ClaimsCore Request for Information

The Centers for Medicare and Medicaid Services (CMS) has issued a Request for Information (RFI) for ClaimsCore, a comprehensive claims processing and adjudication system intended to replace legacy Medicare Fee-for-Service (FFS) claims systems. This is not a solicitation for proposals but rather an information-gathering mechanism to evaluate large-scale claims processing vendors capable of improving beneficiary experience, reducing provider burden, and enhancing administrative efficiency in Original Medicare. Key contract requirements include the ability to process approximately 1.2 billion claims annually, support 33.6 million Medicare beneficiaries, achieve sub-second claims adjudication, deliver 99.9% uptime, and operate as a Software-as-a-Service (SaaS) solution deployable in AWS Cloud environments. The evaluation will assess contractors across three primary factors: Corporate Experience (Mission Focused), Performance Work Statement and Quality Assurance Surveillance Plan, and Past Performance, with non-price factors weighted significantly more heavily than price. CMS anticipates making 2-4 awards and will employ a phased evaluation process. The RFI response deadline is January 23, 2026, and CMS has provided a draft RFP in advance to allow potential offerors to review requirements and submit feedback.

This procurement contains no small business set-aside designation, though the solicitation document notes a small business set-aside provision in other sections, creating potential ambiguity regarding eligibility requirements. The contract is structured as a firm-fixed-price arrangement with a base period and six option years extending from September 2026 through November 2033, though specific award values or budget ranges are not disclosed in the pre-solicitation notice. The solicitation number is 75FCMC26R0022, and the formal offer due date will be November 11, 2026, at 11:00 AM EST, with the RFP issuance expected on January 23, 2026. Contractors selected for this contract are prohibited from serving simultaneously as Recovery Audit Contractors (RACs), Unified Program Integrity Contractors (UPICs), Quality Improvement Organizations (QIOs), or Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) while processing Medicare claims. Prospective offerors must demonstrate extensive experience with high-volume cloud-based claims processing, automated rule mining, fraud detection capabilities, professional services delivery, and financial stability to be considered viable candidates for this strategically important federal healthcare procurement.