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Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Jurisdiction C

Solicitation Number: RFP-CMS-2011-0006
Agency: Department of Health and Human Services
Office: Centers for Medicare & Medicaid Services
Location: Office of Acquisition and Grants Management
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Added: Nov 12, 2010 8:30 am
DME MAC Jurisdiction C Pre-solicitation Notice:

As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS must re-compete its Durable Medical Equipment Medicare Administrative Contractors (DME MAC) contracts every five (5) years. The purpose of this contract is to obtain a DME MAC (hereinafter, referred to as "the Contractor") to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the Medicare FFS program. The Contractor shall perform its responsibilities under the direction of CMS.

The Contractor shall perform numerous functions on behalf of Medicare beneficiaries and shall establish relationships with suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), for a defined geographic area or "jurisdiction." The Contractor shall perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals and CMS requirements to ensure the financial integrity of the Medicare FFS program. The Medicare FFS program's legal, policy and operating environment is complex, and the Contractor shall utilize or interact with certain CMS-required payment schedules, systems, equipment and/or operational capabilities in the performance of its functions. Further, the Contractor shall coordinate its activities not only with CMS, but also with a broad range of agencies (at the federal, state and local levels of government), other CMS partners and Contractors, and a diverse range of stakeholders within the health care system of the United States.

In accordance with CMS' technical specifications, the Contractor shall receive and control Medicare claims from DMEPOS suppliers and beneficiaries within its jurisdiction, as well as perform edits on these claims to determine whether the claims are complete and should be paid. An edit is defined as "logic within the Standard Claims Processing System (or PSC/ZPIC Supplemental Edit Software) that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and, depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review."

In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor also conducts a variety of different supplier services, such as answering written inquiries, and educating them on Medicare's rules and regulations and billing procedures. The Contractor also operates Medicare's supplier's toll-free lines across the country to answer a wide-range of supplier questions. Additionally, the Contractor conducts redeterminations on appeals of claims and responds to complex beneficiary inquiries referred from the Beneficiary Contact Centers.

CMS anticipates releasing a solicitation for Jurisdiction C (comprised of the states of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia) on or about November 30, 2010. The contract will include a base year plus four one-year options. The anticipated proposal due date is January 11, 2011 with an anticipated award date of August 24, 2011.

This solicitation is expected to be issued as pending availability of funds.

Added: Nov 30, 2010 2:54 pm

Solicitation for Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Jurisdiction C

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Solicitation 1

Posted Date:
November 30, 2010
Description: Solicitation for Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Jurisdiction C

Amendment 1

Posted Date:
December 29, 2010
Description: Amendment 000001 - DME C Solicitation RFP-CMS-2011-0006

Amendment 2

Posted Date:
January 5, 2011
Description: Amendment 000002
Description: Amendment 000002 Attachment 1

Amendment 3

Posted Date:
January 6, 2011

Amendment 4

Posted Date:
January 14, 2011
Description: Amendment 000004
7500 Security Blvd.
Baltimore, Maryland 21244-1850
Holly Lynn Lane,
Contract Specialist
Phone: 410-786-8645
Fax: 410-786-9922