SOLICITATION NOTICE
R -- A/B MAC Jurisdiction 5 Pre-Solicitation Notice
- Notice Date
- 5/19/2011
- 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
- RFP-CMS-2011-0014
- Point of Contact
- James W. Wilkerson, Phone: 4107865586, Christina Honey, Phone: 410-786-5791
- E-Mail Address
-
james.wilkerson@cms.hhs.gov, christina.honey@cms.hhs.gov
(james.wilkerson@cms.hhs.gov, christina.honey@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- RFP-CMS-2011-0014 A/B MAC Jurisdiction 5 Pre-solicitation Notice: As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS must re-compete its Part A & B Medicare Administrative Contractor (A/B MAC) contracts every five (5) years. The purpose of this contract is to obtain a A/B 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 will perform numerous functions to support health care services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of health care services, both institutional and professional, for a defined geographic area or "jurisdiction." The Contractor will 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 program. The Medicare program's legal, policy, and operating environment is complex, and the Contractor will utilize or interact with certain CMS-required payment schedules, systems, equipment, and operational capabilities in the performance of its functions. Further, the Contractor will coordinate its activities not only with the 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 institutional and professional providers, suppliers, and beneficiaries within its jurisdiction and will perform standard or required editing 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 will enroll new providers; conduct redeterminations on appeals of claims; operate a Provider Customer Service Program (PCSP) that educates providers about the Medicare program and responds to provider telephone and written inquiries; respond to complex inquiries from Beneficiary Contact Centers (BCCs); and make coverage decisions for new procedures and devices in local areas. The Contractor also will conduct a variety of different provider services, such as enrolling new providers in the program, answering written inquiries, and educating providers on Medicare's rules, regulations, and billing procedures. CMS anticipates releasing a solicitation for Jurisdiction 5 (comprised of the states of Alaska, Idaho, Oregon, Washington, Arizona, North Dakota, South Dakota, Wyoming, Iowa, Kansas, Missouri, Nebraska, Illinois, Minnesota, Wisconsin, Arkansas, Louisiana, Mississippi, Indiana, Michigan, Florida, Alabama, Georgia, Tennessee, North Carolina, South Carolina, Virginia, West Virginia, Massachusetts, New Hampshire, Indiana, Kentucky, Ohio) on or about June 3, 2011. The contract will include a base year plus four one-year options. The anticipated proposal due date is July 15, 2011 with an anticipated award date of March 1, 2012. This solicitation is expected to be issued as pending availability of funds.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/RFP-CMS-2011-0014/listing.html)
- Record
- SN02452651-W 20110521/110519235001-3b35c6d9b292abb782297b3230bc3cd2 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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