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Attachment J.2 – RRB SMAC Deliverable Schedule
RFP 60RRBH21R0011
| RFP/SOW WBS # |
| Related SOW Requirement Name |
| Deliverable Name |
| Deliverable Description |
| Deliver to |
| Deliverable Due Date |
| Frequency |
| C.5.1.1 |
| Implementation Project Plan |
| Implementation Project Plan |
| A detailed description of all activities required to transfer all Medicare operations from the outgoing SMAC to the incoming SMAC. |
| COR and/or Designees |
| Baseline due within 30 calendar days of the kickoff meeting, unless otherwise directed by the COR |
| Once |
| C.5.1.2 |
| Cutover Plan |
| Cutover Plan |
| An expanded part of the Implementation Project Plan that contain the day by day activities and procedures, some of which may be detailed to the hour, that the contractor will follow during the cutover period to ensure a successful cutover. |
| COR and/or Designees |
| Initial at least 45 calendar days prior to the respective cutover date contained in the Implementation Project Plan |
| Once |
C.5.1.3
| Risk Management Plan |
| Risk Management Plan |
| Identifies jurisdiction wide specific risks, mitigation strategies, and maintenance process for the risks associated with the contractor’s workload transition. |
| COR and/or Designees |
| Due within 30 calendar days of the kickoff meeting. |
| Once |
| C.5.1.4 |
| Implementation Stakeholder Communication |
| Communications Plan |
| Identifies the processes and procedures the contractor will follow to ensure that all transition stakeholders are informed of the transition and its progress. |
| COR and/or Designees |
| Due within 30 calendar days after contract award date |
| Once |
| C.5.1.6 |
| Lessons Learned Documentation |
| Lessons Learned Document Regarding Implementation Activities |
| Identifies the lessons learned during the implementation |
| COR and/or Designees |
| Within 40 calendar days after the final cutover |
| Once |
| C.5.1.7 |
| Accounts Receivable Reconciliation |
| Receipt of Accounts Receivable Transmittal Document |
| Certifies receipt of transmittal document that describes the total amounts and counts of the accounts receivables of the outgoing contractor. |
| COR and/or Designees |
| Due within 10 calendar days after receipt of the Accounts Receivable Transmittal Document |
| Once |
| C.5.2.1 |
| Workload Closeout Project Plan (Option that may be exercised at the End of the Contract) |
| Workload Closeout Project Plan |
| Describes the outgoing contractor’s plan for the transfer of Medicare functions and the closeout of operations at contract end. |
| COR and/or Designees |
| Due 15 calendar days after the contractor kickoff meeting |
| Once |
| C.5.2.3 |
| Workload Closeout Risk Management Plan (Option that may be exercised at the End of the Contract) |
| Workload Closeout Risk Management Plan |
| Includes a periodic assessment of new risks and mitigation and contingency planning where appropriate. |
| COR and/or Designees |
| Initial Due within 30 calendar days of replacement contractor kickoff meeting |
| Once |
| C.5.2.4 |
| Accounts Receivable Transmittal Document (Option that may be exercised at the End of the Contract) |
| Accounts Receivable Transmittal Document |
| Describes the total amounts and counts of the accounts receivables of the outgoing contractor. |
| COR and/or Designees |
| 60 days prior to the effective date of the transfer |
| Once |
| C.5.2.5 |
| Cost Accounting Audit (Option that may be exercise at the End of the Contract) |
| Financial Audit Supporting Documentation |
| Describes the details to support the post-cutover financial activities of the outgoing contractor |
| COR and/or Designees |
| Within 30 calendar days after closeout end |
| Once |
| C.5.4.2.1 |
| Post-Award Meeting |
| Post-Award Meeting Minutes |
| Describes the results of the Post-Award meeting conducted. |
| COR and/or Designees |
| Within 3 business days of the Post-Award meeting |
| Once |
| C.5.4.2 |
| Project Management Plan – Implementation Deliverable |
| Project Management Plan |
| Describes the plan for overall management of the program. |
| COR and/or Designees |
| Initial within 30 business days after contract award, updates within 15 calendar days after quarter end |
| Annually |
| C.5.4.2.2 |
| Monthly Status Report and Meeting |
| Monthly Status Report (MSR) |
| Describes the monthly status of the program through a report. This deliverable is comprised of both the narrative MSR Word document and the Monthly SMAC External Metrics Report. Please include in the file name the jurisdiction number, the SMAC Name, and the month for which you are reporting. |
| COR and/or Designees |
| Within 20 calendar days after month end |
| Monthly |
| C.5.4.2.7 |
| Voucher/Financial Management System |
| Monthly Cost Report |
| Submit a monthly cost report to the CMS ART System in accordance with the work breakdown structure (WBS) schedule instructions. In addition, submit a statement to the COR via the deliverable mailbox indicating that this action has been completed. |
| COR and/or Designees |
| Monthly cost reports are due into CMS ART no later than 30 calendar days after the end of the reporting month |
| Monthly |
| L.16.a |
| Volume IIA Business Proposal Cost Template Instructions |
| Final Proposal Revision Business Proposal Reporting |
| Upon award, awardee shall submit Attachments J-10 and J-11 in their entirety, into the CMS ART System. |
| COR and/or Designees |
| Business proposal is due into the CMS ART System no later than five (5) days after contract award. |
| One time |
| C.5.4.2.7 |
| Voucher/Financial Management System |
| Final Estimated Cost Proposal |
| The contractor shall submit the final estimated cost proposal into CMS ART once contract estimated costs have been negotiated, and a subsequent modification has been executed by the CO. In the case of a change order, change order funding shall be entered into CMS ART once the change order has been executed. Once the change order has been definitized, the contractor shall submit the final estimated cost proposal into CMS ART. In addition, the contractor shall submit a statement to the COR via the deliverable mailbox indicating that this action has been completed. |
| COR and/or Designees |
| The final estimated cost proposal shall be entered into CMS ART no later than 5 business days after the contract modification has been executed. In the case of a change order, change order funding shall be entered into CMS ART no later than 5 business days after the execution of the change order. The final estimated cost proposal shall also be entered into CMS ART no later than 5 business days after the change order has been definitized. |
| As required |
| C.5.4.2.11 |
| Operational Productivity Report (OPR) |
| Operational Productivity Report (OPR) |
| The Contractor shall prepare and upload the OPR into the CMS-ART system. An electronic version in excel form should also be sent via email to the COR and Contracting Officer (CO)/Contracting Specialist (CS) on the contract. |
| COR, Contracting Officer/Contracting Specialist, and/or Designees |
| Monthly OPRs are due into CMS-ART no later than 30 calendar days after the end of the reporting month |
| Monthly |
| C.5.4.3 |
| Security |
| Information Technology Systems Contingency Plan Report |
| Information Technology (IT) Systems Contingency Plan (See BPSSM Table 3.1 Planning Table, for 3.4) |
| COR and/or Designees and CMS Business Owner |
| Initial within 90 days prior to the first segment cutover date and annually thereafter |
| Annually |
| C.5.4.3 |
| Security |
| IT Security Tests And Reports |
| Contractor conducted or any other independent IT evaluation. |
| COR and/or Designees |
| 10 business days after conducted |
| As required |
| C.5.4.3 |
| Security |
| Risk Assessment Report |
| Risk Assessment (See BPSSM Table 3.1 Planning Table, for 3.2) |
| COR and/or Designees |
| Initial within 90 days prior to making payments under the contract and annually thereafter |
| Annually |
| C.5.4.3 |
| Security |
| Statement of Security Compliance |
| Annually certification (See BPSSM Table 3.1 Planning Table, for 3.3) |
| COR and/or Designees |
| In accordance with BPSSM |
| Annually |
| C.5.4.3 |
| Security |
| Systems Security Plan |
| Systems Security Plan (SSP) (See BPSSM Table 3.1 Planning Table, for 3.1) |
| COR and/or Designees |
| Initial within 90 days prior to making payments under the contract and annually thereafter |
| Annually |
| C.5.4.3 |
| Security |
| Systems Security Profile Documentation |
| Systems Security Profile (See BPSSM Table 3.1 Planning Table, for 3.7) |
| COR and/or Designees |
| Consistent with frequency |
| As required |
| C.5.4.3.2 |
| Administer Security Program |
| Corrective Action Management Process Report |
| Report progress in correcting deficiencies or findings identified by audits, reviews, etc. in accordance with guidance provided by the BPSSM and other RRB and CMS guidance. |
| COR and/or Designees |
| In accordance with BPSSM or as requested by RRB or CMS (Corrective Action Plans for findings identified in Section 912 Evaluations must be remedied prior to making payments). |
| Monthly |
| C.5.4.3.4 |
| Correct Deficiencies |
| Incident Reporting and Responses Report |
| Incident Reporting and Response (See BPSSM Table 3.1 Planning Table, for 3.6) |
| COR and/or Designees |
| Within 15 calendar days of month end or as required by RRB or CMS. Incidents involving individually identifiable information must be reported within one hour. |
Monthly and As required
| C.5.4.3.5 |
| Security Review and Verification |
| FISMA Assessment |
| Contractor will examine and analyze implemented security safeguards to provide evidence of compliance with applicable laws, regulations, and requirements. |
| COR and/or Designees |
| June 1 |
| Annually |
| C.5.4.3.5 |
| Security Review and Verification |
| FISMA Compliance |
| Any FISMA Compliance evidence to CMS (See H.26- Federal Information Security Management Act (FISMA)) on completed and current CMS/RRB contracts |
| COR and/or Designees |
| As requested by CMS |
| As requested |
| C.5.4.4.1 |
| Quality Control Program |
| Quality Control Plan (QCP) |
| Specifies the procedures and resources applied to ensure services meet contract performance requirements. |
| COR and/or Designees and mailbox QCP@cms.hhs.gov |
| The QCP shall be submitted to CMS ART 45 calendar days prior to the start of the base operational period; 45 calendar days prior to the start of each subsequent contract year; and within 30 calendar days of any substantive changes in the SMAC's quality operations. Both redlined and clean copies should be submitted. |
| Prior to start of base operational period; prior to start of each subsequent contract year; and when substantive changes occur in quality operations. |
| C.5.4.5 |
| Public Relations |
| Public Relations Plan – Implementation Deliverable |
| Describes the contractor’s plans for managing the programs public relations. |
| COR and/or Designees |
| Initial within 30 calendar days of contract award |
| One month after contract award |
| C.5.4.8.3 |
| Successful Implementation of Change Requests |
| Change Request Implementation Problem Log |
| Describes any problems and the resolution status associated with the implementation of change requests. |
| COR and/or Designees |
| Within 15 calendar days of month end. Note: This is only the SMAC's responsibility following cutover. Prior to cutover it is the OGC's responsibility. |
| Monthly |
| C.5.4.8.3 |
| Successful Implementation of Change Requests |
| Change Request Implementation Report (CRIR) |
| Describes the Change Requests (CRs) that the contractor has implemented in the quarterly period. |
| This information shall be submitted electronically to CR_IMPL_REPORTS@cms.hhs.gov. These deliverables must also be delivered concurrently to the COR in accordance with CMS technical direction regarding the contract deliverable process. |
| The due dates for the Change Request Implementation Report are as follows, per the IOM: Quarter 1- Oct, Nov, Dec (report due no later than February 28th); Quarter 2-Jan, Feb, Mar (report due no later than May 28th); Quarter 3-April, May, June (report due no later than August 28th); Quarter 4-Jul, Aug, Sep (report due no later than November 28th). Note: This is only the SMAC's responsibility following cutover. Prior to cutover it is the OGC's responsibility |
| Quarterly |
| C.5.4.8.3 |
| Successful Implementation of Technical Direction Letters |
| Technical Direction Letter (TDL) Compliance Report (TCR) |
| Describes the Technical Direction Letters (TDLs) that the contractor has implemented in the quarterly period. |
| This information shall be submitted electronically to CR_IMPL_REPORTS@cms.hhs.gov. These deliverables must also be delivered concurrently to the COR in accordance with CMS technical direction regarding the contract deliverable process. |
| The due dates for the Technical Direction (TDL) Compliance Report (TCR) are as follows, per the IOM: Quarter 1- Oct, Nov, Dec (report due no later than February 28th); Quarter 2-Jan, Feb, Mar (report due no later than May 28th); Quarter 3-April, May, June (report due no later than August 28th); Quarter 4-Jul, Aug, Sep (report due no later than November 28th). |
| Quarterly |
| C.5.4.9 |
| Continuity of Operations Planning |
| Comprehensive Continuity of Operations (COOP) Plan with IT Contingency/Disaster |
| Describes the Contractor’s policies and procedures to ensure that essential business functions continue during a disaster or emergency, including how to deal. with an IT system interruption. |
| COR and/or Designees |
| Initial 60 calendar days prior to cutover; thereafter annually, or whenever there is a significant change. |
| Once, then Annually |
| C.5.4.10.2 |
| Self-Assessment Process for Internal Controls |
| Certification Package for Internal Controls (CPIC) Report |
| Attestation and documentation of the adequacy of the internal controls. |
| COR and/or Designees. CPIC should also be delivered to CMS internalcontrols@cms.hhs.gov |
| Initial is due within 15 business days after June 30. Update is due 5 business days after September 30 |
| Annually |
| C.5.4.10.3 |
| Correcting Internal Control Deficiencies – CAP process |
| Corrective Action Plan (CAP) |
| Describes a plan of action to correct weaknesses, findings, gaps, or other deficiencies. |
| COR and/or Designees. CAP reports should also be delivered to CMS CAPS@cms.hhs.gov. |
| Initial CAP reports are due within 45 calendar days of receiving a final audit report or after discovery of a material weakness; thereafter 30 calendar days form quarter end |
| Within 45 calendar days after discovery of material weakness, and quarterly |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Position Description for the Compliance Officer and other members of the Compliance Department |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Code of Conduct |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Written compliance policies and procedures |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Compliance training materials used or developed in the last year |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Names and positions of the Board of Directors and/or Compliance Committee members charged with oversight of the compliance program |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Charters for the Board and/or Executive Compliance Committees |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Conflict of interest questionnaire(s) that are completed by employees, managers, officers and Board members |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Risk assessment protocol(s) developed by the Compliance Department |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Internal audit plan |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.4.11 |
| Compliance Program |
| Compliance Documents |
| Any reportable events to RRB and CMS (See H.21- Reportable Events) on completed and current RRB or CMS contracts |
| COR and/or Designees |
| Initial 30 calendar days after contract award and annually thereafter |
| Annually - End of Period of Performance/Contract Year |
| C.5.8.2.5 |
| Payment of Claims Outside Common Working File |
| Workload Report for Payment of Claims Outside Common Working File |
| Workload Report for Payment of Claims Outside Common Working File |
| COR and/or Designees |
| Within 20 calendar days of the month end |
| Monthly |
| C.5.8.5.4 |
| The Do Not Forward Initiative |
| Do-Not-Forward (DNF) Initiative Report |
| Describes the Medicare checks and payments for professional claims returned or held to the contractor thru the DNF initiative. |
| COR and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| C.5.11.1.3 |
| Provider Service Plan |
| Provider Service Plan (PSP) |
| Describes the strategies, project activities, efforts and approaches the contractor will use throughout the duration of its contract. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| By the last day of the first month of the first year of the contract year if the award date is between 1st and 14th.. By the last day of the month for the second month of the contract year if the award date is between the 15th and the last day of the month |
| Provider Service Plan |
| C.5.11.1.4 |
| Provider Customer Service Program (PCSP) Activity Report |
| Provider Customer Service Program (PCSP) Activity Report (PAR) |
| Summarizes and recounts the contractor's provider education and training activities that took place and detail the activities for the year to come . |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Due30 days after the last day of the contract year |
| Annually |
C.5.11.1.5
(SMAC ONLY)
| Provider Contact Center |
| Primary Provider Inquiry Contact |
| Contact information for primary Provider Contact Center (PCC) contact at contractor. |
| COR and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of first month of contract year |
| Annually, as needed as changes made |
C.5.11.1.5
(SMAC ONLY)
| Provider Contact Center |
| Planned Contact Center Closure |
| Schedule of planned closures for contact center, including Federal holiday closures |
| COR and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of first month of contract year |
| Annually |
C.5.11.1.5
(SMAC ONLY)
| Provider Contact Center |
| Ad Hoc Closure Requests |
| Requests to close contact centers at times different from planned closures |
| COR and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| As needed, at least 3 weeks before requested closure date - via email |
| As requested |
C.5.11.1.5
(SMAC ONLY)
| Provider Contact Center |
| Customer Service Operations Surveys |
| Surveys of contractor’s customer service operations, such as PCC technology, staffing, training needs. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Upon request - via email |
| As requested |
C.5.11.1.5.1
(SMAC ONLY)
| Telephone Inquiries |
| Remote Monitoring Instructions |
| Instructions for RRB to remotely monitor live provider inquiry calls. |
| COR and/or Designee. |
| 3 business days before instructions are active |
| Annually, and as instructions change |
C.5.11.1.5.1
(SMAC ONLY)
| Telephone Inquiries |
| Disaster Recovery Plan |
| Plan describing how the Medicare provider telecommunications operations will be maintained or continued in event of natural or manmade disaster |
| COR and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of third month of contract year |
| Annually |
C.5.11.1.5.1
(SMAC ONLY)
| Telephone Inquiries |
| Interruption of Call Center Service Report |
| Report about interruption of telecommunications service, both Verizon related and in-house |
| COR and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| Within 10 calendar days after the end of each month |
| Monthly |
C.5.11.1.7
(SMAC ONLY)
| Inquiry Tracking System |
| Contractor Inquiry Tracking Reports |
| Report of all provider inquiries using standard inquiry categories. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Within 10 calendar days after the end of each month |
| Monthly |
| C.5.11.1.8.2 |
| Web Technology |
| Website Attestation |
| Statement by contractor attesting that CMS' contractor website guidelines have been followed. See IOM Pub. 100-9, Chapter 6, Section 50.2.2. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Within 30 calendar days after cutover; thereafter, by the end of the sixth month of the contract year. |
| Annually |
| C.5.11.1.8.2 |
| Web Technology |
| Website Attestation statement about Current Procedural Terminology (CPT) usage |
| Statement by contractor attesting whether website adheres to requirements in IOM Pub 100-4, Chapter 23, §20.7. |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Within 30 calendar days after cutover; thereafter, by the end of sixth month of contractor year |
| Annually |
C.5.11.1.10
(SMAC ONLY)
| Provider Customer Service Program Staff Training |
| Contact Center Training Schedules |
| A training schedule, including dates, times, topics, subtopics, and contact information about PCC closure |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| 10th of month prior to training closure |
| Monthly |
C.5.11.1.10
(SMAC ONLY)
| Provider Customer Service Program Staff Training |
| Requests for PCC Closure Greater than 4 Hours |
| A request to close PCC for more than 4 hours in a day |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| 1 month prior to requested training date - via email |
| As requested |
C.5.11.1.10
(SMAC ONLY)
| Provider Customer Service Program Staff Training |
| Provider Complaints about PCC Closure |
| Report about provider complaints and their resolution related to PCC closures |
| COR and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Upon request - via email |
| As requested |
C.5.11.2.7
(SMAC ONLY)
| Review Written Responses for Reading Level (Fogging) Accuracy and Timeliness |
| Readability Attestation for Beneficiary Correspondence |
| Contractors are required to attest that they are issuing correspondence that satisfies the readability requirements outlined in the Federal Register. This attestation should include how contractors ensure that this requirement is being met (e.g., software programs, quality reviews, etc.). Additional information regarding the readability requirements is in IOM 100-09, Chapter 2, Section 20.2.1. |
| COR and/or Designees |
| Within 30 days after cutover; thereafter, last day of contract year for next year's contract. |
| Annually |
| C.5.11.2.17 (SMAC ONLY) |
| Beneficiary Satisfaction Survey |
| Beneficiary Satisfaction Survey Recommendations |
| SMAC shall provide innovated recommendations on how to conduct the Beneficiary Satisfaction Survey |
| COR and/or Designees |
| November 30 |
| Annually |
| C.5.13.2 |
| Banking Relations |
| Copy of Tripartite Agreement |
| Describes the agreement between CMS, the contractor and its bank |
| COR and/or Designees |
| Upon initiation |
| Once |
| C.5.13.2.4 |
| Contractor Monthly Bank Reconciliation Worksheet (CMBRW) |
| CMBRW |
| Bank reconciliation |
| COR and CMS Business Owner |
| On or before the 15th of the month |
| Monthly |
| C.5.13.2.4.1 |
| Cash Collection Worksheet |
| Cash Collection Worksheet |
| Reconciles the cash balance |
| COR and CMS Business Owner |
| On or before the 15th of the month |
| Monthly |
| C.5.13.2.4.2 |
| Estimated Allowance for Uncollectible Accounts |
| Allowance Matrix |
| Calculates the allowance percentage of receivable |
| COR and CMS Business Owner |
| 5 business days after month end |
| Monthly |
| C.5.13.2.5 |
| Letter-of-Credit Limitation |
| Letter of Credit Limitation Change Request |
| Written requests for changes to the monthly letter-of-credit limitation |
| COR and/or Designees |
| Consistent with frequency |
| As required |
| C.5.13.4.2 |
| Applications for Extended Schedule |
| Extended Repayment Schedule (ERS) Report |
| In Excel format, this report identifies providers who have requested an ERS and identifies those requests that have been approved, denied and pending. |
| COR and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| C.5.13.7 |
| Unsolicited/Voluntary Refunds |
| Unsolicited/Voluntary Refund Check Summary Report |
| Describes a summary of the unsolicited/voluntary refund checks |
| COR and/or Designees |
| Upon Request |
| Upon Request |
| C.5.13.8.1 |
| Administrative Freeze Payments |
| Provider Overpayment Referral Checklist |
| Describes summary of overpayment information for a Provider in bankruptcy |
| COR and/or Designees |
| Consistent with frequency - via email |
| As required |
| C.5.13.8.2 |
| Closed Bankruptcy Case |
| Quarterly Bankruptcy Tracking Report |
| Describes the status of the discharge of bankruptcy proceedings. Builds on the information contained in the summary of detailed underpayment and overpayment information for a Provider in bankruptcy. |
| COR and/or Designees |
| Quarterly |
| Quarterly |
| C.5.13.9 |
| Financial Reporting and Accounting |
| Statement of Financial Position and Status Accounts Receivable |
| Forms CMS 750/751 Describes the accounts receivable activity for Fiscal year-to-date |
| COR and/or Designees |
| Within 5 business days after the close of the month |
| Monthly |
| C.5.13.9.1 |
| Accounts Receivable Trend Analyses |
| Accounts Receivable Trend Analysis Reports |
| Describes the results of accounts receivable trend analyses |
| COR and/or Designees |
| On or before January 22, April 22, July 22, and October 22. (The third and fourth quarter due dates may change due to the accelerated time periods. Medicare contractors will be notified of these changes by a Technical Direction Letter (TDL). |
| Quarterly |
| C.5.14.2 |
| Development of Improper Payment Reduction Strategy (IPRS) |
| IPRS |
| Describes the operational plan for how the contractor will evaluate data and address program vulnerabilities throughout the year. See PIM 100-08 Chapter 7 |
| COR and/or Designees |
| The Initial strategy is due after contract award no less than 30 calendar days prior to first claims cutover date even if there are multiple cutover dates. Thereafter the strategy is due no less than 30 calendar days prior to start of each option year. If a major revision is needed to the IPRS, notify the COR to determine if a revised strategy is required. See PIM 100-08 Chapter 7. |
| Annually |
| C.5.14.2 |
| Development of Improper Payment Reduction Strategy (IPRS) |
| Strategy Analysis Report (SAR) |
| An annual update to the IPRS that describes progress towards goals as defined in the strategy and any changes that need to be made to the strategy. See PIM 100-08 Chapter 7. |
| COR and/or Designees |
| The SAR is due within 14 calendar days after final cutover date and 7.5 months after option year starts. |
Where the initial SAR and Option year strategy would be due within 60 calendar days of each other the contractor shall inform the COR of this occurrence, to address on a case by case basis.
Annually
C.5.14.2.1
(SMAC ONLY)
| Improper Payment Reduction Activities Report (IPRAR) |
| Improper Payment Reduction Activities Report (IPRAR) |
| An annual report that provides analysis of the SMAC specific CERT findings and activities to support the reduction of improper payments. |
| COR and/or Designees |
| February 15 |
| Annually |
| C.5.14.5 |
| Support of Comprehensive Error Rate Testing |
| Comprehensive Error Rate Testing (CERT) Program: Medicare Administrative Contractor |
Certification
| The SMAC shall submit a certification that all required information has been completely and accurately entered on the CERT Claims Status website. The SMAC's Certifying Official shall sign the certification and submit it to CMS via CMS ART. |
| Contracting Officer's Representative and/or Designees and CMS ART |
| October 15 |
| Annually |
| C.5.14.6 |
| Monthly Reporting of Medical Review Savings |
| Medical Review Savings Report |
| Financial savings to the Trust Fund that result from performing Medical Review. Calculated as denials minus reversals. See PIM 100-8 Chapter 7. |
| CMS ART |
| Due the 20th day of every month |
| Monthly |
| C.5.14.8.1 |
| Defending Medical Review Decisions at ALJ Hearings - Coordination |
| OMHA Contact Information |
| Level 1 appeals contact information |
| Contracting Officer's Representative and AppealsContactInformation_OMHA@cms.hhs.gov |
| The contractor shall ensure that CMS has the most up-to-date contact information for Level 1 appeals in order to support the successful coordination of the appeals process with Levels 2, 3, and 4. The contractor shall provide updated contact information via email using the template provided under TDL-150507 if there are changes to any pertinent contact information (e.g., fax numbers, addresses, telephone numbers). Send all emails to the CMS contact, AppealsContactInformation_OMHA , at AppealsContactInformation_OMHA@cms.hhs.gov, and copy the Contracting Officer’s Representatives (CORs). |
| When contract information changes |
C.5.15.2
(SMAC ONLY)
| Benefit Integrity Staff Personnel |
| Benefit Integrity Personnel Attestation Statement |
| Statement by contractor attesting that BI personnel meet education and work experience backgrounds as required in the SOW |
| COR and/or designees |
| Within 30 calendar days after option year starts |
| Annually |
| C.5.16.2 |
| Electronic Correspondence Referral System Status Inquiries |
| Number of ECRS request submitted to the BCRC |
| Provides the number of MSP prepay ECRS Requests by category (Inquiries and CWF Assistance Requests) sent to the BCRC each month |
| COR and/or Designees |
| Last business day of the following month |
| Monthly |
| C.5.16.4 |
| Identification and Adjudication of Medicare Secondary Payer Claims and Application of Benefits and Processing Formula |
| Number of MSP claims processed |
| Provides the number of MSP claims processed during the given month including the number of claims processed, rejected, adjusted and denied |
| COR and/or Designees |
| Last business day of the following month |
| Monthly |
| C.5.16.5 |
| Medicare Secondary Payer Claims Inquiries |
| The number of inquiries and documentation received and responded to. |
| The number of inquiries and documentation the Contractor responded to from insurers and other interested parties (e.g., attorneys and/or beneficiaries, etc.) on MSP billing requirements to assist with resolving claims inquiries accurately, timely, and responsively. |
| COR and/or Designees |
| Last business day of the following month |
| Monthly |
| C.5.16.9.1 |
| Duplicate Primary Payments |
| Unsolicited/Voluntary MSP Posted Checks Status Report (identifying associated vs. not associated with a known debt) & ECRS entry required vs. No ECRS needed but No A/R has been established yet |
| Provides a listing of all Posted Provider, Physician, or Other Supplier MSP Unsolicited/Voluntary Refund Checks (identifying each entry as (1) associated to a known debt vs. (2) NOT associated to a known debt and ECRS entry required) (3) No ECRS needed but no A/R has been established yet) received by the SMAC Contractor. |
| COR and/or Designees |
| Last business day of the following month |
| Monthly |
| C.5.16.9.2 |
| Inquiries Specific to Debt Collection Efforts for Providers, Physicians, and other Suppliers |
| MSP Pending Correspondence Report |
| Provides a listing of all pending MSP correspondence. |
| COR and/or Designees |
| Last business day of the following month |
| Monthly |
| C.5.16.9.5 |
| Misrouted Benefits Coordination and Recovery Center Medicare Secondary Payer Recovery Checks (Non-GHP checks) and/or Misrouted Commercial Repayment Center MSP Recovery Checks (GHP Checks) |
| Medicare Secondary Payer (MSP) Misrouted Recovery Checks (and Associated Correspondence) (Non-GHP = BCRC and GHP=CRC) |
| Provides a listing of all misrouted MSP - GHP or Non-GHP - checks either transferred to the BCRC for Non-GHP checks only; and/or transferred to the Commercial Repayment Center (CRC) for GHP checks only (broken down by where sent - BCRC or CRC). |
| COR and/or Designees |
| Last business day of the following month |
| Monthly |
| C.5.16.9.6 |
| Misrouted Benefits Coordination and Recovery Center MSP Recovery Correspondence (Non-GHP) and/or Misrouted Commercial Repayment Center MSP Recovery Correspondence (GHP) |
| Medicare Secondary Payer (MSP) Misrouted Recovery Correspondence (Non-GHP = BCRC and GHP=CRC) |
| Provides a listing of all misrouted MSP -GHP or Non-GHP -correspondence that was either transferred to the BCRC for Non-GHP correspondence only and/or either transferred to the Commercial Repayment Center (CRC) - GHP correspondence only (broken down by where sent - BCRC or CRC) |
| COR and/or Designees |
| Last business day of the following month |
| Monthly |
| C.6.1 |
| Joint Operating Agreements |
| Initial Joint Operating Agreement (JOA) |
| The initial JOA defines roles and responsibilities of mutually agreed upon methods to work with and support RRB's and CMS’ missions—with each of the following parties: Qualified Independent Contractors (QICs); Administrative Qualified Independent Contractors (AdQICs); Call Center Operations (CCO); Virtual Data Center (VDC); Commercial Repayment Center (CRC); Beneficiary Coordination and Recovery Center (BCRC), Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO), and Unified Program Integrity Contractors (UPICs) |
| COR and/or Designees |
| 30 calendar days prior to cutover |
| Once |
| C.6.1 |
| Joint Operating Agreements |
| Updated Joint Operating Agreement (JOA) |
| The updated JOA defines any updates to the roles and responsibilities of a mutually agreed upon methods to work with and support RRB's and CMS’ missions—with each of the following parties: Call Center Operations (CCO); Virtual Data Center (VDC); Commercial Repayment Center (CRC); Beneficiary and Coordination Recovery Center (BCRC); Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO), and Unified Program Integrity Contractors (UPICs) |
| COR and/or Designees |
| Consistent with frequency updates: By January 15th, April 15th, July 15th, and October 15th. |
UPIC frequency updates are conducted quarterly based on the implementation date of the JOA.
First Year Quarterly; Subsequent Years Semiannually
| C.6.1.1 and C.6.1.5 |
| Joint Operating Agreement: Qualified Independent Contractor (QIC) and Administrative Qualified Independent Contractor (AdQIC) |
| Updated Joint Operating Agreement |
| The updated JOA defines any updates to the roles and responsibilities of a mutually agreed upon methods to work with and support CMS’ mission—with each of the following parties: QIC and the AdQIC. |
| COR and/or Designees |
| Consistent with frequency updates: on January 1st (or a mutually agreeably time between the respective parties). |
| Annual basis or more frequently if significant changes warrant an interim update. |
| C.6.1.5 |
| Supply of Appeals Case Files |
| Supply of Appeals Case Files Report |
| An electronic report that describes the number of requests from the QIC for redetermination case files (in cases and claims); number of case files forwarded to the QIC in 1–5 days, in 6–10 days, in more than 10 days (in cases and claims); average time to forward redetermination case files; number of case file requests that are pending (request received but files not yet sent to QIC) (in cases and claims); and cost of preparing and forwarding redetermination case files. |
| COR and/or Designees |
| Within 15 calendar days of month end |
| Monthly |
| H.3 |
| Conflict of Interest |
| Annually Conflict of Interest Audit |
| Conflict of Interest Certificate |
| Contracting Officer (CO) |
| Update is due 5 business days after April 30 |
| Annually |
| J.4 |
| Billing Instructions |
| SMAC Estimate at Completion (EAC) Report |
| Report that provides monthly assessments of current estimated total contract expenditures compared to the SMAC's current contract values. |
| COR and/or Designees |
| 30 days from the end of the preceding month |
| Monthly |
7/21/2021
Railroad Retirement Board