Solicitation 60RRBH21R0011 - RRB Specialty MAC

RRB Specialty MAC (Part B) Pre-solicitation Notice:

As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) and Section 509 of the Medicare Access and CHIP Reauthorization Act (MACRA) enacted on April 16, 2015 , RRB, as authorized under paragraph 1842(b)(1) of the Social Security Act, must solicit and compete its Part B Medicare Administrative Contractor (Specialty MAC) contract. The purpose of this contract is to obtain a Specialty MAC (hereinafter, referred to as "the Contractor") to provide specified health insurance benefit administration services, including Medicare Part B claims processing and payment services, in support of the Medicare FFS program. The Contractor shall perform its responsibilities under the direction of RRB in concert with Medicare Program direction from CMS.

The Contractor will perform numerous functions to support health care services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with professional providers of health care services, for a nationwide "jurisdiction." The Contractor will perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals, and CMS requirements to ensure the financial integrity of the Medicare program. The Medicare program's legal, policy, and operating environment is complex, and the Contractor will utilize or interact with certain CMS-required payment schedules, systems, equipment, and operational capabilities in the performance of its functions. Further, the Contractor will coordinate its activities not only with RRB and CMS, but also with a broad range of agencies (at the federal, state, and local levels of government), other CMS partners and Contractors, and a diverse range of stakeholders within the health care system of the United States.

In accordance with RRB's technical specifications, the Contractor shall receive and control Medicare Part B claims from professional providers, suppliers, and beneficiaries within its jurisdiction and will perform standard or required editing on these claims to determine whether the claims are complete and should be paid. An edit is defined as "logic within the Standard Claims Processing System that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and, depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review."

In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor may also conduct redeterminations on appeals of claims; operate a Beneficiary and Provider Customer Service Program (BPCSP) that educates providers and beneficiaries about the Medicare program and responds to provider and beneficiary telephone and written inquiries and make compability of payment decisions nationwide. The Contractor also will conduct a variety of different provider services, such as answering written and telephone inquiries, and educating providers on Medicare's rules, regulations, and billing procedures.

Questions are due July 12, 2021.  Notice of Intent to Make an Offer is due July 15, 2021.  Offers are due August 23, 2021 at 2:00PM CST.  Anticipated award date of March 1, 2022. The resulting contract is anticipated to inlcude the implementation period, base period,  and nine option years.

This solicitation is expected to be issued as pending availability of funds.

8/19/2021- Amendment 0001 issued to provide RRB responses to potential offeror questions, and also to provide new solicitation attachments as well as revised solicitation attachments. Please see the uploaded documents for this Amendment 0001. Offerors shall submit one (1) signed copy of the Amendment 0001 SF 30 with their proposal submission by the due date of September 15, 2021 at 2:00PM CT. 

RRB Specialty MAC (Part B) Pre-solicitation Notice:

As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) and Section 509 of the Medicare Access and CHIP Reauthorization Act (MACRA) enacted on April 16, 2015 , RRB, as authorized under paragraph 1842(b)(1) of the Social Security Act, must solicit and compete its Part B Medicare Administrative Contractor (Specialty MAC) contract. The purpose of this contract is to obtain a Specialty MAC (hereinafter, referred to as "the Contractor") to provide specified health insurance benefit administration services, including Medicare Part B claims processing and payment services, in support of the Medicare FFS program. The Contractor shall perform its responsibilities under the direction of RRB in concert with Medicare Program direction from CMS.

The Contractor will perform numerous functions to support health care services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with professional providers of health care services, for a nationwide "jurisdiction." The Contractor will perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals, and CMS requirements to ensure the financial integrity of the Medicare program. The Medicare program's legal, policy, and operating environment is complex, and the Contractor will utilize or interact with certain CMS-required payment schedules, systems, equipment, and operational capabilities in the performance of its functions. Further, the Contractor will coordinate its activities not only with RRB and CMS, but also with a broad range of agencies (at the federal, state, and local levels of government), other CMS partners and Contractors, and a diverse range of stakeholders within the health care system of the United States.

In accordance with RRB's technical specifications, the Contractor shall receive and control Medicare Part B claims from professional providers, suppliers, and beneficiaries within its jurisdiction and will perform standard or required editing on these claims to determine whether the claims are complete and should be paid. An edit is defined as "logic within the Standard Claims Processing System that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and, depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review."

In addition, the Contractor calculates Medicare payment amounts and remits these payments to the appropriate party. The Contractor may also conduct redeterminations on appeals of claims; operate a Beneficiary and Provider Customer Service Program (BPCSP) that educates providers and beneficiaries about the Medicare program and responds to provider and beneficiary telephone and written inquiries and make compability of payment decisions nationwide. The Contractor also will conduct a variety of different provider services, such as answering written and telephone inquiries, and educating providers on Medicare's rules, regulations, and billing procedures.

Questions are due July 12, 2021.  Notice of Intent to Make an Offer is due July 15, 2021.  Offers are due August 23, 2021 at 2:00PM CST.  Anticipated award date of March 1, 2022. The resulting contract is anticipated to inlcude the implementation period, base period,  and nine option years.

This solicitation is expected to be issued as pending availability of funds.