Centers for Medicare & Medicaid Services (CMS) Medicare Section 111 Reporting Services

The Orange County Transportation Authority (OCTA) is soliciting proposals for professional services to manage Centers for Medicare and Medicaid Services (CMS) Medicare Section 111 reporting for Non-Group Health Plan liability claims. This firm-fixed-price contract is intended for an initial three-year term beginning January 1, 2027, with a potential two-year option period. The primary scope of work involves serving as OCTA's reporting agent, which includes the complex migration and reconciliation of historical CMS data from the incumbent provider, Verisk, into OCTA's Origami Risk claims system. The selected contractor will be responsible for ensuring continuous regulatory compliance, managing monthly eligibility queries, and performing quarterly claim and TIN submissions while maintaining 100% accuracy and timeliness to avoid civil-money penalties. The procurement will be awarded based on a best-value trade-off process, prioritizing technical merit over lowest price. Evaluation factors are weighted as follows: Work Plan (30%), Qualifications of the Firm (25%), Cost (25%), and Staffing/Project Organization (20%). Qualified firms must demonstrate at least three years of specialized experience in Section 111 reporting and proven expertise in secure system integration. High standards for data security are mandatory, requiring encryption, multi-factor authentication, and the ability to provide independent security assurance such as SOC 2 Type II. The contractor must also adhere to strict performance response times for critical issues and assume all financial risk for routine CMS updates or fluctuations in claim volume.