Pricing, Data Analysis, and Coding (PDAC)
Award Notice Posted
- Solicitation number
- RFP-CMS-2007-0019
- Agency
-
Centers for Medicare and Medicaid Services
Department of Health and Human Services
- Awarded
- to Noridian Healthcare Solutions, LLC
- Set-aside
- No set-aside
Opportunity facts
- Contract number
- HHSM-500-2008-M0007Z Federal contract award
- NAICS code
- 524298 All Other Insurance Related Activities
- PSC
- Not on record
Notice details come from SAM.gov. Updated .
Notice text
2 versions
Update #2 · Latest ·
The purpose of this contract is to obtain a Pricing, Data Analysis and Coding (PDAC) Contractor, hereinafter, referred to as the Contractor to provide specified services in support of the sound administration of the DMEPOS benefit within the traditional Medicare FFS program. The Contractor shall perform its responsibilities under the direction of CMS. The Contractor shall facilitate, coordinate, and support activities among various Medicare contractors with DMEPOS-related responsibilities (e.g., DME MACs, DME PSCs, NSCs, etc.) as well as other agencies (at the federal and state levels of government) and other stakeholders.
The Contractor shall perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals (as specified in this SOW) and CMS requirements to ensure the financial integrity of the Medicare FFS program. The Medicare programs legal, policy and operating environment is complex, and the Contractor shall utilize or interact with certain CMS-required systems, equipment and/or operational capabilities in the performance of its functions
The Contractor shall receive and control Medicare national DMEPOS claims data from CMS. The Contractor conducts a variety of different supplier services, such as answering written inquiries and providing Medicare guidance and advice on coding of DMEPOS claims. The Contractor answers a wide-range of questions from DMEPOS suppliers and other stakeholders from across the country. The Contractor will operate and maintain a web-based tool used by suppliers and other stakeholders to facilitate coding claims for DMEPOS. The Contractor performs complex statistical analyses of Medicare FFS DMEPOS claims data and reports on trends, significant changes and other relevant factors. The Contractor stores and maintains this information in a data warehouse. The Contractor maintains statistical reports, data analyses and other statistical information in a web-based environment that is easily accessible to the DME PSCs, DME MACs, NSC, CMS and certain law enforcement staff. The Contractor controls access to this environment through user passwords and other physical, administrative, and technical safeguards. The Contractor develops and maintains a crosswalk for certain drugs from the NDC code to an appropriate HCPCS code. The Contractor codes and prices certain oral anti-cancer drugs. All of these functional activities have major component tasks as specified under Section E of this SOW.
Update #1 ·
The Centers for Medicare & Medicaid Services (CMS) intends to solicit proposals for a contractor to perform Pricing, Data Analysis, and Coding (PDAC) services for all four DME MACs under contract to CMS. The PDAC contractor will be the single organizational entity responsible for providing specified support functions to CMS contractors that adjudicate Medicare claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and/or perform program integrity functions with respect to such Medicare DMEPOS claims (i.e., the DME MACs and the DME PSCs). These support activities facilitate processing DMEPOS claims and include pricing, coding, and policy development; additionally, they provide statistical analysis in support of the program integrity function.
The PDAC MAC was developed because of the unique and specialized requirements that distinguish DMEPOS suppliers, claims processing, and statistical analyses from other similar functions (i.e. fee-for-service) under Medicare.
The primary functions of the PDAC MAC are, at a minimum, to 1. coordinate the development of Healthcare Common Procedure Coding System (HCPCS) codes for DME, prosthetics, orthotics, and supplies in support of numerous Medicare DMEPOS claims processing-related functions (e.g., policy development, claims processing, program integrity, and medical review); 2. provide Medicare coding guidance and advice to the DMEPOS supplier community and other stakeholders including Medicaid State Agencies, MACs, carriers, and fiscal intermediaries; 3. provide statistical analyses of regional and national DMEPOS claims data to CMS, the DME MACs, the DME PSCs, the National Supplier Clearinghouse MAC, and law enforcement in support of program integrity and medical review activities, including policy development; 4. develop and maintain a cross-walk to be used in processing claims between HCPCS codes and the National Drug Code for certain drugs; and, 5. establish and distribute pricing files for oral anti-cancer drugs to DME MACs in support of their claims processing operations.
The successful offeror must have current and direct access to and experience with Medicare DMEPOS claims data through one or more Medicare systems such as the Common Working File system and substantial experience in administering CMS-contracted Medicare activities involving DMEPOS. There are no exceptions to this requirement; offers which do not clearly demonstrate such access and experience will not be given further consideration.
In addition, the successful offeror:
- must have the capability to conduct sophisticated and complex statistical analyses and be capable of achieving full production mode in a very short time frame (i.e., 30-60 days);
- must provide or recruit staff (i.e., medical director/pharmacist, nurses, statisticians, etc.) to perform the functions described in this notice within a very short time frame;
- will be required to determine the best approach for absorbing this workload from the current Statistical Analysis DME Regional Carrier;
- must develop and maintain a web-based data and analytical support infrastructure that can be accessed by CMS and contractors;
- must develop and maintain a web-based system for making DMEPOS coding information available to suppliers and the general public; and
- must appropriately review and test products and assign appropriate HCPCS codes.
CMS intends to issue a solicitation for a competitive procurement for the PDAC Contractor - Medicare Administrative Contractor (PDAC MAC). It is anticipated that a contract will be awarded with a base period plus 4 option years. This announcement is not a request for proposal (RFP). CMS anticipates release of the RFP on or about August 30, 2007, and it will be available on the Federal Business Opportunities (FedBizOpps) website. The anticipated award date for this effort is on or before December 1, 2007.
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