A/B Medicare Administrative Contractor (MAC) Jurisdiction E, K, or L

Introduction This SOURCES SOUGHT NOTICE is 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) capable of providing specific fee-for-service (FFS) health insurance benefit administration services, including Medicare claims processing and payment services, in support of the "traditional" Medicare program (also known as the Medicare fee-for service, or FFS program) in accordance with the Draft Statement of Work (SOW) entitled A/B Medicare Administrative Contractor (MAC) Sources Sought SOW Draft. The information obtained from this market research will assist the Centers for Medicare & Medicaid Services (CMS) in the planning of its acquisition strategy. When responding, please be sure to indicate whether you have a GSA schedule contract, a GSA 8(a) STARS contract, or a GSA VETS GWAC. THIS NOTICE IS STRICTLY FOR THE PURPOSE OF MARKET RESEARCH. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH. Background As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS must re-compete its MAC contracts every five (5) years. The purpose of the competition is to obtain a MAC (hereinafter, referred to as "the Contractor") to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the Medicare FFS program. The Contractor will perform its responsibilities under the direction of CMS. The Contractor will perform numerous functions on behalf of Medicare beneficiaries and will establish relationships with providers of Medicare services, both in-patient (Part A) and out-patient (Part B) for a defined geographic area or "jurisdiction." The Contractor will perform the requirements of the contract in accordance with applicable laws, regulations, Medicare manuals and CMS requirements to ensure the financial integrity of the Medicare FFS program. The Medicare FFS program's legal, policy and operating environment is very complex; consequently, the Contractor is required to be familiar with and able to use or interact with certain CMS-required payment schedules, systems, equipment and/or operational capabilities in the performance of the contract functions. Further, the Contractor shall coordinate its activities not only with 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. In accordance with CMS' technical specifications, the Contractor will receive and control Medicare claims from providers, suppliers and beneficiaries within the particular jurisdiction, and will perform edits on these claims to determine whether the claims are complete and should be paid. An edit is logic within the Standard Claims Processing System, or Program Integrity Supplemental Edit Software, that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and, depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review. Contractors must be able to determine the need for locality-driven edits in their jurisdiction, as well as those included in the Standard and Supplemental systems, and to develop the logic for those local coverage determinations. In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor also conducts a variety of Medicare provider and supplier outreach and response services, such as education with respect to Medicare rules and regulations, billing procedures; the contractor will also answer written inquiries. The Contractor will operate the Medicare provider and supplier toll-free lines across the country to answer a wide-range of questions. Additionally, the Contractor will conduct redeterminations with respect to appeals of claims, responds to complex beneficiary inquiries referred from the Beneficiary Contact Centers, performs Medical Review on selected claims, and conducts rigorous quality control on the tens of millions of claims processed each year. The Contractor will receive and review over five hundred Change Requests issued by CMS each year to modify the systems and services offered by Medicare, determine the impact of the Change Requests on the Contractor's processes and systems, and implement these changes in the time frames specified in the Change Requests. This Sources Sought notice is targeted for: Part A/B Jurisdiction E: California, Hawaii, Nevada, Pacific Islands Part A/B Jurisdiction K: New York, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Part A/B Jurisdiction L: Delaware, Maryland, Pennsylvania, New Jersey, Washington, D.C. Response Information In order to respond to this notice, potential small businesses must submit a capability statement to indicate experience and/or the ability: 1. To perform all MAC functions specified in either of the attached MAC SOWs and outlined in both the CMS Internet-Only-Manuals (IOMs) at this web address: http://www.cms.hhs.gov/Manuals/IOM/list.asp and Paper-Based Manuals; and 2. To provide specified health insurance benefit administrative services, including Medicare claims processing and payment services, in support of the Medicare FFS program. Potential small businesses shall also include the business information outlined in the section below as part of their response. Business Information 1. DUNS: 2. Company Name 3. Company Address 4. Current GSA Schedules appropriate to this Sources Sought 5. Indicate whether you have a Government approved accounting system. If so, please identify the agency that approved the system. 6. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp. 7. Company Point of Contact, Phone, and Email address Teaming Arrangements All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged. Response Due Date Responses must be submitted electronically not later than 2:00 PM Eastern Standard Time, Friday, August 5, 2011 to Brenda A. Clark, Contracting Officer, at Brenda.Clark@cms.hhs.gov and Jason Vollmer, at Jason.Vollmer@cms.hhs.gov. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is 10 pages. This Sources Sought Notice is for information and planning purposes only and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded based upon this Notice. No reimbursement will be made for any costs associated with providing information in response to this Notice. Respondents will not be notified of the results of CMS' review of the information submitted. . Capability statements will not be returned and will not be accepted after the due date.