Medicare Administrative Contractor (MAC) Jurisdiction 8 (J8) - Synopsis/Draft RFP / Presolicitation

The Centers for Medicare & Medicaid Services (CMS) intends to issue a Request for Proposal (RFP) to obtain a Medicare Administrative Contractor (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 Program (also known as the Medicare Fee-For-Service or FFS) for Jurisdiction 8. Jurisdiction 8 encompasses the following states: Indiana and Michigan.

Prior to issuing the final solicitation, with this synopsis CMS is issuing a draft RFP (inclusive of the RFP and attachments) to allow potential offerors an opportunity to review the requirements and submit questions.

Consistent with the statement of work, the contractor shall perform numerous functions to support healthcare 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). 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.

Pursuant to the authority of FAR Part 15, Contracting by Negotiation, CMS intends to conduct a full and open procurement to fulfill this need. Accordingly, the Contracting Officer will seek to award to the vendor whose proposal represents the best solution to CMS’ requirements at a fair and reasonable price.

Award will be made to the Offeror whose proposal offers the best overall value to the Government using FAR 15.103-1 Trade-off approach, which “…is appropriate when it may be in the Government’s best interest to consider award to other than the lowest priced offeror or other than the highest technically rated offeror …”; affording the Government the most advantageous balance of cost and...