Workers’ Compensation Center for Medicare Reporting Compliance Services (CMS Reporting)

The State of Wisconsin Department of Administration, Bureau of State Risk Management is seeking a contractor to provide Workers' Compensation Center for Medicare Reporting Compliance Services (CMS Reporting) to ensure compliance with federal reporting requirements under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. The primary objectives include querying claims against CMS databases, maintaining a secured web-based system for submitting claim information, and submitting quarterly Medicare-eligible workers' compensation reports to the U.S. Department of Health and Human Services. Bidders must have a minimum of two years' experience providing CMS reporting services to workers' compensation carriers or administrators. Key deliverables include daily data processing of Microsoft Excel reports, monthly CMS queries, and quarterly reporting of claims matching specific criteria. The contract requires services to be performed exclusively within the United States, with three to five Bureau users needing access to the contractor's website portal. Bid questions were due by October 2, 2017, with final bid submissions required on October 18, 2017, at 2:00 p.m. Central Time. The initial contract term is three years, with options to renew for up to two additional one-year periods.

The solicitation includes opportunities for minority-owned business enterprises, disabled veteran-owned businesses, and woman-owned business enterprises to receive supplier diversity considerations. The incumbent contractor is Corvel, and the current claims system is Marsh Clearsight. The state estimates approximately 200 preliminary claim identifications monthly, 200 CMS queries monthly, and 20 claims to be reported quarterly. Pricing will be structured as a net unit price per claim, with prices remaining fixed for the initial three-year contract term. Price adjustments at renewal periods are limited to the lesser of the Consumer Price Index-Urban (CPI-U) change or 3 percent, requiring written agreement by the Department of Administration. The state does not guarantee a minimum purchase quantity or dollar amount and retains the right to terminate the contract for cause or convenience with 30 days' notice. Contractors must comply with HIPAA requirements, provide certificates of insurance, and submit to potential background checks. The state will retain all rights to data and records produced under the contract.