Solicitation RRB11R001 - 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), 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) contracts every five (5) years. 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 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 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 February 18, 2011.  Notice of Intent to Make an Offer is due February 22, 2011.  Offers are due March 25, 2011 at 11:00 a.m. (CST).  Anticipated award date of August 1, 2011.

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

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), 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) contracts every five (5) years. 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 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 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 February 18, 2011.  Notice of Intent to Make Offer is due February 22, 2011.  Proposals are due March 25, 2011, 11:00 a.m.  (CST)Anticipated award date of August 1, 2011.

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

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), 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) contracts every five (5) years. 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 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 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.

RRB anticipates releasing a solicitation for this nationwide jurisdiction on or about DECEMBER 8, 2010. The contract will include a base year plus four one-year options. The anticipated proposal due date is JANUARY 18, 2011 with an anticipated award date of June 1, 2011.

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

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), 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) contracts every five (5) years. 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 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 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.

RRB anticipates releasing a solicitation for this nationwide jurisdiction on or about November 23, 2010. The contract will include a base year plus four one-year options. The anticipated proposal due date is January 11, 2011 with an anticipated award date of June 1, 2011.

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

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), 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) contracts every five (5) years. 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 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 providers of health care services, both institutional and professional, 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 claims from institutional and 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 enroll new providers; 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 coverage decisions for new procedures and devices in local areas. The Contractor also will conduct a variety of different provider services, such as enrolling new providers in the program, answering written inquiries, and educating providers on Medicare's rules, regulations, and billing procedures.

RRB anticipates releasing a solicitation for this nationwide jurisdiction on or about November 3, 2010. The contract will include a base year plus four one-year options. The anticipated proposal due date is January 11, 2011 with an anticipated award date of June 1, 2011.

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