SOURCES SOUGHT
R -- Railroad Board (RRB) Specialty Medicare Part B Services Administrative Contract (MAC)
- Notice Date
- 11/10/2009
- Notice Type
- Sources Sought
- NAICS
- 524114
— Direct Health and Medical Insurance Carriers
- Contracting Office
- Railroad Retirement Board, Acquisition Management Division, OA, Procurement Section, 844 North Rush Street, 9th Floor NE, Chicago, Illinois, 60611-2092
- ZIP Code
- 60611-2092
- Solicitation Number
- RRB10R001
- Archive Date
- 12/9/2009
- Point of Contact
- Karen J. Haskins-Brewer, Phone: (312) 751-4615, Paul T. Ahern, Phone: (312) 751-7130
- E-Mail Address
-
karen.haskins-brewer@rrb.gov, paul.ahern@rrb.gov
(karen.haskins-brewer@rrb.gov, paul.ahern@rrb.gov)
- Small Business Set-Aside
- N/A
- 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 Statement of Work (SOW) entitled Part B Railroad Specialty Medicare Administrative Contractor Statement of Work as summarized in the description of work below. History: As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS has replaced 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. Also a part of the MMA was the distinction that the new Railroad Medicare Contractor entity would be called the RRB Specialty MAC Describe the work: The Contractor will perform numerous functions to support health care services for Railroad Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of health care services, both institutional and professional, on a Nation-wide basis. 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 Railroad Medicare program. The Medicare programs 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 RRB and CMS, but also with a broad range of agencies (at the federal, state, and local levels of government), other RRB and CMS partners, Contractors, and a diverse range of stakeholders within the health care system of the United States. The Contractor will receive and control Railroad Medicare claims from institutional and professional providers, suppliers, and beneficiaries on a Nation-wide basis 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 insure that all providers are enrolled with regional MACs; 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; operate a Beneficiary Contact Center that responds to Railroad Beneficiary telephone and written inquiries; also respond to complex inquiries from the Medicare Beneficiary Contact Centers (BCCs); and make coverage decisions for new procedures and devices in local areas after consulting with the Regional MACs. The Contractor will conduct benefit integrity activities to identify program vulnerabilities, determine patterns of fraud and work with Medical Review and internal personnel. The Contractor will also provide law enforcement referrals and support. The Contractor also will conduct a variety of different provider services, such as answering written inquiries, and educating providers on Medicare's rules, regulations, and billing procedures. This Sources Sought notice is targeted for any firms cable to conduct the performance of work across a Nation-wide Jurisdiction. The contract will include the following scope of services: 1. Capability to perform all Part B Medicare Administrative Contractor functions specified in attached SOW and outlined in both CMS's Internet-Only-Manuals (IOMs) and Paper-Based Manuals. 2. Provide specified health insurance benefit administrative services, including Part B Medicare claims processing and payment services, in-support 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 as generally described above. Interested parties having the capabilities necessary to perform the stated requirements may submit capability statements by the date and time listed below via email to Karen Haskins-Brewer at Karen.haskins-brewer@rrb.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.); Dun and Bradstreet (DUNS) number 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. Responses must be submitted not later than 4:00 p.m. Central Time on Tuesday, November 24, 2009. 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 RRB to award a contract. The sole intent is to obtain capabilities for set-aside and procurement planning purposes. Contact information: Paul Ahern, Contracting Officer/Supervisory Contract Specialist, 312-751-4923, paul.ahern@rrb.gov; Karen Haskins-Brewer, Contract Administrator, 312/751-4615, Karen.haskins-brewer@rrb.gov.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/RRB/BSS/PD/RRB10R001/listing.html)
- Place of Performance
- Address: Not Applicable for This Sources Sought Notice, United States
- Record
- SN02001404-W 20091112/091110235129-b86197e4397a76a12b0a23b0b4921bb3 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
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