DA10--Payment Integrity Validation and Oversight Tool (PIVOT) (VA-26-00015670) RFI 3
Inactive on SAM.gov — responses were due 6 Feb 2026 · Unrestricted (full and open) · Department of Veterans Affairs (VA) · NAICS 541519 · Solicitation 36C10B26Q0121
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Description
Page 1 of 10 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. 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…
Version history
SAM.gov has posted 3 notices under solicitation 36C10B26Q0121, oldest first.
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