ClaimsCore ePMO LSJ Redacted.pdf
PDF 556 KB Posted
- Solicitation number
- 270134
About this file
This is a Limited Source Justification (J&A) for a sole source contract award by the Centers for Medicare & Medicaid Services (CMS), Office of Information Technology.
The acquisition authorizes award of a contract to TEGRIA SERVICES GROUP – US INC (located at 1255 Fourier DR, STE 101, Madison, WI, 53717) for ClaimsCore Enterprise Program Management Office (ePMO) support services on a sole source basis under FAR RFO 6.103-1. The contract type is Firm-Fixed Price with a Total Projected Cost of $7,246,800 (including options) for Fiscal Year 2026. The Period of Performance consists of a 12-month Base Period (September 1, 2026 – August 31, 2027), followed by Option Period 1 (3 months: September 1, 2027 – November 28, 2027) and Option Period 2 (12 months: November 29, 2027 – November 28, 2028), totaling 27 months. This is classified as a New Requirement.
The contractor will provide integrated, vendor-neutral, and evidence-based support services for the ClaimsCore initiative, a large-scale modernization effort to replace Medicare Fee-for-Service legacy systems with a Commercial Off-the-Shelf platform. Key deliverables include Technical PMO Leadership (scheduling, RAID tracking, stage gates, status reporting), Executive Advisory services (C-suite governance and technical approach guidance), Enterprise Architecture (target-state architecture and integration patterns), Dual-Platform Support (Balanced Facets & HealthEdge guidance and testing), and Integration & Readiness services (integration plans, data conversion, cutover runbooks). CMS determined Tegria is the only capable source due to its unmatched concentration of former TriZetto/Cognizant senior leaders with deep Facets platform expertise, C-suite level vendor executive availability, dual-platform technical capability, and integrated team structure. CMS will publish the J&A on SAM.gov with a minimum 14-day public comment period, allowing other responsible sources to submit capability statements for consideration.
View the file
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
elsewhere as a coordinated team,
2. Dual-Platform Capability - Tegria is the strongest identified match for an immediately available, integrated dual-platform technical ePMO. The proposed team brings direct Facets implementation, configuration, conversion, claims-accuracy, and integration experience through former TriZetto/Cognizant product consulting and testing leaders, vendor CIOs, and enterprise architects. No other identified source offers this combination of Cognizant/Facets depth alongside potential HealthEdge familiarity under a single integrated management framework.
3. C-suite Level Availability - Senior former vendor executives and enterprise architects are immediately available and already familiar with ClaimsCore; a competitive process cannot replicate this within the ClaimsCore POC schedule,
4. Integrated Team Structure - All capabilities are delivered under one management framework, eliminating fragmented accountability and procurement delays.
3. Market Research Summary: Market research conducted by CMS, informed by the Government's extensive experience and knowledge of the payer-core modernization marketplace, confirms that Tegria Services Group – US Inc is the only identified source capable of providing the specific, integrated, senior, dual-platform implementation team required within the ClaimsCore proof-of-concept schedule.
Industry Engagement: Through direct experience in the marketplace, CMS has developed an informed understanding of the highly concentrated and specialized talent pool required to fulfill this requirement. The combination of deep TriZetto/Cognizant delivery leadership, Facets implementation depth, and C-suite level vendor executive experience available as a coordinated team under a single firm is effectively unique in the market. This understanding is grounded in CMS's ongoing engagement with the payer-core modernization industry and direct familiarity with the firms and individuals operating within this space.
Commercial Marketplace Analysis: Based on the Government's experience in the marketplace, CMS has determined that no other source exists that can meet the Government's minimum need. Tegria is the strongest identified firm offering direct, deep Facets implementation expertise including configuration, conversion, claims-accuracy, and integration experience through former TriZetto/Cognizant product consulting and testing leaders combined with HealthEdge familiarity, under a single integrated team. Former TriZetto/Cognizant senior leaders and C-suite level former vendor executives of this caliber are highly concentrated within Tegria and are not broadly available through general IT consulting firms or any other single source in the commercial marketplace.
4. Actions to Increase Competition: CMS will publish this J&A notice on SAM.gov providing a minimum 14-day public comment period. Any responsible source that believes it can satisfy the Government's requirements is encouraged to submit a capability statement for consideration. CMS will evaluate all responses received and will conduct a competitive acquisition if another responsible source is identified that can meet the minimum need within the required timeframe.
5. Any other facts supporting the justification: This requirement is directly driven by CMS's strategic decision to conduct a challenge-based acquisition for ClaimsCore, in which multiple vendors compete with distinct platform solutions. This acquisition strategy, while promoting competition for the full-term contract creates a unique, time-limited need for independent expertise across both platforms that cannot be met through a competitive solicitation within the required timeframe. The sole source determination is a direct and necessary consequence of CMS's pro-competitive challenge-based acquisition strategy for ClaimsCore.
7. HHS Competition Advocate Approval
_____N/A______________________________________________ Name / Date
8. Senior Procurement Executive (SPE) Approval Based on the foregoing justification, I hereby confirm the circumstances described above apply and approve the Limited Source Justification.
_____N/A______________________________________________ Name / Date
File details come from the government source that posted it. Updated .