R -- ORGANIZATION TO PROCESS MEDICARE PART B CLAIMS FOR CLINICAL DIAGNOSTIC LABRATORY TESTS

Notice Date

November 2, 2000

Contracting Office

Health Care Financing Administration, Acquisition and Grants Group, C2-21-15, 7500 Security Boulevard, Baltimore, MD., 21244-1850

ZIP Code

21244-1850

Solicitation Number

HCFA-00-4-MCD-BCS

Point of Contact

Bart C. Smetana, Contract Officer 410-786-7909 E-mail bsmetana@hcfa.gov

E-Mail Address

Bart C. Smetana@HCFA.gov (Bart C. Smetana @HCFA.gov)

Description

DESC: The Balanced Budget Act of 1997 (BBA), provided a number of amendments to the Social Security Act affecting the Medicare program. Among those amendments is a provision found at Section 4554 intended to improve the administration of the Laboratory Tests Benefit. That section requires the Secretary to divide the United States into no more than five regions and to designate a Regional Laboratory Carrier (RLC) for each region. The RLCs will process and make payment of claims under Part B of title XVIII of the Social Security Act with respect to clinical diagnostic laboratory tests. The Secretary has decided to limit the number of carriers processing clinical diagnostic laboratory test claims to two contractors and will be procuring those contracts through full and open competition. The Health Care Financing Administration (HCFA) has decided to implement the RLC provisions incrementally. The first increment will involve claims for clinical diagnostic laboratory tests submitted only by independent laboratories. The RLCs will perform all of the duties associated with the processing of clinical diagnostic laboratory test claims as described in the solicitation's Statement of Work. The RLC contracts will contain provisions that will allow the RLCs to assume the additional increments as they are implemented. This provision of the BBA also provides that claims for clinical diagnostic laboratory tests submitted by physician office laboratories be included in the RLC jurisdiction, unless the Secretary determines that to do so would result in an undue burden. HCFA is currently in the process of accessing the impact of including clinical diagnostic laboratory test claims submitted by physicians to the selected RLC contractors. If the Secretary determines that including claims for physician office laboratory tests does not result in an undue burden, those claims will be added to the RLC's processing workload. HCFA will require that the RLCs use the HCFA approved Multi-Carrier System (MCS) claims processing system to process RLC claims. Offerors not currently using the MCS should provide their strategy for meeting this requirement. To qualify the offeror must meet the statutory definition of a carrier. For purposes of this procurement the statutory definition of a carrier means "with respect to providers of services and other persons, a voluntary association, corporation, partnership, or other nongovernmental organization which is lawfully engaged in providing, paying for, or reimbursing the costs of health services under group insurance policies or contracts, medical or hospital service agreement, membership or subscription contracts, or similar group agreement, in consideration of premiums or other periodic charges payable to the carrier, including a health benefits plan duly sponsored or underwritten by an employee organization and with respect to providers of services only, any agency or organization with which an agreement is in effect under section 1816 of the Social Security Act." Potential offerors will be limited to the award of just one of these procurements. Interested parties are asked to respond in writing to this notice when requesting a copy of the RFP. Telephone requests for the RFP will not be accepted. Any organization receiving an RFP will automatically receive any amendments to the solicitation. It is anticipated that solicitation number HCFA-00-4-MCD-BCS will be released on or about December 31, 2000. Requests shall be mailed to the above address, or faxed to (410) 786-643.

Record

Loren Data Corp. 20001106/RSOL002.HTM (W-307 SN5057X2)