D -- Advanced Technology Platform for the Centers for Medicare and Medicaid Services (CMS) Claims Processing

Advanced Technology Platform for CMS Claims Processing -- Sources Sought Notice The Centers for Medicare and Medicaid Services (CMS) is seeking sources to develop modern systems for the automated administration and support of its claims processing and associated functions. The following features that differentiate this platform from currently deployed technology shall characterize the advanced system. 1. The system shall be based on a fully articulated model of entities and relationships that represent the semantics of the CMS Health Care programs. This model shall be furnished as part of the product and be configurable to accommodate future changes to those programs. This model shall be an active model such that the components defined within it are used directly in the definition of the execution mapping which actually drives the logic path for the computer. 2. The system shall feature a high-level English oriented language that is semantically specific to the Health Care Industry. This language shall be suitable for defining Medicare and Medicaid regulations, directives and manual procedures by business analysts having no previous computer programming experience. This language shall be translatable directly to the definition of the execution mapping which actually drives the logic path for the computer. 3. The system shall create modular execution maps that define major business functions such as claims adjudication. These execution maps shall be formed by combining attributes and methods found within the formalized system model and the high-level English oriented language. These execution maps shall be easily maintainable and interactively updateable. These execution maps shall not rely upon the third generation edit-compile-link-debug-edit cycle. 4. The system shall support the generation of commercial quality programmatic notices, such as Medicare Summary Notices, directly from the high-level English oriented language described in Item 2 above. 5. The system shall feature integrated version control that tracks all changes. 6. The system shall be developed using open, portable technology standards. The system is required to run on both mid-tier (Unix) platforms as well as mainframe (IBM OS//390) platforms. 7. The system shall use Internet technology to enable the user interface. 8. The system shall support near-real time replication of online transactions to data warehousing processors for the support of multi-tier information retrieval requirements. CMS plans to acquire this technology platform to support a proof of concept project that must be completed within calendar year 2002. Any questions with regards to this sources sought notice should be directed to Ms. Cathy Baldwin at (410) 786-5791 or e-mail at cbaldwin@cms.hhs.gov. If your organization can meet these requirements, please submit sufficient documentation for our review. In addition, please provide Company Name, Company address, Company Point of Contact (phone number and e-mail), and Company size (Large Business, Small Business, and Small Disadvantaged Business). All responses to this sources sought notice shall be received at the following address no later than Monday, April 22, 2002: Centers for Medicare & Medicaid Services, Attn: Cathy Baldwin-MS C2-21-15, 7500 Security Blvd., Baltimore, MD 21244.