Opportunity
Centers for Medicare & Medicaid Services #APP#: 270048
CMS Solicitation for Supplemental Medical Review Contractor (SMRC) Services
Buyer
Health and Human Services Department, Centers for Medicare & Medicaid Services, Office of the Secretary
Posted
June 04, 2026
Identifier
APP#: 270048
NAICS
541690
This opportunity involves the Centers for Medicare & Medicaid Services (CMS) seeking a Supplemental Medical Review Contractor (SMRC) to support nationwide post-payment medical review activities. - Government Buyer: - U.S. Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - Center for Program Integrity (CPI) - Scope of Work: - Nationwide post-payment medical review of Medicare Fee-for-Service claims - Includes reviews for Medicare Part A, Part B, and DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) - Two main tasks: - Provider Compliance Group (PCG) 'Specialty Reviews' - Program Integrity Reviews - Focus on reducing improper payments and combating fraud, waste, and abuse - Contract Details: - Cost Plus Fixed Fee contract type - Estimated value: at least $100 million - Duration: more than five years - Full and open competition (no set-aside) - Products/Services Requested: - Medical Review Services (1 lot) - OEMs and Vendors: - No specific OEMs or vendors are named in the notice - Unique Requirements: - Contractor must have the capability to conduct complex medical reviews nationwide - Emphasis on supporting program integrity and compliance initiatives
Description
The CMS plans to procure a Supplemental Medical Review Contractor (SMRC) to perform and support nationwide post-payment medical review tasks aimed at reducing improper payments and combating fraud, waste, and abuse. The contract includes two core tasks within the Center for Program Integrity (CPI): Provider Compliance Group (PCG) 'Specialty Reviews' and Program Integrity Reviews providing comprehensive medical review for CMS requests. Medical reviews will be performed on Medicare Fee-for-Service claims for Medicare Part A, Part B, and DMEPOS programs. The contract duration is more than 5 years with an estimated total value of $100 million or more.