Notice Type: Presolicitation Notice
Subject: Part A/B Medicare Administrative Contractor, Jurisdiction J
Classification Code: G - Social services
The purpose of this contract is to obtain a Medicare Administrative Contractor (hereinafter referred to as "the contractor" or "MAC") to provide specified health insurance benefit administration services, including
The Medicare FFS program has complex legal, policy, and operating environments. The Contractor shall be familiar with, utilize and interact with all pertinent 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 CMS, but must also work with a broad range of Federal, State, and Local government agencies, CMS partners and Contractors, and a diverse range of stakeholders in the health care system of
Further, the Contractor conducts redeterminations on appeals of claims, responds to complex beneficiary inquiries referred to from the Beneficiary contact Centers, performs Medical Review on selected claims, makes coverage decisions for new procedures and devices in local area, and conducts rigorous quality control on the tens of millions of claims processed each year. The Contractor shall receive and review over five hundred Change Requests issued by CMS each year to modify the systems and services offered by
CMS anticipates releasing a solicitation for Jurisdiction J on or about
This solicitation is expected to be issued as pending availability of funds.