SOLICITATION NOTICE
G -- Part A/B Medicare Administrative Contractor, Jurisdiction M
- Notice Date
- 7/11/2014
- Notice Type
- Presolicitation
- NAICS
- 524114
— Direct Health and Medical Insurance Carriers
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd., C2-21-15, Baltimore, Maryland, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- HHSM-500-2014-RFP-0071
- Archive Date
- 8/1/2014
- Point of Contact
- Alice McGruder, Phone: 4107868166, R. Salem Fussell, Phone: 4107868859
- E-Mail Address
-
alice.mcgruder@cms.hhs.gov, salem.fussell@cms.hhs.gov
(alice.mcgruder@cms.hhs.gov, salem.fussell@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS must recompete its MAC contracts every five (5) years. The purpose of this contract is to obtain a MAC (hereinafter, referred to as "the Contractor") to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the Medicare FFS program. The Contractor shall perform its responsibilities under the direction of CMS. The Contractor shall perform numerous functions on behalf of Medicare beneficiaries and shall establish relationships with providers of Medicare services, both in-patient (Part A) and out-patient (Part B) for a defined geographic area or "jurisdiction." The Contractor shall perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals and CMS requirements to ensure the financial integrity of the Medicare FFS program. The Medicare FFS program's legal, policy and operating environment is complex, and the Contractor shall be familiar with and utilize or interact with certain CMS-required payment schedules, systems, equipment and/or operational capabilities in the performance of its functions. Further, the Contractor shall coordinate its activities not only with CMS, but also with a broad range of agencies at the federal, state and local levels of government, other CMS partners and Contractors, and a diverse range of stakeholders within the health care system of the United States. In accordance with CMS' technical specifications, the Contractor shall receive and control Medicare claims from providers, suppliers and beneficiaries within its jurisdiction, as well as perform edits on these claims to determine whether the claims are complete and should be paid. An edit is logic within the Standard Claims Processing System, or Program Integrity Supplemental Edit Software, that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and, depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review. Contractors must be able to determine the need for locality-driven edits in their jurisdiction, as well as those included in the Standard and Supplemental systems, and to develop the logic for those local coverage determinations. In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor also conducts a variety of different Medicare provider and supplier outreach and response services, such as education and on Medicare's rules and regulations and billing procedures, and answering written inquiries. The Contractor also operates Medicare's provider and supplier toll-free lines across the country to answer a wide-range of questions. Additionally, the Contractor conducts redeterminations on appeals of claims, responds to complex beneficiary inquiries referred from the Beneficiary Contact Centers, does Medical Review on selected claims, and conducts rigorous quality control on the tens of millions of claims processed each year. The Contractor shall receive and review over five hundred Change Requests issued by CMS each year to modify the systems and services offered by Medicare, determine the impact of the Change Requests on the Contractor's processes and systems, and implement these changes in the timeframes specified in the Change Requests. CMS anticipates releasing a solicitation for Jurisdiction M (which includes the states North Carolina, South Carolina, Virginia, and West Virginia) on or about August 1, 2014. The contract will include a base year plus four one-year options. The anticipated proposal due date is October 1, 2014 with an anticipated award date of May 15, 2015. This solicitation is expected to be issued as pending avaAs required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS must recompete its MAC contracts every five (5) years. The purpose of this contract is to obtain a MAC (hereinafter, referred to as "the Contractor") to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the Medicare FFS program. The Contractor shall perform its responsibilities under the direction of CMS. The Contractor shall perform numerous functions on behalf of Medicare beneficiaries and shall establish relationships with providers of Medicare services, both in-patient (Part A) and out-patient (Part B) for a defined geographic area or "jurisdiction." The Contractor shall perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals and CMS requirements to ensure the financial integrity of the Medicare FFS program. The Medicare FFS program's legal, policy and operating environment is complex, and the Contractor shall be familiar with and utilize or interact with certain CMS-required payment schedules, systems, equipment and/or operational capabilities in the performance of its functions. Further, the Contractor shall coordinate its activities not only with CMS, but also with a broad range of agencies at the federal, state and local levels of government, other CMS partners and Contractors, and a diverse range of stakeholders within the health care system of the United States. In accordance with CMS' technical specifications, the Contractor shall receive and control Medicare claims from providers, suppliers and beneficiaries within its jurisdiction, as well as perform edits on these claims to determine whether the claims are complete and should be paid. An edit is defined as "logic within the Standard Claims Processing System (or PSC/ZPIC Supplemental Edit Software) that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and, depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review." In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor also conducts a variety of different Medicare provider and supplier outreach and response services, such as education and on Medicare's rules and regulations and billing procedures, and answering written inquiries. The Contractor also operates Medicare's provider and supplier toll-free lines across the country to answer a wide-range of questions. Additionally, the Contractor conducts redeterminations on appeals of claims, responds to complex beneficiary inquiries referred from the Beneficiary Contact Centers, does Medical Review on selected claims, and conducts rigorous quality control on the tens of millions of claims processed each year. The Contractor shall receive and review over five hundred Change Requests issued by CMS each year to modify the systems and services offered by Medicare, determine the impact of the Change Requests on the Contractor's processes and systems, and implement these changes in the timeframes specified in the Change Requests. CMS anticipates releasing a solicitation for Jurisdiction M (which includes the states North Carolina, South Carolina, Virginia, and West Virginia) on or about August 1, 2014. The contract will include a base year plus four one-year options. The anticipated proposal due date is October 1, 2014 with an anticipated award date of May 15, 2015. This solicitation is expected to be issued as pending availability of funds. lability of funds.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/HHSM-500-2014-RFP-0071/listing.html)
- Record
- SN03422190-W 20140713/140712022105-b8afa46192745401bebdb134a23fb4f2 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
| FSG Index | This Issue's Index | Today's FBO Daily Index Page |