ClaimsCore Combined Synopsis/Solicitation
Closed Solicitation Posted
This opportunity was awarded. See its 2 award notices in the notice history.
- Solicitation number
- 75FCMC26R0022
- Agency
-
Centers for Medicare and Medicaid Services
Department of Health and Human Services
- Responses due
- Set-aside
- No set-aside
Opportunity facts
- NAICS code
- 541512 Computer Systems Design Services
- Place of performance
- Windsor Mill, Maryland 21244, United States
Notice details come from SAM.gov. Updated .
About this opportunity
The Centers for Medicare and Medicaid Services (CMS) is seeking a Software as a Service (SaaS) Commercial-Off-The-Shelf (COTS) platform combined with configuration and integration services to re-platform Medicare Fee-for-Service claims processing through Solicitation 75FCMC26R0022. The procurement aims to replace four legacy systems—the Multi-Carrier System (MCS), Fiscal Intermediary Shared System (FISS), Durable Medical Equipment Claims System (DME), and Common Working File (CWF)—with a flexible, interoperable platform capable of processing approximately 1.2 billion claims annually across 33.6 million beneficiaries while delivering near real-time adjudication, improved fraud prevention, enhanced beneficiary transparency, and reduced provider burden. The evaluation employs a two-phase best-value tradeoff approach in which non-price factors are significantly more important than price, with Phase One assessing Corporate Experience across seven focus areas including high-volume cloud-based claims processing, systems migrations, professional services capacity, financial stability, provider burden reduction, edit/rule extraction capabilities, and fraud detection capabilities, and Phase Two evaluating the Performance Work Statement, Quality Assurance Surveillance Plan, Past Performance, and Price. CMS estimates awarding up to four contracts. The Phase One proposal deadline is March 13, 2026, at 11:00 a.m. Eastern Time, with written questions due by March 6, 2026, at 11:00 a.m. ET; Phase Two proposals will be due at a later date following advisory down-select notifications.
This acquisition is unrestricted with no small business set-aside, and no incumbent contractor is identified in the solicitation materials. The contract consists of a base Proof of Concept period from May 5, 2026, through November 4, 2026, followed by seven annual option periods extending through November 4, 2033, with the contractor required to process a baseline of 4 million claims per day with burst capacity to 2x that volume within 15 minutes while maintaining 99.9% uptime and subsecond adjudication times. Pricing is structured using a Per Member Per Month (PMPM) or Per Claim methodology applied to estimated monthly beneficiary volumes of approximately 33.5 million, with unit prices subject to annual prospective true-up adjustments based on actual volumes; specific contract values are dependent on offeror proposals marked as "TBD." The place of performance is Windsor Mill/Milford Mill, Maryland 21244, with phased rollout across Medicare Administrative Contractor (MAC) jurisdictions beginning with one MAC in year one and expanding to three MACs annually thereafter. All work is subject to HIPAA Business Associate requirements, FISMA Moderate/FedRAMP compliance standards, Section 508 accessibility requirements, and conflict of interest oversight.
Notice text
4 versions
Update #4 · Latest ·
ClaimsCore Combined Synopsis/Solicitation Amendment 0003- The purpose of this amendment is to request offerors provide a copy of any CTA, as applicable in Phase 2 as stated in Amendment 3 - Attachment 3, ClaimsCore Instructions to Offerors.
ClaimsCore Combined Synopsis/Solicitation Amendment 0002- The purpose of this amendment is to correct the Phase 1 RFP submission due date as stated in Amendment 2 - Attachment 3, ClaimsCore Instructions to Offerors.
ClaimsCore Combined Synopsis/Solicitation Amendment 0001 - The purpose of this amendment is to 1) provide responses to RFP questions, 2) provide an Amended Solicitation - 75FCMC26R0022, 3) provide an amended Attachment 1 - ClaimsCore SOO, 4) provide an Amended Attachment 3 - ClaimsCore Instructions to Offerors, and 5) rename and provide an amended Attachment 6 - Beneficiary Quantities Claims and Unit Pricing.
This is a combined synopsis/solicitation for commercial products or commercial services prepared in accordance with FAR part 12. This announcement constitutes the only solicitation. Offers are being requested and a separate written solicitation will not be issued.
Solicitation number 75FCMC26R0022 is issued as a request for proposal (RFP) for ClaimsCore. The ClaimsCore program seeks to re-platform Medicare Fee for Service claims processing by replacing legacy “Shared Systems” including the Multi-Carrier System (MCS), Fiscal Intermediary Shared System (FISS) and Durable Medical Equipment Claims System (DME) as well as the Common Working File (CWF) with a flexible and interoperable platform that reduces administrative burden and sets improvement of the beneficiary experience as the program’s guiding objective. CMS intends to procure a Software as a Services (SaaS) Commercially-Available-Off-The-Shelf (COTS) product and complimentary configuration and integration services that will provide CMS with near real-time adjudication and claims status, policy agility, industry leading enterprise tools, improved fraud prevention capabilities, and tighter integration across CMS, Medicare Administrative Contractor (MACs), providers, and partners.
This acquisition is not set-aside for small business concerns. This solicitation incorporates provisions and clauses by reference. The full text of provisions and clauses may be accessed electronically at www.acquisition.gov.
Contract Line Item Number (CLIN) Structure:
See Attached Soliciation-75FCMC26R0022 for a full breakdown of the CLIN structure, items, quantities, and units of measure (including option(s)).
See Attachment 1 – ClaimsCore Statement of Objectives for full description of the requirements being acquired.
See the attached Solicitation - 75FCMC26R0022 and Attachment 5 - FAR 52.212-5 to find the full list of solicitation provisions and contract clauses that apply to the acquisition (see 12.205(a)).
Date, Response Times, Place for receipt of offer and Point of Contacts:
All questions regarding this solicitation shall be submitted via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 6, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
Offerors shall submit Phase One (1) proposals via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 13, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
See Attachment 3 - ClaimsCore Instructions to Offerors for full instructions.
Update #3 ·
ClaimsCore Combined Synopsis/Solicitation Amendment 0002- The purpose of this amendment is to correct the Phase 1 RFP submission due date as stated in Amendment 2 - Attachment 3, ClaimsCore Instructions to Offerors.
ClaimsCore Combined Synopsis/Solicitation Amendment 0001 - The purpose of this amendment is to 1) provide responses to RFP questions, 2) provide an Amended Solicitation - 75FCMC26R0022, 3) provide an amended Attachment 1 - ClaimsCore SOO, 4) provide an Amended Attachment 3 - ClaimsCore Instructions to Offerors, and 5) rename and provide an amended Attachment 6 - Beneficiary Quantities Claims and Unit Pricing.
This is a combined synopsis/solicitation for commercial products or commercial services prepared in accordance with FAR part 12. This announcement constitutes the only solicitation. Offers are being requested and a separate written solicitation will not be issued.
Solicitation number 75FCMC26R0022 is issued as a request for proposal (RFP) for ClaimsCore. The ClaimsCore program seeks to re-platform Medicare Fee for Service claims processing by replacing legacy “Shared Systems” including the Multi-Carrier System (MCS), Fiscal Intermediary Shared System (FISS) and Durable Medical Equipment Claims System (DME) as well as the Common Working File (CWF) with a flexible and interoperable platform that reduces administrative burden and sets improvement of the beneficiary experience as the program’s guiding objective. CMS intends to procure a Software as a Services (SaaS) Commercially-Available-Off-The-Shelf (COTS) product and complimentary configuration and integration services that will provide CMS with near real-time adjudication and claims status, policy agility, industry leading enterprise tools, improved fraud prevention capabilities, and tighter integration across CMS, Medicare Administrative Contractor (MACs), providers, and partners.
This acquisition is not set-aside for small business concerns. This solicitation incorporates provisions and clauses by reference. The full text of provisions and clauses may be accessed electronically at www.acquisition.gov.
Contract Line Item Number (CLIN) Structure:
See Attached Soliciation-75FCMC26R0022 for a full breakdown of the CLIN structure, items, quantities, and units of measure (including option(s)).
See Attachment 1 – ClaimsCore Statement of Objectives for full description of the requirements being acquired.
See the attached Solicitation - 75FCMC26R0022 and Attachment 5 - FAR 52.212-5 to find the full list of solicitation provisions and contract clauses that apply to the acquisition (see 12.205(a)).
Date, Response Times, Place for receipt of offer and Point of Contacts:
All questions regarding this solicitation shall be submitted via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 6, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
Offerors shall submit Phase One (1) proposals via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 13, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
See Attachment 3 - ClaimsCore Instructions to Offerors for full instructions.
Update #2 ·
ClaimsCore Combined Synopsis/Solicitation Amendment 0001 - The purpose of this amendment is to 1) provide responses to RFP questions, 2) provide an Amended Solicitation - 75FCMC26R0022, 3) provide an amended Attachment 1 - ClaimsCore SOO, 4) provide an Amended Attachment 3 - ClaimsCore Instructions to Offerors, and 5) rename and provide an amended Attachment 6 - Beneficiary Quantities Claims and Unit Pricing.
This is a combined synopsis/solicitation for commercial products or commercial services prepared in accordance with FAR part 12. This announcement constitutes the only solicitation. Offers are being requested and a separate written solicitation will not be issued.
Solicitation number 75FCMC26R0022 is issued as a request for proposal (RFP) for ClaimsCore. The ClaimsCore program seeks to re-platform Medicare Fee for Service claims processing by replacing legacy “Shared Systems” including the Multi-Carrier System (MCS), Fiscal Intermediary Shared System (FISS) and Durable Medical Equipment Claims System (DME) as well as the Common Working File (CWF) with a flexible and interoperable platform that reduces administrative burden and sets improvement of the beneficiary experience as the program’s guiding objective. CMS intends to procure a Software as a Services (SaaS) Commercially-Available-Off-The-Shelf (COTS) product and complimentary configuration and integration services that will provide CMS with near real-time adjudication and claims status, policy agility, industry leading enterprise tools, improved fraud prevention capabilities, and tighter integration across CMS, Medicare Administrative Contractor (MACs), providers, and partners.
This acquisition is not set-aside for small business concerns. This solicitation incorporates provisions and clauses by reference. The full text of provisions and clauses may be accessed electronically at www.acquisition.gov.
Contract Line Item Number (CLIN) Structure:
See Attached Soliciation-75FCMC26R0022 for a full breakdown of the CLIN structure, items, quantities, and units of measure (including option(s)).
See Attachment 1 – ClaimsCore Statement of Objectives for full description of the requirements being acquired.
See the attached Solicitation - 75FCMC26R0022 and Attachment 5 - FAR 52.212-5 to find the full list of solicitation provisions and contract clauses that apply to the acquisition (see 12.205(a)).
Date, Response Times, Place for receipt of offer and Point of Contacts:
All questions regarding this solicitation shall be submitted via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 6, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
Offerors shall submit Phase One (1) proposals via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 13, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
See Attachment 3 - ClaimsCore Instructions to Offerors for full instructions.
Update #1 ·
This is a combined synopsis/solicitation for commercial products or commercial services prepared in accordance with FAR part 12. This announcement constitutes the only solicitation. Offers are being requested and a separate written solicitation will not be issued.
Solicitation number 75FCMC26R0022 is issued as a request for proposal (RFP) for ClaimsCore. The ClaimsCore program seeks to re-platform Medicare Fee for Service claims processing by replacing legacy “Shared Systems” including the Multi-Carrier System (MCS), Fiscal Intermediary Shared System (FISS) and Durable Medical Equipment Claims System (DME) as well as the Common Working File (CWF) with a flexible and interoperable platform that reduces administrative burden and sets improvement of the beneficiary experience as the program’s guiding objective. CMS intends to procure a Software as a Services (SaaS) Commercially-Available-Off-The-Shelf (COTS) product and complimentary configuration and integration services that will provide CMS with near real-time adjudication and claims status, policy agility, industry leading enterprise tools, improved fraud prevention capabilities, and tighter integration across CMS, Medicare Administrative Contractor (MACs), providers, and partners.
This acquisition is not set-aside for small business concerns. This solicitation incorporates provisions and clauses by reference. The full text of provisions and clauses may be accessed electronically at www.acquisition.gov.
Contract Line Item Number (CLIN) Structure:
See Attached Soliciation-75FCMC26R0022 for a full breakdown of the CLIN structure, items, quantities, and units of measure (including option(s)).
See Attachment 1 – ClaimsCore Statement of Objectives for full description of the requirements being acquired.
See the attached Solicitation - 75FCMC26R0022 and Attachment 5 - FAR 52.212-5 to find the full list of solicitation provisions and contract clauses that apply to the acquisition (see 12.205(a)).
Date, Response Times, Place for receipt of offer and Point of Contacts:
All questions regarding this solicitation shall be submitted via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 6, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
Offerors shall submit Phase One (1) proposals via electronic mail (e-mail) no later than 11:00 am Eastern Time (ET) on March 13, 2026 to Contract Specialist, Lauren Holsey, at Lauren.Holsey@cms.hhs.gov and cc: Contracting Officer, Candace Straker, at Candace.Straker@cms.hhs.gov.
See Attachment 3 - ClaimsCore Instructions to Offerors for full instructions.
Files
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Notice history
| Notice | Type | Posted |
|---|---|---|
| ClaimsCore Combined Synopsis/Solicitation | Award Notice | |
| ClaimsCore Combined Synopsis/Solicitation | Award Notice | |
| This notice | Solicitation |
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