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Award: A/B MAC Jurisdiction L - RFP-CMS-2012-0003

Solicitation Number: RFP-CMS-2012-0003
Agency: Department of Health and Human Services
Office: Centers for Medicare & Medicaid Services
Location: Office of Acquisition and Grants Management
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September 17, 2012
Novitas Solutions, Inc.
1800 Center Street
P.O. Box 890089
Camp Hill, Pennsylvania 17089
United States
Added: Jan 05, 2012 2:33 pm
As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS must re-compete its Part A & B Medicare Administrative Contractor (A/B MAC) contracts every five (5) years. The purpose of this contract is to obtain a A/B 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 will perform numerous functions to support health care services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of health care services, both institutional and professional, for a defined geographic area or "jurisdiction." The Contractor will 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 program. The Medicare program's legal, policy, and operating environment is complex, and the Contractor will utilize or interact with certain CMS-required payment schedules, systems, equipment, and operational capabilities in the performance of its functions. Further, the Contractor will coordinate its activities not only with the 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 institutional and professional providers, suppliers, and beneficiaries within its jurisdiction and will perform standard or required editing 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 will enroll new providers; conduct redeterminations on appeals of claims; operate a Provider Customer Service Program (PCSP) that educates providers about the Medicare program and responds to provider telephone and written inquiries; respond to complex inquiries from Beneficiary Contact Centers (BCCs); and make coverage decisions for new procedures and devices in local areas. The Contractor also will conduct a variety of different provider services, such as enrolling new providers in the program, answering written inquiries, and educating providers on Medicare's rules, regulations, and billing procedures.

CMS anticipates releasing a solicitation for Jurisdiction L- Previously Jurisdiction 12 (comprised of the states of Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania.) on or about January 4, 2012. The contract will include a base year plus four one-year options. The anticipated proposal due date is February 23, 2012 with an anticipated award date of August 20, 2012.

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

Added: Feb 10, 2012 2:38 pm
Amendment 1 - RFP-CMS-2012-0003
Added: Sep 17, 2012 5:16 pm
Provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the Medicare program (also known as the Medicare fee-for-service, or FFS, program) for Jurisdiction L. Jurisdiction L consists of the following states: Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania.
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Solicitation 1

Posted Date:
January 5, 2012
Description: A/B MAC Jurisdiction L (Formerly MAC Jurisdiction 12)

Amendment 1

Posted Date:
February 10, 2012
Description: J-08 Past Performance Questionnaire
Description: RFP Amd 1 02-10-2012 Redlined
Description: RFP Amd 1 02-10-2012 Final
Description: JL SF30 Amd1signed
Description: J-03 Small Business Subcontracting Plan
Description: J-01 Statement of Work_JL_FINAL_FEB-03-2012
Description: JL AB MAC Offeror's RFP Questions and Answers.FINAL
Description: AB MAC CLIN 0002 Cost Proposal Template Base Year
Description: AB MAC CLIN 0003 Cost Proposal Template Option Year1
Description: J-02 Deliverable Schedule JL_02032012
7500 Security Blvd.
Baltimore, Maryland 21244-1850
Jacob Reinert,
Contract Specialist
Phone: 4107861278
Chip Farmer,
Contracting Officer
Phone: 410-786-1997