Centers for Medicare & Medicaid Services #HHSM-500-2004-00010I

CMS Solicits Contractor for Medicare Appeals Training, Coordination, and Eligibility Determinations

This opportunity is issued by the Centers for Medicare & Medicaid Services (CMS), under the Department of Health and Human Services. - Government Buyer: - Centers for Medicare & Medicaid Services (CMS) - Department of Health and Human Services - Scope of Work: - Contractor will serve as the Administrative Qualified Independent Contractor (AdQIC) for the Medicare appeals process - Responsibilities include: - Appeals training and coordination - Long-term case file storage - Referrals to the Medicare Appeals Council within the Departmental Appeals Board - Notification to Medicare Administrative Contractors to implement Administrative Law Judge and Appeals Council decisions - Support CMS in eligibility determinations for retrospective appeals as the Eligibility Contractor (EC) - Act as a single point of contact for incoming retrospective appeal requests from beneficiaries or their representatives - Contract Structure: - Indefinite Delivery Indefinite Quantity (IDIQ) - Firm fixed price - No set aside - Estimated Value: - Between $20 million and $50 million - Period of Performance: - Five years anticipated duration - No specific OEMs or vendors are named in the notice - Unique Requirements: - Contractor must provide both appeals process support and eligibility determination services - Must be able to handle sensitive beneficiary information and coordinate with multiple CMS stakeholders

Description

The Administrative QIC (AdQIC) contract provides appeals training and coordination, long term case file storage, referrals to the Medicare Appeals Council, and notification to Medicare Administrative Contractors to effectuate ALJ and Appeals Council decisions. The contractor will also support CMS in making eligibility determinations for retrospective appeals, serving as the Eligibility Contractor (EC) and single point of contact for incoming retrospective appeal requests. The contract is an IDIQ with a firm fixed price and no set aside used. The contract duration is 5 years starting from 09/14/2026.

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