J-02_RRB SMAC_Deliverables.xlsx
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Railroad Retirement Board
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Solicitation RRB11R001 Attachment JO2 Deliverables
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Deliverable Schedule
| Deliverable Schedule- RFP- RRB-11-R-001- Attachment J-02 | |||||||
| RFP/SOW WPS # | Related SOW Requirement Name | Deliverable Name | Deliverable Description | Deliver to | Deliverable Due Date | Frequency | |
| C.5.1.1 | Jurisdiction Implementation Project Plan | Jurisdiction Implementation Project Plan | A detailed description of all activities required to transfer all Medicare operations from the current carrier to the new contractor’s jurisdiction. | Contracting Officer's Technical Representative and/or Designees | Baseline due within 30 calendar days after contract award | 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 | Contracting Officer's Technical Representative and/or Designees | Due within 30 calendar days after jurisdiction kickoff meeting. | Once | |
| C.5.1.2 | Jurisdiction Cutover Plan | Jurisdiction Cutover Plan | An expanded part of the Jurisdiction 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. | Contracting Officer's Technical Representative and/or Designees | Initial within 45 calendar days after jurisdiction kickoff meeting. | Once | |
| C.5.1.5 | Jurisdiction Test Plan (Not Included in RRB SOW by Programs+B12) | Jurisdiction Test Plan | A consolidated plan to identify the approach to testing, types of tests, schedule, and progress for all implementations. | ||||
| Contracting Officer's Technical Representative and/or Designees | Initial within 30 calendar days after first segment kickoff meeting, Updates are due within 30 calendar days following all remaining segment kickoff meetings. | Once | |||||
| C.5.1.7 | Accounts Receivable Reconciliation | Accounts Receivable Transmittal Document | Describes the total amounts and counts of the accounts receivables of the outgoing contractor. | Contracting Officer's Technical Representative and/or Designees | Due within 10 calendar days after the date of transfer | 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. | Contracting Officer's Technical Representative and/or Designees | Initial within 30 calendar days after Jurisdiction kickoff meeting. | 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. | Contracting Officer's Technical Representative and/or Designees | Initial within 30 calendar days of replacement contractor kickoff meeting | Once | |
| C.5.2.1 | Closeout Project Plan (Option that may be exercised at the End of the Contract) | Jurisdiction Workload Closeout Report | Identifies workload indicators for a jurisdiction to allow RRB and CMS to determine if the outgoing Contractor is processing claims in accordance with the SOW. | Contracting Officer's Technical Representative and/or Designees | Within 3 business days of biweekly period end | Biweekly | |
| C.5.2.3 | Workload Closeout Risk Management Plan | Workload Closeout Risk Management Plan | Includes a periodic assessment of new risks and mitigation and contingency planning where appropriate. | Contracting Officer's Technical Representative 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. | Contracting Officer's Technical Representative and/or Designees | Due within 10 calendar days after the date of transfer | Once | |
| C.5.4.2.1 | Post-Award Meeting | Post-Award Meeting Minutes | Describes the results of the Post-Award meeting conducted. | Contracting Officer's Technical Representative and/or Designees | Within 3 business days of the Post-Award meeting | Once | |
| C.5.4.2 | Project Management Plan | Project Management Plan | Describes the plan for overall management of the program. | Contracting Officer's Technical Representative and/or Designees | Initial within 30 business days after contract award, updates within 15 calendar days after quarter end | Quarterly | |
| 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 Supplied Data Excel document. Please include in the file name the jurisdiction number, the SMAC Name, and the month for which you are reporting. | Contracting Officer's Technical Representative 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 Contracting Officer's Technical Representative via the deliverable mailbox indicating that this action has been completed. | Contracting Officer's Technical Representative 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. | Contracting Officer's Technical Representative 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 Contracting Officer's Technical Representative via the deliverable mailbox indicating that this action has been completed. | Contracting Officer's Technical Representative 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.5.4.3 | Security | Information Technology Systems Contingency Plan Report | Information Technology (IT) Systems Contingency Plan (See BPSSM Table 3.1 Planning Table, for 3.4) | Contracting Officer's Technical Representative 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 | Contracting Officer's Technical Representative 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) | Contracting Officer's Technical Representative and/or Designees | Initial within 90 days prior to making AB payments under the contract and annually thereafter | Annually | |
| C.5.4.3 | Security | Statement of Security Compliance | Annual certification (See BPSSM Table 3.1 Planning Table, for 3.3) | Contracting Officer's Technical Representative 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) | Contracting Officer's Technical Representative and/or Designees | Initial within 90 days prior to making AB 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) | Contracting Officer's Technical Representative 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. | Contracting Officer's Technical Representative 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) | Contracting Officer's Technical Representative 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.5.4.4.1 | Quality Control Program | Quality Control Plan (QCP) | Specifies the procedures and resources applied to ensure services meet contract performance requirements. | Contracting Officer's Technical Representative and/or Designees and CMS Business Owner | No later than 45 calendar days after contract award; then annually at contractor renewal, thereafter, as significant changes occur. | Annually at contractor renewal or when there is a significant change to the operation or plan. | |
| C.5.4.5 | Public Relations | Public Relations Plan | Describes the contractor’s plans for managing the programs public relations. | Contracting Officer's Technical Representative and/or Designees | Initial within 30 calendar days of contract award, thereafter within 7 calendar days of annual period end | One month after contract award then Annually thereafter | |
| 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. | Contracting Officer's Technical Representative 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 | Describes the Change Requests (CRs) that the contractor has implemented in the quarterly period. | Contracting Officer's Technical Representative and/or Designees | 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.5.4.9 | Business Continuity Planning and Disaster Recovery | Comprehensive Continuity of Operations (COOP) Plan | Describes the Contractor’s policies and procedures to ensure that essential business functions continue during a disaster. The COOP plan elements include protection of physical infrastructure, IT disaster recovery, business continuity (with or without system availability), and other topics | Contracting Officer's Technical Representative and/or Designees | 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. | Contracting Officer's Technical Representative 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. | Contracting Officer's Technical Representative 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.5.4.10.4 | Statement on Auditing Standards 70 Audit | Final Statement on Auditing Standards (SAS) 70 Report | Describes the Final SAS 70 Report includes a matrix at Section I reporting all SAS 70 findings. Working papers and supporting documentation must be made available upon request to any party designated by RRB or CMS. | Contracting Officer's Technical Representative and/or Designees | Draft Report due by June 15 of each fiscal year. Final Report due by July 1 of each fiscal year. | Annually | |
| C.5.4.10.4 | Statement on Auditing Standards 70 Audit | Final CAP Follow-up Report | Describes the Final CAP Follow-up Report which includes a matrix to report the status of all prior CAPs. Working papers and supporting documentation must be made available upon request to any party designated by RRB or CMS. | Contracting Officer's Technical Representative and/or Designees | Draft Report due by June 15 of each fiscal year. Final Report due by July 1 of each fiscal year. | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Position Description for the Compliance Officer and other members of the Compliance Department | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Code of Conduct | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Written compliance policies and procedures | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Compliance training materials used or developed in the last year | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Names and positions of the Board of Directors and/or Compliane Committee members charged with oversight of the compliance program | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Charters for the Board and/or Executive Compliance Committees | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Conflict of interest questionnaire(s) that are completed by employees, managers, officers and Board members | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Risk assessment protocol(s) developed by the Compliance Department | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Internal audit plan | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| C.5.4.11 | Compliance Program | Compliance Documents | Any reportable events to RRB and CMS (See H.18- Reportable Events) on completed and current RRB or CMS contracts | Contracting Officer's Technical Representative and/or Designees | Initial 30 calendar days after contract award and annually therafter | Annually | |
| 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 | Contracting Officer's Technical Representative 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. | Contracting Officer's Technical Representative and/or Designees | Within 15 calendar days of quarter end | Quarterly | |
| C.5.11.1.2.5 | Bulletin/Newsletter Publication | Alternative Bulletin Plan | Plan for electronic distribution of bulletins/newsletters | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | As requested | As required | |
| C.5.11.1.2.5 | Bulletin/Newsletter Publication | Alternative Bulletin Evaluation | Evaluation of alternative bulletin implementation | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | 6 months after implementation of alternative bulletin approach | As required | |
| C.5.11.1.3 | Provider Service Plan | Provider Service Plan (PSP) | Describes the outreach and education activities the contractor will accomplish throughout the year | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | By the last day of the first month of the contract year. | Annual | |
| C.5.11.1.4 | Education Activity Report | Education Activity Report (EAR) | Summarizes and recounts the completed Provider Outreach and Education activities in the previous 5.5-6 month period. | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | First report due on the 30th day after the first six months of the contract year; second report due 30 days after the last day of the contract year. | Semiannual | |
| C.5.11.1.5 | Provider Contact Center | Primary Provider Inquiry Contact | Contact information for primary Provider Contact Center (PCC) contact at contractor. | Contracting Officer's Technical Representative and/or Designees and mailbox ServiceReports@cms.hhs.gov | End of first month of contract year | Annual, as needed as changes made | |
| C.5.11.1.5 | Provider Contact Center | Planned Contact Center Closure | Schedule of planned closures for contact center, including Federal holiday closures | Contracting Officer's Technical Representative and/or Designees and mailbox ServiceReports@cms.hhs.gov | End of first month of contract year | Annual | |
| C.5.11.1.5 | Provider Contact Center | Ad Hoc Closure Requests | Requests to close contact centers at times different from planned closures | Contracting Officer's Technical Representative and/or Designees and mailbox ServiceReports@cms.hhs.gov | As needed, at least 3 weeks before requested closure date | As requested | |
| C.5.11.1.5 | Provider Contact Center | Customer Service Operations Surveys | Surveys of contractor’s customer service operations, such as PCC technology, staffing, training needs. | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | Upon request | As requested | |
| C.5.11.1.5.1 | Telephone Inquiries | Remote Monitoring Instructions | Instructions for RRB and CMS to remotely monitor live provider inquiry calls | Contracting Officer's Technical Representative and/or Designees and mailbox ServiceReports@cms.hhs.gov | 3 business days before instructions are active | Annual, and as instructions change | |
| C.5.11.1.5.1 | Telephone Inquiries | Disaster Recovery Plans | Plan describing how the Medicare provider telecommunications operations will be maintained or continued in event of natural or manmade disaster | Contracting Officer's Technical Representative and/or Designees and mailbox ServiceReports@cms.hhs.gov | End of third month of contract year | Annual | |
| C.5.11.1.5.1 | Telephone Inquiries | Interruption of Call Center Service Report | Report about interruption of telecommunications service, both Verizon related and in-house | Contracting Officer's Technical Representative and/or Designees and mailbox ServiceReports@cms.hhs.gov | End of month | Monthly | |
| C.5.11.1.7 | Inquiry Tracking System | Contractor Inquiry Tracking Reports | Report of all provider inquiries using standard inquiry categories. | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | End of month following each quarter of contract year | Quarterly | |
| C.5.11.2.7 | Review Written Responses for Reading Level (Fogging) Accuracy and Timeliness | Readability Attestation for Beneficiary Appeals 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 100-04, Chapter 29, Section 290.3.2 -- Reading Levels. | Contracting Officer's Technical Representative and/or Designees and CMS Business Owner | Within 30 days after cutover | annual | |
| 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. | Contracting Officer's Technical Representative 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, .5.3.1, §20.7 | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | End of sixth month of contractor year | Annual | |
| C.5.11.1.10 | Provider Customer Service Program Staff Training | Contact Center Training Schedules | A training schedule, including dates, times, topics, subtopics, and contact information about PCC closure | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | 15th of month prior to training closure | Monthly | |
| C.5.11.1.10 | 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 | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | 1 month prior to requested training date | As requested | |
| C.5.11.1.10 | Provider Customer Service Program Staff Training | Provider Complaints about PCC Closure | Report about provider complaints and their resolution related to PCC closures | Contracting Officer's Technical Representative and/or Designees and mailbox ProviderServices@cms.hhs.gov | Upon request | As requested | |
| C.5.13.2 | Banking Relations | Copy of Tripartite Agreement | Describes the agreement between CMS, the contractor and its bank. | Contracting Officer's Technical Representative and/or Designees | Upon initiation | Once | |
| C.5.13.2.4 | Contractor Monthly Bank Reconciliation Worksheet | CMBRW | Bank reconciliation | Contractoring Officer's Technical Representative, CMS Business Owner, and mailbox higlasbankrecon@cms,hhs,gov | 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 | Contractoring Officer's Technical Representative, CMS Business Owner, and mailbox | Monthly | ||
| C.5.13.2.4.2 | Estimated Allowance for Uncollectible Accounts | Allowance Matrix | Calculates the allowance percentage of receivable | Contractoring Officer's Technical Representative, CMS Business Owner, and mailbox | HIGLAS Contractors: 4 days after quarter end Non-HIGLAS: April 21 and as stated by Year End JSM | HIGLAS Contractors: Monthly Non-HIGLAS Contractors: March and September | |
| 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. | Contracting Officer's Technical Representative and/or Designees | Consistent with frequency | As required | |
| C.5.13.4.2 | Applications for Extended Plan | Extended Repayment Plan (ERP) Extension Requests | Usually in Excel format, this report identifies providers who have requested an ERP and identifies those requests that have been approved and denied. | Contracting Officer's Technical Representative 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. | Contracting Officer's Technical Representative 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. | Contracting Officer's Technical Representative and/or Designees | Consistent with frequency | 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. | Contracting Officer's Technical Representative and/or Designees | Quarterly | As required | |
| 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 | Contracting Officer's Technical Representative and/or Designees | Within 21 days of the quarter end | Quarterly | |
| C.5.13.9.1 | Accounts Receivable Trend Analyses | Accounts Receivable Trend Analysis Reports | Describes the results of accounts receivable trend analyses. | Contracting Officer's Technical Representative and/or Designees | On or before February 8, May 8, August 8, and November 1. (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 Joint Signature Memorandum (JSM). | Quarterly | |
| C.5.14.1 | Development of Medical Review Strategy | Medical Review Strategy Report (MRS) | Describes the operational plan for how the contractor will evaluate data and address program vulnerabilities throughout the year. | ||||
| Effective 4/1/2008 the MR system located at CMS's Local Coverage Systems Portal Website is the primary collection tool for the MRS (refer to CR 5760). | Contracting Officer's Technical Representative 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 45 calendar days prior to start of each option year. (See also PIM 100-08 Chapter 1.2.3 where there are major changes). | Annually | ||||
| C.5.14.1 | Development of Medical Review Strategy | Strategy Analysis Report (SAR) | A once annual update to the MR Strategy Report that describes progress towards goals as defined in the strategy and any changes that need to be made to the strategy. | ||||
| Effective 4/1/2008 the MR system located at CMS's Local Coverage System Portal Website is the primary collection tool for the SAR (refer to CR 5760). | Contracting Officer's Technical Representative and the CMS Local Coverage Systems Portal Website via the MR. | 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 30 calendar days of each other the contractor shall inform the Contracting Officer's Technical Representative of this occurrence, to address on a case by case basis | Annually | ||||||
| C.5.16.2 | Electronic Correspondence Referral System Status Inquiries | Number of ECRS request submitted to the COBC | Provides the number of MSP prepay ECRS Requests by category (Inquiries and CWF Assitance Requests) sent to the COBC each month. | Contracting Officer's Technical Representative and/or Designees | Last business day of the 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. | Contracting Officer's Technical Representative and/or Designees | Last business day of the month | Monthly | |
| C.5.16.5 | Medicare Secondary Payer Claims Inquiries | The number of inquiries and documentation received and rsponded 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. | Contracting Officer's Technical Representative and/or Designees | Last business day of the month | Monthly | |
| C.5.16.8 | Transfer of Documentation and Phone Calls to the Coordination of Benefits Contractor | Number of phone calls and documentation transferred to the COBC | Number of phone calls and documentation transferred to the COBC | Contracting Officer's Technical Representative and/or Designees | Last business day of the 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) | 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) received by the SMAC Contractor. | Contracting Officer's Technical Representative and/or Designees | Last business day of the 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. | Contracting Officer's Technical Representative and/or Designees | Last business day of the month | Monthly | |
| C.5.16.9.5 | Misrouted Medicare Secondary Payer Recovery Checks | Medicare Secondary Payer (MSP) Misrouted Recovery Checks (and Associated Correspondence) | Provides a listing of all misrouted checks and correspondence that was transferred to the Medicare Secondary Payer Recovery Contractor | Contracting Officer's Technical Representative and/or Designees | Last business day of the month | Monthly | |
| C.5.16.9.6 | Misrouted Medicare Secondary Payer Post Payment Recovery | Medicare Secondary Payer (MSP) Misrouted Recovery Correspondence | Provides a listing of all misrouted correspondence that was transferred to the Medicare Secondary Payer Recovery Contractor | Contracting Officer's Technical Representative and/or Designees | Last business day of the month | Monthly | |
| C.6.1 | Joint Operating Agreements | Initial Joint Operating Agreement (JOA) | The initial JOA defines 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: Program Safeguard Contractors (PSCs) with Benefit Integrity (BI) task orders; other specialty PSCs, if applicable; Qualified Independent Contractors (QICs); Administrative Qualified Independent Contractors (AdQICs); Quality Improvement Organizations (QIOs); Recovery Audit Contractors (RACs); Beneficiary Contact Center (BCC); and Enterprise Data Center (EDC). | Contracting Officer's Technical Representative and/or Designees | 30 calendar days prior to cutover | Once | |
| C.6.1 | Joint Operating Agreements | 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 RRB's and CMS’ missions—with each of the following parties: PSCs with BI task orders; other specialty PSCs, if applicable; QICs; AdQICs; QIOs; RACs; and BCC. | Contracting Officer's Technical Representative and/or Designees | Consistent with frequency updates: By January 15th, April 15th, July 15th, and October 15th. | First Year Quarterly; Subsequent Years Semiannually | |
| C.6.1.2.2 | Referrals to Quality Improvement Organization | Quality Improvement Organization Referrals | Describes the referrals to the QIO for medical necessity determinations. | Contracting Officer's Technical Representative and/or Designees | Consistent with frequency | Every 6 months due January 1 & July 1 | |
| C.6.1.2.2 | 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. | Contracting Officer's Technical Representative and/or Designees | Within 15 calendar days of month end | Monthly | |
| C.6.2.1 | State Agencies Responsible for Licensing Institutional Providers (e.g., Survey and Certification, Licensing Authorities) (NOT IN RRB SOW) | Health Insurance Benefits Agreement, Provider-Based Determination, or Other Institutional Provider Information | The Health Insurance Benefits Agreement, Provider-Based Determination, or Other Institutional Provider Information is provided in the format requested to state agencies with a copy to CMS. | Contracting Officer's Technical Representative and/or Designees | Consistent with frequency | As required | |
| H.3 | Conflict of Interest | Annual Conflict of Interest Audit | Conflict of Interest Certificate | Contracting Officer (CO) | Annually on the anniversary date that the contract became fully operational | Annually |
&"Arial Narrow,Regular"RFP-CMS-2010-0050 &"Arial Narrow,Regular"Attachment J-02 Updated 5/19/10
&"Arial Narrow,Regular"RFP- RRB11-R-001 &"Arial Narrow,Regular"Attachment J-02 Updated11/15/10
&"Arial Narrow,Regular"Page &P of &N
&"Arial Narrow,Regular"Page &P of &N mailto:ServiceReports@cms.hhs.govmailto:ServiceReports@cms.hhs.govmailto:ServiceReports@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ProviderServices@cms.hhs.govmailto:ServiceReports@cms.hhs.govmailto:ServiceReports@cms.hhs.govmailto:ServiceReports@cms.hhs.govmailto:ProviderServices@cms.hhs.gov
File details come from the government source that posted it. Updated .