Supplemental Medical Review Contract
Closed Pre-Solicitation Posted
- Solicitation number
- 270048
- Agency
-
Centers for Medicare and Medicaid Services
Department of Health and Human Services
- Responses due
- Set-aside
- No set-aside
Opportunity facts
- Forecast
- Supplemental Medical Review Contract (SMRC) Federal forecast
- NAICS code
- 541990 All Other Professional, Scientific, and Technical Services
- PSC
- Q403 Medical- Evaluation/Screening
- Place of performance
- Windsor Mill, Maryland 21244, United States
Notice details come from SAM.gov. Updated .
About this opportunity
The Centers for Medicare and Medicaid Services intends to solicit a Supplemental Medical Review Contractor to perform post-payment medical reviews and related activities supporting the Center for Program Integrity nationwide across Medicare Fee-for-Service programs (Parts A, B, and DMEPOS), with a sources sought notice response deadline of June 23, 2026, and no set-aside indicated.
The contract encompasses two primary work streams: Provider Compliance Group Specialty Reviews supporting federal agencies including the Office of Inspector General and Government Accountability Office, and Program Integrity Reviews identifying fraud, waste, and abuse patterns. The contractor will manage approximately 500,000 claims annually across 80–100 dynamic projects requiring rapid staffing adjustments. Task 1 assumes minimum 110,000 annual claims reviewed across 10–15 projects with 40,000 Discussion and Education sessions, 100 monthly Medical Assistance Commission appeals documentation requests, and 20 Administrative Law Judge appeals monthly. Task 2 involves approximately 50,000 annual claims reviewed across 45–50 projects with 400 monthly MAC appeals requests and 30 ALJ appeals monthly.
Offerors must demonstrate extensive experience with high-volume Medicare FFS medical review operations, program integrity and fraud detection, data analysis and claims scrubbing, Medicare coverage and billing policies, extrapolation methodology, appeals support, Authority to Operate compliance, Electronic Submission of Medical Documentation systems, artificial intelligence application, and patient safety issue recognition. Performance spans all 50 states and six territories with place of performance nationwide.
Responses are limited to 10 pages and must include DUNS, company name and address, government accounting system approval status, SAM validation, point of contact, and GSA Multiple Award Schedule number if applicable. Teaming arrangements and joint ventures are acceptable. The NAICS code is 541990 (All Other Professional, Scientific, and Technical Services) with small business size standards applicable, and CMS specifically seeks 8(a), service-disabled veteran-owned, HUBZone, small disadvantaged, and women-owned small business participation.
Notice text
Perform post payment medical reviews (MR) and medical review related activities in support of initiatives within the Center for Program Integrity (CPI)
Files
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