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Description: HICPS is the key delivery mechanism for the adjudication and payment of pharmacy, medical supplies and equipment, and dental benefits under Health Canada’s Non-Insured Health Benefits (NIHB) Program. HICPS supports the delivery of much-needed health benefits for over 790,000 eligible First Nations and Inuit clients. The HICPS includes a full range of claims processing and payment services; provider audit services; provider registration; and communications services. In fiscal year 2007/08, a total number of 24,631 active NIHB providers were registered with the HICPS claims processor and, during this time, more than 17 million claim lines were processed through HICPS.
The HICPS Project was established to conduct a competitive procurement to replace the existing HICPS contract, to manage the implementation of the new service contract and ensure a smooth transition from the current incumbent to the new contractor.
Project Implementation - The HICPS Major Crown Project entered the project pre-implementation phase with the December 4, 2007 award of the HICPS contract to ESI Canada.
Overview - The HICPS Project Implementation phase will terminate in December 2009 with a project evaluation. The new adjudication system will be put into operation on December 1, 2009.
Lead Department: Health Canada
Contracting Authority: Public Works and Government Services Canada
Participating Departments: Indian and Northern Affairs Canada
Prime Contractor: ESI Canada, Mississauga, Ontario, Canada
Major Subcontractor: Resolve Corporation, Toronto, Ontario, Canada
Initial meetings with Contractor, coordination of implementation phase project plan
Contract Award (December 4, 2007 through January 2008)
Business Requirements Gathering and Design
February 2008 to August 2008
September 2008 to April 2009
HICPS Testing and Acceptance
May to September 2009
Documentation, Simulations, Validation, Data Conversion and Training
September 2009 to November 2009
HICPS Implementation (ESI Canada officially takes over real-time service provision)
December 1, 2009
Evaluation of the HICPS Project and lessons learned
December 2010 to March 2011
Progress Report and Explanations of Variances: Following the contract award to ESI Canada on December 4, 2007, Health Canada has undertaken joint project planning with ESI Canada. The HICPS Major Crown Project has progressed to date in accordance with the established project milestones. The business requirements gathering phase was completed in August 2008 and the system and service development phase is well underway. Health Canada is also working with ESI and the current contractor in order to ensure a smooth transition of the operations between the two organizations on December 1, 2009.
Industrial Benefits The Industrial Regional Benefits (IRB) model was modified to focus on benefiting the Aboriginal economic community, rather than a specific industry or region of Canada, resulting in an Aboriginal benefit requirement (ABR) which is unique to the HICPS Project.
The development of the ABR approach for the HICPS Project was informed by industry feedback through two Requests for Information (RFI) consultation processes, and approved by Treasury Board. As HICPS Prime Contractor, ESI Canada is required to ensure a mandatory and substantial Aboriginal benefits requirement representing direct or indirect benefits to Aboriginal businesses or individuals.