Part A and B (A/B) Medicare Administrative Contractor (MAC), Jurisdiction 6 (J6)

The Centers for Medicare & Medicaid Services (CMS) intends to issue a Request for Proposal to obtain a Medicare Administrative Contractor (hereinafter referred to as "the contractor") to provide specified health insurance benefit administration services, including Medicare claims processing and payment services, in support of the Medicare Program (also known as the Medicare Fee-For-Service or FFS) for Jurisdiction 6. Jurisdiction 6 includes the following states: Illinois, Minnesota and Wisconsin. The Jurisdiction 6 (J6) MAC is also responsible for processing Medicare home health and hospice billings in thirteen states and five U.S. territories: the states of Alaska, Arizona, California, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Wisconsin and Washington, as well as the territories of American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.
The contractor shall perform numerous functions to support healthcare services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of Medicare services, both institutional and professional, both in-patient (Part A) and out-patient (Part B). The contractor will perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals, as well as CMS requirements to ensure the financial integrity of the Medicare FFS Program.
Pursuant to the authority of FAR Part 15, Contracting by Negotiation, CMS intends to conduct a full and open procurement to fulfill this need. Accordingly, the Contracting Officer will seek to award to the vendor whose proposal represents the best solution to CMS' requirements at a fair and reasonable price. Trade-offs may be considered, where applicable, affording the most advantageous balance of cost and technical factors as defined in the forthcoming solicitation.
Award will be made to the Offeror whose proposal offers the best overall value to the Government using FAR 15.101-1 trade-off processes, which "...allows the Government to consider award to other than the lowest cost Offeror or other than the highest technically rated Offeror."
CMS anticipates releasing a solicitation for Jurisdiction 6 on or about Jan 29, 2019. The contract will include a base year plus six (6) one-year options. The anticipated proposal due date is March 29, 2019, with an anticipated award date of November 29, 2019. In the event a draft solicitation is published, please note that the anticipated March 29, 2019 proposal due date is not expected to change.
This solicitation is expected to be issued as pending availability of funds.
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