ClaimsCore Combined Synopsis/Solicitation

This Firm-Fixed-Price contract, awarded under solicitation number 75FCMC26R0022, was issued by the Centers for Medicare & Medicaid Services under the Department of Health and Human Services to acquire a Commercial-Off-The-Shelf claims processing platform to replace legacy Medicare Fee-for-Service adjudication systems. The contract spans multiple option periods from May 2026 through November 2033, with a focus on delivering a cloud-based, interoperable SaaS platform that supports sub-second adjudication, real-time fraud prevention, and integration via HIPAA X12 and FHIR/REST APIs. The Statement of Objectives emphasizes uninterrupted transition, improved beneficiary experience, enhanced policy agility, and seamless connectivity across CMS, Medicare Administrative Contractors, providers, and partners. Pricing for key service line items — CLINs 0004, 0006, 0008, 0010, 0012, and 0014 — is set at firm-fixed monthly unit prices per unique beneficiary (PMPM), with annual prospective true-up adjustments based on actual versus projected beneficiary volumes submitted by the contractor. Unit prices were not finalized at time of solicitation, making the total contract value contingent on future volume estimates and reconciliation. The evaluation process prioritizes non-price factors significantly over cost, assessing corporate experience, performance work statement, quality assurance surveillance plan, and past performance through a best-value tradeoff, with award decisions not limited to the lowest-priced offeror. Proposal submissions must adhere to strict formatting, electronic submission via email, page limits, and font requirements, with all submissions due by March 13, 2026. Contractors are required to comply with extensive cybersecurity, data handling, and procurement integrity standards including FedRAMP authorization, NIST SP 800-88 data sanitization, FIPS 140 and 201-2 encryption and identity verification, Section 508 accessibility, HHS electronic content standards, and prohibitions on covered telecommunications equipment. Compliance with FAR clauses covering code of ethics, whistleblower protections, small business utilization, labor standards, and anti-trafficking is mandatory. Contractor personnel require PIV credentials, and organizational conflicts of interest must be fully disclosed and mitigated. Invoicing is mandatory through the Invoice Processing Platform, with WAWF prohibited. The Contracting Officer and Contract Specialist, based in Baltimore, Maryland, are the primary points of contact for administration and