Sources Sought Notice - Encounter Data Processing Systems (EDPS)

This is a SOURCES SOUGHT NOTICE posted for INFORMATIONAL PURPOSES ONLY. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding the availability and capability of qualified small businesses only (including 8(a), service-disabled veteran owned small business (SDVOSB), HUBZone small business, small disadvantaged business (SDB), veteran-owned small business (VOSB), and women-owned small business (WOSB) to successfully perform the requirements described herein. Teaming arrangements and Joint Ventures are acceptable as long as all requirements are met. CMS is conducting market research to identify qualified sources that meet the requirements generally described in this notice to assist in determining the appropriate acquisition strategy to obtain contractor support services to perform the requirements to those described in this notice. The Centers for Medicare & Medicaid Services (CMS) may or may not issue a request for proposal or request for quotation. Responses to this sources sought notice shall be the submission of a capability statement; THIS IS STRICTLY MARKET RESEARCH. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THE RESULTS OF THIS MARKET RESEARCH. REQUIREMENT This Notice concerns the potential requirement for a contractor to build, test, implement, and maintain the operations of a claims processing system to validate Encounter Data Records (EDRs) against industry and CMS standards submitted by Medicare Advantage organizations (MAOs) and other organizations offering Medicare private health plans (Program for All-Inclusive Care of the Elderly (PACE) organizations, cost plans, and the Medicare-Medicaid demonstration plans); and to provide reporting services to EDR submitters and to CMS. The core function under this contract of processing/validating EDRs also includes the function of generating a FFS-equivalent price for each EDR. CMS intends that encounter data records will inform risk-adjustment of payment, in to facilitating assessments of coverage, service utilization, and quality of care between the FFS and MA programs. The Encounter Data Processing System (EDPS) is a system that accepts X12 837 (version 5010) format EDRs from our Customer Support Front End System (CSFES) front-end system, validates the EDRs (which includes clinical processing and pricing), and sends the processed EDRs to CMS' Integrated Data Repository (IDR). The Medicare Plan Payment Group in the Center for Medicare (MPPG/CM) then extracts EDRs from the IDR to calculate beneficiary-level risk scores (indicators of beneficiary health status) that are used to calculate Part C and Part D payments to MAOs. Currently, Part C and D program payments are about $250 billion a year for items and services provided to about 18 million Part C beneficiaries receiving medical services through Medicare Advantage (MA) plans and about 40 million Fee-for-Service and Part C beneficiaries receiving prescription drugs through Part D plans.