SOURCES SOUGHT
D -- Fiscal Intermediary Shared System Maintainer - draft statement of work
- Notice Date
- 2/17/2016
- Notice Type
- Sources Sought
- NAICS
- 541512
— Computer Systems Design Services
- 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
- APP170406
- Archive Date
- 3/18/2016
- Point of Contact
- Anginna Sims, Phone: 410-786-2129, Charles Littleton, Phone: 410-786-3291
- E-Mail Address
-
anginna.sims@cms.hhs.gov, charles.littleton@cms.hhs.gov
(anginna.sims@cms.hhs.gov, charles.littleton@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- sources sought notice draft statement of work This is a SOURCES SOUGHT NOTICE posted for INFORMATIONAL PURPOSES ONLY. It will be used to obtain information regarding the availability and capability of small businesses (e.g.: 8(a), service-disabled veteran owned small businesses, HUBZone small businesses, women-owned small businesses and small businesses) to provide the services described herein. The Centers for Medicare & Medicaid Services (CMS) will use the information received to determine if the work described herein will be set-aside for small business. Based upon the results of the evaluation of the respondents' capability, CMS may set the work aside for a specific type of small business (i.e. HubZone, WOSB, SDVOSB, or 8(a)), small business, or determine that the work should be competed on an unrestricted basis. Background The Medicare program is a Federal health insurance program. The program benefits senior citizens aged 65 or older and those who are disabled or diagnosed with chronic renal disorders. Congress established Medicare in 1965 when it enacted Title XVIII of the Social Security Act (the Act). CMS has the primary responsibility for administering the Medicare program as delegated by the Secretary of the Department of Health and Human Services (DHHS). CMS administers the Medicare program on a day-to-day basis, including formulation and promulgation of Medicare policy and guidance, contract execution, operation and management, maintenance and review of utilization records, and general Medicare financing. CMS is the largest purchaser of health care in the United States. It is CMS' mission to assure high quality health care for all beneficiaries. This contract specifically applies that mission by fostering excellence in the design and administration of CMS' programs. Within the timeframe of this contract, that mission has the following objectives: 1.Stabilize the Medicare claims processing environment 2.Modernize CMS' systems and databases and reduce system maintenance costs while extending the life of the system 3.Move toward standardizing all shared system maintainers (SSMs) 4.Improve system quality and performance 5.Incorporate more mandates on an annual basis 6.Implement changes and enhancements It is CMS' goal to achieve these objectives by improving the quality and timeliness of Medicare business requirements. It is CMS' requirement that the shared system maintainer provide the means to achieve these goals by maximizing the use of automation and other Best Practices across the system development life cycle (SDLC). Medicare's traditional Fee for Service (FFS) coverage consists of two distinct parts: 1.Part A hospital insurance covers expenses for medical services furnished in institutional settings, such as hospitals or skilled nursing facilities, or services provided by a home health agency or hospice, and 2.Part B supplemental medical insurance covers physician and other practitioner services; outpatient services and certain Durable Medical Equipment, Prosthetics and Orthotics Supplies (DMEPOS) services. In the 1980's CMS began the transition to a national standardization in processing. Core requirements for Medicare system contractors were established and contractors were encouraged to use standard software systems in claims processing and shared processing. The goal of these initiatives was twofold: Reduce variation in software and hardware platforms by sharing a single platform among multiple contractors, and achieve savings in system development and maintenance as well as a reduction in processing costs. The transition to standardized processing resulted in the establishment of the following: 1.Three claims processing Shared System: Fiscal Intermediary Shared System (FISS) for institutional Part A and B services, Multi Carrier System (MCS) for physician and other practitioner services, and DME Maintainer for DMEPOS services, 2.The Medicare eligibility system Common Working File ((CWF), which provides a single data source where the contractors can verify beneficiary eligibility to receive prepayment review and approval of claims, and 3.The single testing contractor (STC) is responsible for BETA testing for the shared systems and interfaces, previously referred to as Independent Testing Contractor (ITC), Beta testing, Quarterly Release Test Management (QRTM) and off-quarter testing of production support fixes and enhancements. Purpose CMS, previously the Health Care Financing Administration, currently has one Part A national shared claim processing system used by Medicare Administrative Contractors (MACs). This system is the Fiscal Intermediary Shared System (FISS). The purpose of this task order is to obtain computer software services to support FISS, including maintenance, developmental enhancements, and special projects. FISS is the primary component of Medicare's claim processing function under Medicare Part A. All efforts shall be performed in accordance with CMS requirements and shall meet the objectives of increasing efficiency and effectiveness of claims processing operations and timely implementation of statutory and regulatory requirements. FISS System Overview The FISS is a critical component of the Fee-for-Service (FFS) program, processing over $270 billion dollars of Medicare claims a year, supporting Medicare's mission to provide quality health care to beneficiaries. The FISS is the shared systems used to process Medicare Part A claims, including outpatient claims submitted under Part B. It interfaces directly with the Common Working File (CWF) system for verification, validation, and payment authorization. Claims are entered, corrected, adjusted, or canceled. Inquiries for status of claims, for additional development requests, or for eligibility and various codes are processed. Claims paid through the FISS systems include the new CMMI initiatives; Prior Authorization, Next Generation Accountable Care Organization new payment models and HITECH. The FISS meets CMS' core requirements for processing Medicare Part A claims, to include: data collection and validation, claims control, pricing, adjudication, correspondence, on-line inquiry, file maintenance, reimbursement, and financial processing. The FISS has four quarterly releases that control, implement, and update software changes due to legislative mandates that dictate the amount of payment for services or coverage levels. FISS also implement changes needed to support the Medicare Administrative Contractors (MACs) authority for the Medicare FFS Program. Software changes for the claims processing operations are managed in quarterly releases developed through a change control process that begins with the Medicare Change Control Board (MCCB) review and prioritization of pending requests. The FFS Operations Board approves the quarterly releases with oversight by the FFS Governance Council and manages/integrates day-to-day operations of the FFS program across CMS. Error-free releases that implement legislative mandates with minimal interruption to processing ensure that beneficiaries receive the correct service and providers receive the correct payment. The FISS is made up of very complex and a significant number of lines of code based upon traditional CICS online, COBOL, COBOL II and ALC batch programs, using a VSAM data structure. MACs use the FISS to process claims submitted by providers. The claims received are processed through various computer software modules and sub routines, databases, files and records, including interfacing with the CWF. The FISS computer software currently performs data collection and validation, claims control, pricing, adjudication, correspondence, on-line inquiry; file maintenance, reports, reimbursement, and financial processing. Currently all Medicare MACs use the FISS to process claims submitted by providers. Claims received are processed through various computer software modules and sub routines, databases, files and records, including interfacing with CWF. FISS computer software currently performs data collection and validation, claims control, pricing, adjudication, correspondence, on-line inquiry; file maintenance, reports, reimbursement, and financial processing. The FISS is made up of over 4.7 million lines of code based upon traditional CICS online and COBOL, COBOL II and ALC batch programs, using a VSAM data structure. The following drivers control processing: 1. Controller/router (prioritize actions and route claims), 2. Denial (modify claim record and generate benefit savings record), 3. Control (establish beneficiary record and update beneficiary data), 4. Unibill/preconsistency (unibill face-of-claim validity and numeric/alphanumeric data check), 5. Consistency edit (shared system, value code, condition code, span code, etc.), 6. Administrative edit (provider, Integrated Outpatient Code Editor [IOCE], Medicare Secondary Payer [MSP], other physician, End Stage Renal Disease [ESRD], etc.), 7. Duplicate edit (type of bill 11X through 85X), 8. Lab/HCPCS (lab pricing, DME pricing, mammography pricing, etc.), 9. ESRD edit (historical data analysis, duplicate processing, pricing), 10. Benefit utilization, 11. Medical policy (parameter edits, physical therapy edits), 12. Pricing edits, 13. Payment, 14. MSP primary (error from CWF, MSP common edits, individual MSP code edits, etc.), 15. MSP secondary (pay MSP interface, MSP update record, apply MSP pay changes, etc.), 16. Additional development request (ADR) (generate, track, denial action), 17. Session termination (CWF transmit/accept, update files), and 18. Post payment (identify prior claims, cost-avoid savings, adjustments, etc.), and 19. The Healthcare Integrated General Ledger Accounting System (HIGLAS). FISS contains the following sub-systems: 1. Report, 2. Financial, 3. Automated correspondence, 4. Purge and retrieval, 5. Expert Claims Processing System. The FISS contractor coordinates activities with the Baltimore Data Center, the STC, CWF and HIGLAS. Responses should include, at a minimum, the information identified in each of the following: 1. Business Information: a. Company Name b. Company Address c. D&B DUNS Number d. Current GSA or GWAC contract(s) and/or schedules(s) that you possess which are appropriate to this Sources Sought. e. Does your organization have a Government approved accounting system? If so, please identify the agency that approved the system. f. Type of company (e.g., small business, 8(a), veteran-owned small business, service-disabled veteran owned small business, HUB Zone small business, small disadvantaged business, and women owned small business) as validated via the Central Contractor Registration (CCR). g. Company Point of Contact (POC) name, phone and email address h. POC, phone and email address of individuals who can corroborate the demonstrated capabilities identified in the responses. NOTE: All teaming arrangements and Joint Ventures shall also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements and Joint Ventures are encouraged. Prime/Sub teaming arrangements, defined under FAR 9.601(2), should identified the roles for each business entity listed for each capability point, and show that the Prime has the capability and capacity to perform at least 50% of the work in the Prime/Sub relationship. Joint Ventures are defined by FAR 9.601(1). 2. Please describe your general overall knowledge and experience with, and/or ability to provide with teaming partners, the various programs overseen or operated by CMS. Also, please describe your experience working with CMS data systems (including shared systems) and files. 3. Please describe your general overall experience in, and/or ability to provide with teaming partners, the use of complex programing to develop shared systems that ensures maximum functionally. Please also describe techniques you have used to achieve the stated response for programing the FISS or similar system in size and scope. 4. Please describe your experience in, and/or ability to provide with teaming partners, the implementation of a shared system that runs in an IBM operating environment and uses Virtual Storage Access Method (VSAM) file structure with CICS as the data communications protocol. The experience should also be with COBOL LE; file compression and expansion, and special utility modules written in Assembler Language Code (ALC). 5. At the point of award, the awardee will have a transition onto the project. Please describe your experience in, and/or ability to provide with teaming partners, a seamless transition that insures claims processing remains uninterrupted. 6. Please describe current or past projects where your firm or teaming partners have been successful in implementing systems that support claim processing in the public or private sector. Please include a brief description of the methodology, your role in developing the methodology and the challenges you faced in implementing the project and the overall size of the project (by lines of code). Interested parties having the capability and expertise necessary to perform the stated requirements outlined above are requested to submit capability statements via email to: Anginna.Sims@cms.hhs.gov and Charles.Littleton@cms.hhs.gov on or before 12:00 Noon (EST) March 3, 2016. Responses are limited to 12 pages only and should be submitted in a Word or Word comparable document. Page size should be 8.5 by 11 inches, using 12 pt. font and standard margins. While the intent of this sources sought is to determine capabilities, vendors submitting a capabilities statement, may submit a single page of questions and comments on the provided draft Statement of Work (SOW). This one page will not be counted as part of the 12 page limit for capabilities statements. Additional Information: •Proprietary Information and Disclaimers: Respondents should identify any proprietary information in its SSN response. Information submitted in response to this SSN will be used at the discretion of the Government. Further, the information submitted will remain confidential insofar as permitted by law, including the Freedom of Information and Privacy Acts. CMS reserves the right to utilize any non-proprietary technical information in the anticipated SOW or solicitation. •Responses to the SSN are not offers and cannot be accepted by CMS to form a binding contract. CMS does not intend to award a contract on the basis of this SSN, or to otherwise pay for the information solicited. No reimbursement for costs will be made associated with providing information in response to this SSN or follow-up information request. •Respondents should be aware that this SSN is for market research purposes only and any responses submitted do not constitute a commitment by CMS to treat any offeror more or less favorably in any anticipated forthcoming solicitation and/or ultimate award. •Responses to the SSN will not be returned. All communications shall be by email. •Respondents will not be notified of the results of the review of the responses. •Although it is not necessary to address within capability statements, interested vendors and teaming partners, should be aware of any potential, actual, or perceived organizational conflicts of interests. Any real or potential conflicts must be sufficiently mitigated prior to contract award. For further guidance, refer to the Federal Acquisition Regulation, Part 9.5.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/APP170406/listing.html)
- Place of Performance
- Address: 7500 Security Blvd, Baltimore, Maryland, 21244, United States
- Zip Code: 21244
- Zip Code: 21244
- Record
- SN04022365-W 20160219/160217235152-9de50440e8a1403c84e18edcf6a958f8 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
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