COORDINATION OF BENEFITS (COB) DRAFT REQUEST FOR PROPOSAL AND PRESOLICITATION CONFERENCE The Health Care Financing Administration (HCFA) intends to issue the Medicare Integrity Program's (MIP) Coordination of Benefits (COB) DRAFT Request for Proposal (RFP) for comment on or about Oct 19, 1998, and hold a Pre-Solicitation Conference on Oct 30, 1998. BACKGROUND: The Health Insurance Portability and Accountability Act of 1996 (HIPAA), (Public Law 104-191) was enacted on August 21, 1996. Section 202 of HIPAA adds a new section 1893 to the Social Security Act establishing the "Medicare Integrity Program" (MIP). This Program is funded from Medicare's Federal Hospital Insurance Trust Fund for activities related to both Medicare Parts A and B. Specifically, section 1893 enables HCFA to contract with an expanded pool of eligible entities to carry out the Medicare program integrity activities that are currently performed under contracts with FIs and carriers. Section 1893 identifies Medicare secondary payment (MSP) determinations as one of five enumerated activities that comprise the MIP. MSP generally refers to those situations where a party other than Medicare has primary responsibility to pay for the health care expenses incurred by a Medicare beneficiary. The MSP process was developed to safeguard against making mistaken Medicare primary payments and thus ensure that the Medicare program pays only what the statute requires. Under this solicitation, HCFA is seeking to consolidate activities that would support the collection, management, and reporting of all health insurance coverage of Medicare beneficiaries for the purpose of implementing an improved plan of coordination of Medicare benefits with other insurance coverages. HCFA intends to develop a centralized coordination of benefits operation that will provide quality customer service to its providers and beneficiaries by streamlining the payment process while assuring the integrity of the Medicare Trust Funds. To further that goal, HCFA is seeking a single entity to maintain a comprehensive insurance profile on all Medicare beneficiaries. This entity, called the Coordination of Benefits (COB) Contractor, will be tasked with consolidating the following programs: a) Initial Enrollment Questionnaire (IEQ); b) IRS/SSA/HCFA Data Match (referred to simply as Data Match); c) First Claim Development (FCD); d) Trauma Code Development (TCD); e) 411.25 Notices (a mandated-by-law notice whereby an insurer notifies HCFA that an erroneous primary payment has been made by Medicare); f) Secondary Claims Development; g) Coordination of Benefits Agreement (COBA) (A new HCFA initiative relating to trading partner agreements currently negotiated between Medicare contractors and health plans for the exchange of paid claims data); and h) PAYERID (the proposed national health plan identifier) Registry. The COB Contractor will perform a variety of functions including, but not limited to, the following: a) conduct beneficiary surveys (IEQ) requesting information on the existence of health insurance coverage, other than Medicare, on approximately 200,000 newly enrolled Medicare beneficiaries monthly in accordance with Public Law 103.432 (Medicare Secondary Payer Reforms); b) conduct an annual survey on approximately 250,000 employers soliciting other health insurance coverage of selected Medicare beneficiaries in employer group health plans (GHPs) in accordance with 42 U.S.C. 1395y(b)(5) (Data Match); c) conduct development of other health insurance on controlled work items (FCD, TCD, 411.25 Notices, Secondary Claims) received from HCFA as the result of HCFA Medicare claims processing; d) tabulate and evaluate the information resulting from these surveys and forward the pertinent information to HCFA on an ongoing basis; e) negotiate and maintain agreements (COBA) between HCFA and other health insurers (and Medicaid State Agencies, and their fiscal agents) for the exchange of eligibility and paid claims data for purposes of coordinating correct health claim benefit payments by Medicare and other insurers; f) maintain and operate the PAYERID registry, currently being built by HCFA,that will enumerate all health plans in the United States; and g) maintain customer service staff to validate insurance information to resolve discrepant information and electronically update beneficiary records at HCFA with other insurance information. ABOUT THE COB DRAFT RFP: The COB Draft RFP will be released to the general public on or about Oct 19, 1998. HCFA is interested in receiving questions and comments regarding the entire Draft RFP. Questions and comments should be submitted after Oct 19th. HCFA will evaluate comments received from the general public at the end of the comment period (Nov 13, 1998) and modify the COB Draft RFP accordingly for an anticipated formal solicitation in Nov/Dec 1998. At the Pre-Solicitation Conference, HCFA will attempt to answer as many questions received as possible. ABOUT THE HCFA MIP INTERNET WEB SITE: HCFA has provided information about the Medicare Integrity Program (MIP) on the Internet (WWW.HCFA.GOV/MEDICARE/MIP/). HCFA intends to use this site to provide information about the COB Draft RFP, Pre-Solicitation Conference, COB Interested Parties Database and COB Draft RFP Question and Comment Database. On or about Oct 19, 1998, the web site will allow vendors to place their name on the COB Interested Parties Database, RSVP for the presoliciation conference, download the COB Draft RFP and enter questions and comments to the COB Draft RFP Question and Comment Database (See below). You are encouraged to visit the MIP Internet web site for all information regarding the COB Draft RFP and Pre-Solicitation Conference. PRE-SOLICITATION CONFERENCE INFORMATION: HCFA will hold a Pre-Solicitation Conference on Oct 30, 1998, to explain the requirements of the Draft RFP to interested sources. The conference will be held in the HCFA auditorium and will start at 10:00 a.m. It is anticipated that the conference will run to approximately 3:00 p.m. The conference date is subject to change. Therefore, you should visit the MIP web site to confirm the date before traveling to Baltimore. Organizations wishing to attend the Pre-Solicitation Conference must RSVP by Oct 28, 1998, and may do so via the MIP Web Site at WWW.HCFA.GOV/MEDICARE/MIP/. For those who do not have Internet access, E-mail communications to COB@HCFA.GOV will be acceptable or contact Debbie Strittmatter, Contract Specialist, at 410-786-5136. E-mail communications should include company name, address, point of contact, business type (i.e. audit firm, health insurance company, health care provider, information technology company, other), business size under Standard Industrial Classification (SIC) 7374 which has a size standard of $18 million (See FAR 19.102), number and name of attendees, and if a paper copy of the COB Draft RFP is requested (see below). Conference attendance should be limited to 2 individuals per organization when possible. HCFA is not responsible for travel costs for the pre-solicitation conference. HOW TO OBTAIN THE COB DRAFT RFP: The COB Draft RFP will be available to the general public on or about Oct 19, 1998. Since the COB Draft RFP is large and includes numerous attachments available only in electronic format, HCFA will NOT be providing the COB Draft RFP to the public in an all-paper form. The following formats are available: 1) Internet downloading (see above); and 2) for interested sources who do not have Internet access, a paper copy of the RFP will be provided with RFP attachments and SOW appendices available for viewing at the HCFA library from 8:00 a.m. to 4:00 p.m. daily M-F (contact Elnora Scott at 410-786-7804 if you intend to visit the HCFA library). You are encouraged to use the Internet MIP web site to obtain a copy of the COB Draft RFP. The paper Draft RFP will be sent on or about Oct 19, 1998. Only one Draft RFP will be sent to each organization. COB INTERESTED PARTIES DATABASE AND RSVP FOR PRESOLICITATION CONFERENCE : A COB Interested Parties Database will be generated which will be available for viewing on the MIP web site at all times during the comment period. This database will provide organizations with information about other organizations also interested in the COB effort so that partnering, teaming, subcontracting, etc. relationships can be developed for the anticipated formal proposal submission. This site will allow the vendor to both enter its company information into the interested parties database and to record the names of those who will be attending the presoliciation conference. NOTE: THE "MIP INTERESTED PARTIES DATABASE" AND THE "PSC INTERESTED PARTIES DATABASE" ARE SEPARATE DATABASES. If you wish to be included on those lists you must enter the appropriate information at those specific sites. The "COB INTERESTED PARTIES DATABASE" is for the COB acquisition only. COB DRAFT RFP QUESTIONS & COMMENTS DATABASE: HCFA prefers that interested parties submit questions and comments regarding the COB Draft RFP via the MIP Internet Web Site. However, for parties who do not have access to the Internet, please submit questions and comments electronically via E-Mail to COB@HCFA.GOV. Questionsand comments may also be submitted via postal mail on a 3 inch diskette in WordPerfect version 6.1 to: HCFA, Acquisitions and Grants Group, Attn: Debbie Strittmatter, 7500 Security Blvd, C2-21-15, Baltimore, MD 21244-1850. The COB Draft RFP Questions and Comments database will contain all questions and comments asked via the Internet and will be available for viewing on the MIP web site at all times during the comment period which ends Nov 13, 1998. Posted 10/07/98 (I-SN259968).

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