Medicare Claims Adjudication and Case Management

The Medicare Claims Adjudication and Case Management subcontract, issued by the Department of Health and Human Services Office of Acquisition and Grants Management, focuses on the adjudication of Medicare reconsiderations for prime contractors. The scope of work involves processing reconsiderations of initial determinations, adjudicating claims, and managing cases specifically within the Medicare Appeals System. Key operational requirements include performing electronic case management and document imaging to establish second-level electronic case files. The successful provider is responsible for delivering final adjudication decisions and ensuring all electronic case files are complete within the designated system. This opportunity falls under NAICS code 541990, with a response deadline of November 5, 2026.