SOURCES SOUGHT
R -- A/B MAC Cycle One( J1, J2, J7, J13) and Cycle Two
- Notice Date
- 10/16/2006
- Notice Type
- Sources Sought
- NAICS
- 524114
— Direct Health and Medical Insurance Carriers
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, formerly known as the Health Care Financing Administration, Office of Acquisition and Grants Management, 7500 Security Blvd. C2-21-15, Baltimore, MD, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- AB-MAC-Cycle-One-and-Cycle-Two
- Response Due
- 10/30/2006
- Archive Date
- 11/14/2006
- Description
- Background: This is a SOURCES SOUGHT NOTICE to determine the availability of potential small businesses (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that can provide specific fee-for service health insurance benefit administration services including Medicare claims processing and payment services, in support of the Medicare program (also known as the Medicare fee-for service, or FSS program in accordance with the Draft Statement of Work (SOW) entitled Part A and Part B Medicare Administrative Contractor Statement of Work. The second RFP (A/B MAC Cycle One) will be for Jurisdictions 1, 2, 7 and 13. There will be future RFP?s (A/B MAC Cycle Two) within the year that will encompass the other jurisdictions. Multiple awards will be made. This sources sought notice covers the Second RFP for Cycle One (Jurisdictions 1,2,7 and 13) and Cycle Two (Jursidiction 6,8,9,10,11,14 and 15). History: As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS will replace its current claims payment contractors, fiscal intermediaries and carriers with new contract entities called Medicare Administrative Contractors (MACs). As a result of MMA, CMS designed new MAC jurisdictions to balance the allocation of workloads, promote competition, account for integration of claims processing activities and mitigate the risk to the Medicare program during the transition to the new contractors. Describe the work: 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. The Contractor will 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. In addition, the Contractor will calculate Medicare payment amounts and arrange for remittance of 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 that both responds to provider telephone and written inquiries and provides educational opportunities with respect to the Medicare program; 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. In addition, the Contractor will staff CMS? Medicare provider toll-free lines to answer a wide range of provider questions for its jurisdiction. The North American Industrial Classification Sysytem (NAICS) code is 524114: direct Health and Medical Insurance Carriers. This Sources Sought notice is targeted for Jurisdiction 1 (includes California, Nevada, Guam, Northern Mariana Islands, Ameican Samoa, and Hawaii), Jurisdiction 2 (includes Washington, Oregon, Idaho, and Alaska), Jurisdiction 6 (includes Illinois, Minnesota , and Wisconsin), Jurisdiction 7 (includes Arkansas, Louisiana, and Mississippi), Jurisdiction 8 (includes Indiana, and Michigan), Jurisdiction 9 (includes Florida , Virgin Islands, and Puerto Rico), Jurisdiction 10 (includes Alabama, Georgia, and Tennessee), Jurisdiction 11 (includes North Carolina, South Carolina, Virginia, and West Virginia), Jurisdiction 13 (includes New York, and Connecticut), Jurisdiction 14 (includes Massachusettes, Maine, New Hampshire, Rhode Island, andVermont), Jurisdiction 15 (includes Kentucky, and Ohio). The contract will include the following scope of services: 1. Capability to perform all Medicare Administrative Contractor functions specified in attached SOW and outlined in both the Internet-Only-Manuals (IOMs) and Paper-Based Manuals. 2. Provide specified health insurance benefit administrative services, including Medicare claims processing and payment services, insupport of the Medicare fee-for-services (FFS) program . List Contractor Requirements: The contractor will be responsible for the requirements set forth in the Statement of Work attached to this notice. Interested parties having the capabilities necessary to perform the stated requirements may submit capability statements via email to Desiree Wheeler at Desiree.Wheeler@cms.hhs.gov. CAPABILITY STATEMENTS MUST DEMONSTRATE THE MINIMUM REQUIREMENTS OUTLINED ABOVE. Please address each in the same order as listed above. Capability statements shall also include the following information: company name, address, point of contact, phone/fax/email, and business size and status,(e.g., small business, 8(a), veteran-owned small business, service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, and women owned small business) including any letters, certificates, or similar documentation indicating such status; corporate structure (corporation, LLC, sole proprietorship, partnership, limited liability partnership, professional corporation, etc.); and tax identification number. Capability Statements shall be limited to 20 pages and shall include any/all teaming arrangements. Teaming Arrangements: All teaming arrangements shall also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged. Responses must be submitted not later than Monday, October 30, 2006. Capability statements will not be returned and will not be accepted after the due date. This is not an invitation for bid, request for proposal or other solicitation and in no way obligates CMS to award a contract. The sole intent is to obtain capabilities for set-aside and procurement planning purposes. Contact information: Cathy Baldwin, Contracting Officer, 410-786-5791, Cathy.Baldwin@cms.hhs.gov; Desiree Wheeler, Contract Specialist, 410-786-2404, Desiree.Wheeler@cms.hhs.gov
- Record
- SN01165818-W 20061018/061016220145 (fbodaily.com)
- Source
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