Presolicitation Notice - Part A/B Medicare Administrative Contractor, Jurisdiction J - Insurance News | InsuranceNewsNet

InsuranceNewsNet — Your Industry. One Source.™

Sign in
  • Subscribe
  • About
  • Advertise
  • Contact
Home Now reading Newswires
Topics
    • Life Insurance News
    • Annuity News
    • Health/Employee Benefits
    • Property and Casualty
    • Advisor News
    • Washington Wire
    • Regulation News
    • Companies
    • Earnings
    • Video
    • Monthly Focus
    • Sponsored Articles
  • Exclusives
  • NewsWires
  • Magazine
  • Webinars
  • Free Newsletters
Sign in or register to be an INNsider.
  • INN Exclusives
  • Life Insurance News
  • Annuity News
  • Health/Employee Benefits
  • Property and Casualty
  • AdvisorNews
  • Washington Wire
  • Regulation News
  • Sponsored Articles
  • Monthly Focus
  • INN Exclusives
  • NewsWires
  • Magazine
  • Webinars
  • Free Newsletters
  • Insider Pro
  • About
  • Advertise
  • Editorial Staff
  • Contact
  • Newsletters

Get Social

  • Facebook
  • Twitter
  • LinkedIn
Newswires
Newswires RSS Get our newsletter
Order Prints
March 31, 2016 Newswires No comments
Share
Share
Tweet
Email

Presolicitation Notice – Part A/B Medicare Administrative Contractor, Jurisdiction J

FedBizOpps

Notice Type: Presolicitation Notice

Posted Date: 30-MAR-16

Office Address: Department of Health and Human Services; Centers for Medicare & Medicaid Services; Office of Acquisition and Grants Management; 7500 Security Blvd.C2-21-15 Baltimore MD 21244-1850

Subject: Part A/B Medicare Administrative Contractor, Jurisdiction J

Classification Code: G - Social services

Contact: Phillip A. Smith, Contract Specialist, Phone 410-786-9492, Email [email protected] - Bridget R Rineker, Contracting Officer, Phone 410-786-0185, Email [email protected]

Description: Department of Health and Human Services

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

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 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 J. Jurisdiction J includes the following states: Alabama, Georgia and Tennessee. The Contractor shall perform its responsibilities under the direction of CMS. The Contractor shall perform numerous functions to support health care services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of Medicare services, both institutional and professional, both in-patient (Part A) and out-patient (Part B) for a defined geographic area or "jurisdiction." The Contractor will perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals, as well as CMS requirements to ensure the financial integrity of the Medicare FFS program.

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 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 all standard or otherwise required editing with respect to these claims to determine whether they are complete and should be paid. An edit is the 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. Contractors must be able to determine the need for locality-driven edits in their jurisdiction, as well as those included in the Standard and Supplemental systems, and to develop the logic for those local coverage determinations. In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor also operates a provider customer service program and conducts a variety of Medicare provider and supplier outreach and response services, such as education regarding Medicare rules and regulations, billing procedures and answering telephone and written inquiries. The Contractor will also operate Medicare's provider and supplier toll-free lines across the country to respond to a wide-range of questions.

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 Medicare, determine the impact of the Change Requests on the Contractors processes and systems, and implements these changes in the timeframes specified in the Change Requests.

CMS anticipates releasing a solicitation for Jurisdiction J on or about April 14, 2016. The contract will include a base year plus four one-year options. The anticipated proposal due date is June 13, 2016 with an anticipated award date of October 31, 2016.

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

Link/URL: https://www.fbo.gov/spg/HHS/HCFA/AGG/HHSM-500-2016-RFP-0012/listing.html

Older

GE Capital Files Request To Have SIFI Designation Rescinded

Newer

Combine Solicitation – THIS IS A SUBCONTRACTING OPPORTUNITY WITH RESCARE, INC., A SUBCONTRACTOR FOR EDUCATION MANAGEMENT CORPORATION, NOT THE U.S. DEPARTMENT OF LABOR TO PROVIDE CENTER MENTAL HEALTH CONSULTANT (CMHC)

Advisor News

  • Two-thirds of employees say student loan repayments will derail retirement plans
  • 2/3 of employees say student loan repayments will derail retirement plans
  • IRI study: Consumers seek secure income, asset protection
  • Paul Brahim named 2024 president-elect of the Financial Planning Association
  • Study: RIAs say clients are worried about retirement
More Advisor News

Annuity News

  • Deviled eggs and FIA annual reset — who knew?
  • 2/3 of employees say student loan repayments will derail retirement plans
  • IRI study: Consumers seek secure income, asset protection
  • Three reasons to seek annuity income
  • Committee of Annuity Insurers Issues Public Comment to Treasury Dept.
Sponsor
More Annuity News

Health/Employee Benefits News

  • NC Medicaid Expansion will launch Dec. 1
  • Many states are expanding Medicaid to provide dental care to poorest residents
  • Tony Messenger: Retired couple take a stand over $12 penalty on hospital bill
  • What does state-mandated LTCi mean for your clients?
  • Medicare Advantage and Medicare prescription drug programs to remain stable in 2024
More Health/Employee Benefits News

Life Insurance News

  • Phony Crown Point insurance agent sentenced to just over a year in prison
  • Life Insurance Awareness Month: Key points to reinforce with consumers and clients
  • John Hancock launches Premier Benefit IUL
  • Why aren’t more women buying life insurance?
  • Corebridge Financial to sell UK life insurance business to Aviva
More Life Insurance News

- Presented By -

Top Read Stories

  • Allstate, other insurers among those facing robocall lawsuits
  • Insurance industry well positioned to use AI, panelists say
  • North Dakota judge halts long-term care bailout plan crafted in Pa.
  • Big rules are coming; Prudential exec hopes they aren’t ‘overly conservative’
  • ESG is getting the insurance industry’s attention, panelists say
More Top Read Stories >

Press Releases

  • Hexure and Paperclip Announce Partnership to Enhance Application Data Workflows
  • Hexure Acquires Vive
  • Senior Market Sales Adds EMG Insurance Brokerage to Growing Network of Health and Wealth Companies
  • Investors Preferred Life Insurance Company Names Nikki Pethtel as Its Next President
  • Insurity Celebrates its 15-Year Partnership with RCG Global Services, Marking a Legacy of Trust, Growth, and Digital Transformation
More Press Releases > Add Your Press Release >

How to Write For InsuranceNewsNet

Find out how you can submit content for publishing on our website.
View Guidelines

Topics

  • Life Insurance News
  • Annuity News
  • Health/Employee Benefits
  • Property and Casualty
  • Advisor News
  • Washington Wire
  • Regulation News
  • Companies
  • Earnings
  • Video
  • Monthly Focus
  • Sponsored Articles

Top Sections

  • Life Insurance News
  • Annuity News
  • Health/Employee Benefits News
  • Property and Casualty News
  • AdvisorNews
  • Washington Wire
  • INN Magazine

Our Company

  • About
  • Editorial Staff
  • Magazine
  • Write for INN
  • Advertise
  • Contact

Sign up for our FREE e-Newsletter!

Get breaking news, exclusive stories, and money- making insights straight into your inbox.

select Newsletter Options
Facebook Linkedin Twitter
© 2023 InsuranceNewsNet.com, Inc. All rights reserved.
  • Terms & Conditions
  • Privacy Policy
  • AdvisorNews

Sign in with your Insider Pro Account

Not registered? Become an Insider Pro.
Insurance News | InsuranceNewsNet