Sources Sought Notice – ViPS Medicare System (VMS)

Notice Type: Sources Sought Notice

Posted Date: 18-JUN-15

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: ViPS Medicare System (VMS)

Classification Code: D - Information technology services, including telecommunications services

Solicitation Number: HHS-CMS-SBSS-16-287

Contact: Erin M. Crockett, Contract Specialist, Phone 4107862088, Email [email protected] - Charles Littleton, Phone 410-786-3291, Fax 410-786-9088, Email [email protected]

Setaside: N/AN/A

Place of Performance (address): 7500 Security BlvdBaltimore, MD

Place of Performance (zipcode): 21244

Place of Performance Country: US

Description: Department of Health and Human Services

Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

Sources Sought Notice Introduction

This is a SOURCES SOUGHT NOTICE posted for INFORMATIONAL PURPOSES ONLY. It will be used to obtain information regarding the availability and capability of small businesses (e.g.: 8(a), service-disabled veteran owned small businesses, HUBZone small businesses, women-owned small businesses and small businesses) to provide the services described herein. The Centers for Medicare & Medicaid Services (CMS) will use the information received to determine if the work described herein will be set-aside for small business. Based upon the results of the evaluation of the respondents' capability, CMS may set the work aside for a specific type of small business (i.e. HubZone, WOSB, SDVOSB, or 8(a)), small business, or determine that the work should be competed on an unrestricted basis.

Background

The Medicare program is a Federal health insurance program. The program benefits senior citizens aged 65 or older and those who are disabled or diagnosed with chronic renal disorders. Congress established Medicare in 1965 when it enacted Title XVIII of the Social Security Act. Sections 1816(a) and 1842(a) of the Social Security Act provide that public or private entities and agencies may participate in the administration of the Medicare Program under contracts or agreements entered into with CMS.

CMS has the primary responsibility for administering the Medicare program as delegated by the Secretary of the Department of Health and Human Services (DHHS). CMS administers the Medicare program on a day-to-day basis, including formulation and promulgation of Medicare policy and guidance, contract execution, operation and management, maintenance and review of utilization records, and general Medicare financing. CMS is the largest purchaser of health care in the United States.

It is CMS' mission to assure high quality health care for all beneficiaries. This contract specifically applies that mission by fostering excellence in the design and administration of CMS' programs. Within the timeframe of this contract, that mission has the following objectives:

1.Stabilize the Medicare claims processing environment 2.Modernize CMS' systems and databases and reduce system maintenance costs while extending the life of the system 3.Move toward standardizing all shared system maintainers (SSMs) 4.Improve system quality and performance 5.Incorporate more mandates on an annual basis 6.Implement changes and enhancements

It is CMS' goal to achieve these objectives by improving the quality and timeliness of Medicare business requirements. It is CMS' requirement that the shared system maintainer provide the means to achieve these goals by maximizing the use of automation and other Best Practices across the system development life cycle (SDLC).

Medicare's traditional Fee for Service (FFS) coverage consists of two distinct parts:

1.Part A hospital insurance covers expenses for medical services furnished in institutional settings, such as hospitals or skilled nursing facilities, or services provided by a home health agency or hospice, and 2.Part B supplemental medical insurance covers physician and other practitioner services; outpatient services and certain Durable Medical Equipment, Prosthetics and Orthotics Supplies (DMEPOS) services.

In the 1980's CMS began the transition to a national standardization in processing. Core requirements for Medicare system contractors were established and contractors were encouraged to use standard software systems in claims processing and shared processing. The goal of these initiatives was twofold: Reduce variation in software and hardware platforms by sharing a single platform among multiple contractors, and achieve savings in system development and maintenance as well as a reduction in processing costs. The transition to standardized processing resulted in the establishment of the following:

1.Three claims processing Shared System: Fiscal Intermediary Shared System (FISS) for institutional Part A and B services, Multi Carrier System (MCS) for physician and other practitioner services, and ViPS Medicare System (VMS) for DMEPOS services 2.The Medicare eligibility system Common Working File ((CWF), which provides a single data source where the contractors can verify beneficiary eligibility to receive prepayment review and approval of claims, and 3.The single testing contractor (STC), responsible for BETA testing for the shared systems and interfaces, previously referred to as Independent Testing Contractor (ITC), Beta testing, Quarterly Release Test Management (QRTM) and off-quarter testing of production support fixes and enhancements. Purpose

CMS uses VMS to process claims submitted by suppliers of Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) to one of four Durable Medical Equipment Medicare Administrative Contractors (DME MACs). DME MAC geographic regions or jurisdictions are located at:

http://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/DME-MAC-Jurisdictions.html

The VMS claims processing system also processes the National Council of Prescription Drug Programs (NCPDP) claims. The VMS claims processing software will be furnished to, and maintained by, the VMS SSM contractor as Government Furnished Software. The VMS performs processing functionality for claims collection, editing, pricing, adjudication, correspondence, online inquiry, file maintenance, financial processing and reporting. The VMS also includes DME MAC-specific requirements related to claims pricing, Certificate of Medical Necessity (CMNs), claims processing, supplier interfaces with the Provider Enrollment, Chain and Ownership System (PECOS), Common Electronic Data Interchange (CEDI), and CWF interfaces.

VMS System Overview DME MACs use the VMS to process claims submitted by suppliers of DMEPOS. Claims received are processed through various computer software modules and sub-routines, databases, files and records, including interfacing with CWF. VMS meets CMS' minimum core requirements for processing DMEPOS claims. These requirements include, but are not limited to: data collection and validation, claims control, pricing, adjudication, correspondence, online inquiry, file maintenance, report generation, reimbursement, and financial processing.

The VMS claims processing system runs in an IBM operating environment. The system uses a Virtual Storage Access Method (VSAM) file structure with CICS as the data communications protocol. The system is written in COBOL LE; file compression and expansion, and special utility modules are written in Assembler Language Code (ALC).

The base system consists of approximately 3,000 source modules and roughly 2,346 copy members. There are both batch and online components to this system. Claims are input and corrected online. The online claims subsystem includes validity, consistency, and eligibility edits; development capabilities; and claims pricing, all with automated functionality and error resolution through user-updated parameter tables. Transportation is provided to other online subsystems and, in certain situations, to Health Insurance Master Record (HIMR) screens.(HIMR is an online history inquiry tool used to view beneficiary information). Claims correction activities go through the Automated Paperless Exceptions Subsystem (APEX), which automatically feeds suspense claims to examiners based on selection criteria such as error category, age of claim, operator ID, or Health Insurance Claim (HIC) Number. The VMS claims processing system also supports online master file inquiry and update functions; claim history, correspondence and financial inquiry and tracking; and system administration functions, including security and system parameter table maintenance. Other online transactions support various management functions. For example, operator productivity statistics are viewable online; the Online Quality Control (OQC) system allows supervisors, trainers, and Quality Assurance (QA) personnel to select samples of claims, review the work of examiners, return claims to the examiner if corrections are required, and perform online editing.

The batch claim adjudication process is where the system performs historical auditing of the in-process claim against other previously processed or in-process claims (duplicate check and pre-payment utilization reviews). Once a claim passes these audits, the batch system sends the claim to CWF for eligibility determination, and then processes the CWF response. It then generates checks, remittances, and Medicare Summary Notices (MSN). The standard system then produces a flat file, based on CMS requirements, for transmission to the Benefits Coordination and Recovery Contractor (BCRC), if applicable.

The standard claims processing system contains many other supporting online and batch processes, including but not limited to:

1.Management and workload reporting 2.Correspondence and appeals reporting 3.Medical review and Medicare Secondary Payer (MSP) savings reporting and audit trails 4.Claim history file maintenance 5.Provider and beneficiary file maintenance 6.Parameter and other master file maintenance 7.Online entry of change requests through the telecommunications network 8.Tracking of all changes through the evaluation, development, and implementation process 9.Reports (online and hard copy) 10.Online browsing of change requests so that users, as well as other interested parties, may track the progress of their requests

The shared system maintainer shall, at a minimum: 1.Provide access to INFOMAN (or other CMS approved software) for a minimum of 150 users 2.Provide information to CMS by recommending appropriate systems changes 3.Provide technical advice to CMS and system users 4.Identify system standardization projects (to be approved by CMS) and support the completion of directed changes 5.Work with CMS and the CWF maintainer to clarify impacts on users and providers regarding CMS mandates and other system changes 6.Provide routine management and administrative support 7.Make changes or corrections to program code 8.Perform data dictionary maintenance, including major updates to coding tables 9.Create as well as maintain documentation 10.Develop as well as maintain Job Control Language (JCL) 11.Provide database maintenance 12.Support downstream systems and ensure the integrity of the data.

The VMS claims processing system supports commercially available security packages (e.g., ACF-2 and Resource Access Control Facility (RACF)). The VMS software products are documented in the SOW. The following Commercial Off-The-Shelf (COTS) packages have been integrated into the system:

1.CLIENT LETTER 2.FINALIST 3.Expert Claims Processing System (ECPS), also known as SuperOp.

CMS requests that respondents specifically address each question identified below. In general, while this Notice is not a request for a technical proposal, respondents should provide enough information for CMS to make a determination as to the capability to perform the same or similar work in size and scope.

Responses should include, at a minimum, the information identified in each of the following:

1. Business Information: a. Company Name b. Company Address c. D&B DUNS Number d. Current GSA or GWAC contract(s) and/or schedules(s) that you possess which are appropriate to this Sources Sought. e. Does your organization have a Government approved accounting system If so, please identify the agency that approved the system. f. Type of company (e.g., small business, 8(a), veteran-owned small business, service-disabled veteran owned small business, HUB Zone small business, small disadvantaged business, and women owned small business) as validated via the Central Contractor Registration (CCR). g. Company Point of contact (POC) name, phone and email address h. POC, phone and email address of individuals who can corroborate the demonstrated capabilities identified in the responses.

NOTE: All teaming arrangements and Joint Ventures shall also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements and Joint Ventures are encouraged. Prime/Sub teaming arrangements, defined under FAR 9.601(2), should identified the roles for each business entity listed for each capability point, and show that the Prime has the capability and capacity to perform at least 51% of the work in the Prime/Sub relationship. Joint Ventures are defined by FAR 9.601(1).

2. The base VMS system consists of approximately 3,000 source modules and roughly 2,346 copy members. Please describe your overall experience in, and/or ability to provide with teaming partners, programing that will perform the complex processing functionality for claims collection, editing, pricing, adjudication, correspondence, online inquiry, file maintenance, financial processing and reporting. The overall experience should also include DME MAC-specific development requirements related to claims pricing, Certificate of Medical Necessity (CMNs), claims processing, supplier interfaces with the Provider Enrollment, Chain and Ownership System, Common Electronic Data Interchange (CEDI), and CWF interfaces. Please state your experience working with the Change Control Processes and Change Control Boards, Change Requests (CRs), experience with interfacing systems such as the Common Working File, Single Testing Contractor and the. Please also state your experience with user acceptance testing, software support services and System Development Life Cycle (SDLC) management.

3. Please describe your general overall knowledge and experience with, and/or ability to provide with teaming partners, the various programs overseen or operated by the Centers for Medicare and Medicaid Services. Also, please describe your experience working with CMS data systems (including shared systems) and files.

4. Please describe your general overall experience in, and/or ability to provide with teaming partners, the use of complex programing to develop shared systems that ensures maximum functionally. Please also describe techniques you have used to achieve the stated response for programing the VMS or similar system in size and scope.

5. Please describe your experience in, and/or ability to provide with teaming partners, the implementation of a shared system that runs in an IBM operating environment and uses Virtual Storage Access Method (VSAM) file structure with CICS as the data communications protocol. The experience should also be with COBOL LE; file compression and expansion, and special utility modules written in Assembler Language Code (ALC).

6. At the point of award, the awardee will have a transition onto the project. Please describe your experience in, and/or ability to provide with teaming partners, a seamless transition that insures claims processing remains uninterrupted.

7. Please describe current or past projects where your firm or teaming partners have been successful in implementing systems that support claim processing in the public or private sector. Please include a brief description of the methodology, your role in developing the methodology and the challenges you faced in implementing the project and the overall size of the project (by lines of code).

Link/URL: https://www.fbo.gov/spg/HHS/HCFA/AGG/HHS-CMS-SBSS-16-287/listing.html