MCA_Bridge_JOFOC_8.4_Unusual_and_compelling_urgency_Redacted.pdf

This is a Justification for Other Than Full and Open Competition under Federal Acquisition Regulation (FAR) Subpart 8.4 for a sole source procurement on the General Services Administration (GSA) Federal Supply Schedule (FSS) and Multiple Award Schedule (MAS).

The U.S. Department of Justice, Federal Bureau of Prisons, is procuring Medical Claims Adjudication (MCA) services and software platform to support healthcare claims processing and fraud detection. The requirement will be awarded as a Firm-Fixed-Price (FFP) task order with a 6-month base period and two 3-month option periods under an existing GSA FSS MAS contract. The Bureau's Health Services Division requires a specialized MCA software platform that ensures healthcare service providers are paid under Medicare-based rate structures, guarantees compliance with Medicare Claims processing guidelines and National Correct Coding Initiative edits, and includes customized fraud monitoring and detection capabilities. The proposed contractor (Apprio) provides the only known solution available for immediate implementation that includes a complete, integrated system with custom interface capabilities, analytic tools, Explanation of Benefits (EOBs) functionality, and real-time fraud alerts without requiring multiple awards and additional costs within the required timeframe. Price reasonableness has been determined fair and reasonable based on GSA FSS MAS contract pricing at the award level, with further validation through price analysis comparing proposed prices to historical prices previously paid and independent government estimates. The justification was approved under the unusual urgency statutory exception in GSAR 538.7104-3(b)(1)(i), and the agency will publish this justification within 30 days to https://www.sam.gov as required by 41 U.S.C. 3304(f).