as displaying rule logic , pricing formulas , and calculation steps within the Rules Library , ensuring that all compliance logic is fully auditable . The demonstration should also briefly illustrate how rules progress through multiple environments such as development , test , pre - production , and production to ensure proper governance and VA approval before activation . The demo should also include a sample set of the vendor s mature comprehensive library of healthcare payer compliance rules , payment policies , pricing logic , reimbursement calculations , and associated business logic reflecting industry - standard operations . Pattern Recognition and Anomaly Detection : The demonstration should illustrate how the Pattern Recognition Engine detects anomalies , trends , and suspicious billing behaviors such as upcoding , unbundling , Sudden shifts in billing behavior , and modifier misuse . Vendors should explain how risk and confidence scores are generated and presented to users , and how the system provides explainable AI outputs to support decision - making . Additionally , vendors should show how flagged anomalies are routed to analyst queues and how Human - in - the - Loop feedback is captured to improve model accuracy over time . Real - time Analytical Capabilities : Vendors should exhibit how the solution performs near real - time rule execution during claim ingestion , as well as retrospective analysis of historical claims . The demonstration should show how flagged claims are prioritized based on configurable risk thresholds and how the system supports proactive identification of improper payments . This portion should make clear that the system can handle both real - time and retrospective workflows effectively . Reporting and Dashboard Functionalities : The demonstration should present the solutions reporting tools . Vendors should show dashboard customization options , and how ad hoc reporting can be performed without contractor intervention . The ability to export reports in standard formats such as CSV , Excel , and PDF should also be demonstrated . The demonstration should include tools for performing ROI analysis , demonstrating the financial impact and benefits of the PIVOT , including cost savings , recovered payments , and efficiency gains . System Performance : Vendors should validate that their solution can handle high throughput while maintaining audit trails and data integrity . The demonstration should include evidence of uptime monitoring , alerting mechanisms , and performance dashboards that track system health and responsiveness . Role - based Access Controls : Vendors should demonstrate how the system enforces role - based access controls , including user provisioning , role assignment , and audit logging for access changes . The demo should confirm compliance with VA Identity and Access Management standards , including PIV authentication , and show how the system adheres to the principle of least privilege . By effectively demonstrating these components , vendors will highlight their capability to fulfill VA s requirements and deliver a comprehensive , reliable , and efficient PIVOT solution . Submittal Information : All responsible sources may submit a response in accordance with the information below . There is a page limitation for the technical functionality description designed for this RFI of 2 pages . There is no slide limitation for the PowerPoint deck . The Government will not review any other information or attachments included , that are in excess of the 2 page limit . NO MARKETING MATERIALS ARE ALLOWED AS PART OF THIS RFI . Generic capability statements will not be accepted or reviewed . Your response must address capabilities specific to the services required in the attached PWS and must include the following , limited to 2 pages ( not including the technical functionality description , also limited to 2 pages ): Interested Vendors shall at a minimum , provide the following information in the initial paragraph of the submission : Name of Company Address Point of Contact Phone Number Fax Number Email address Company Business Size and Status For VOSB and SDVOSBs , proof of verification in VIP . NAICS code ( s ) Socioeconomic data Data Universal Numbering System ( DUNS ) Number Existing Contractual Vehicles ( GWAC , FSS , or MAC ) Indicate your size status under NAICS ( code TBD ). Identify existing contract vehicles ( GSA , T4NG , NASA SEWP V , etc .) in which you are a contract holder that can be utilized to procure these services . Indicate whether your company intends to participate in the VA PIVOT solution demonstration . If your company intends to participate in the VA PIVOT solution demonstration , provide the list of participants ( up to 10 ). Provide a separate Rough Order of Magnitude ( ROM ) cost estimate for the SaaS product in accordance with PWS . Has the draft PWS provided sufficient detail to describe the technical / functional requirements that encompass the software development and production operations support services to be performed under this effort . ______ YES _______ NO ( if No , answer the next question ) If NO , please provide your technical comments / recommendations on elements of the draft PWS that may contribute to a more accurate proposal submission and efficient , cost effective effort . Vendor intent to participate in the solution demos should be submitted by January 23 , 2026 at 12 PM to allow time for scheduling coordination . The 2 - page technical documents and PowerPoint presentations should be submitted no later than February 6 , 2026 at 12 PM . All questions should be submitted no later than January 16 at 12 PM . Responses and questions are to be sent via email to Felica Griffin at Felica . Griffin @ va . gov . Please include " 36C10B26Q0121 " in the subject line of your response . Mark your response as " Proprietary Information " if the information is considered business sensitive . The email file size shall not exceed 5 MB .

New Jersey

2026-04-29