SAM #75FCMC27R0001

CMS Medicare Administrative Contractor Services for Jurisdiction 8 (Indiana and Michigan)

CMS is seeking a Medicare Administrative Contractor (MAC) for Jurisdiction 8 (Indiana and Michigan) to administer Medicare fee-for-service (FFS) operations. - Government Buyer: - Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services - Jurisdiction 8 covers Indiana and Michigan - Services Requested: - Comprehensive Medicare claims processing for Parts A and B - Provider enrollment, appeals handling, customer service, medical review, financial management, and program integrity - Provider audit and reimbursement services for hospitals, skilled nursing facilities, ESRD facilities, and rural health clinics - Recovery Audit Contractor (RAC) support, Medicare Integrity Program (MIP) activities, and records storage (approx. 155,592 boxes) - Provider outreach, education, and customer service (including conferences, mailings, telephone inquiries) - Products Requested: - Commercial Off The Shelf (COTS) translation software for HIPAA-compliant EDI transactions - Combined Common Edits and Enhancement Module (CCEM) software and hardware (supports Part A and B processing; requires JVM 1.6, JBoss EAP, Oracle 11g/12c or Microsoft SQL Server, RedHat Linux or Windows Server, CPUs, memory, disk space) - Personal computers for Next Generation Desktop (NGD) operations (specific hardware/software requirements) - Cisco AnyConnect VPN client software and hardware (with RSA SID800 token or CMS-issued PIV card, Windows OS, anti-virus software, two-factor authentication, encrypted hard drives) - Unique/Notable Requirements: - Compliance with Social Security Act, HIPAA, Medicare manuals, and CMS regulations - Secure VPN access and strict IT security standards - Detailed labor mix and workload estimates for program management and audit activities - Transition and implementation periods for incoming and outgoing contractors - Increasing adoption of electronic Medicare Summary Notices (eMSNs) - No specific OEMs or vendors are named, but Cisco and RSA are referenced for VPN and authentication hardware/software.

Description

The Centers for Medicare & Medicaid Services (CMS) intends to issue a Request for Proposal (RFP) to obtain a Medicare Administrative Contractor (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 Program (also known as the Medicare Fee-For-Service or FFS) for Jurisdiction 8. Jurisdiction 8 encompasses the following states: Indiana and Michigan.

Prior to issuing the final solicitation, with this synopsis CMS is issuing a draft RFP (inclusive of the RFP and attachments) to allow potential offerors an opportunity to review the requirements and submit questions.

Consistent with the statement of work, the contractor shall perform numerous functions to support healthcare services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of Medicare services, both institutional and professional, both in-patient (Part A) and out-patient (Part B). The contractor will perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals, as well as CMS requirements to ensure the financial integrity of the Medicare FFS Program.

Pursuant to the authority of FAR Part 15, Contracting by Negotiation, CMS intends to conduct a full and open procurement to fulfill this need. Accordingly, the Contracting Officer will seek to award to the vendor whose proposal represents the best solution to CMS’ requirements at a fair and reasonable price.

Award will be made to the Offeror whose proposal offers the best overall value to the Government using FAR 15.103-1 Trade-off approach, which “…is appropriate when it may be in the Government’s best interest to consider award to other than the lowest priced offeror or other than the highest technically rated offeror …”; affording the Government the most advantageous balance of cost and technical factors as defined in the upcoming solicitation.

The resulting contract is anticipated to include a base year plus eight (8) one-year options. The NAICS code applicable to this procurement is 524114, Direct Health and Medical Insurance Carriers, with a small business size standard of $47.0 million.

All questions concerning the procurement must be submitted electronically in response to this Draft RFP via email in Microsoft Excel format to the following address: MAC_Procurement@cms.hhs.gov by 10:00 AM EST, August 17, 2026. Technical questions submitted by telephone or verbally will not be honored. The offeror shall group questions together, i.e., by relevant solicitation section or attachment.

Submission of questions shall include at a minimum, company name, address, point of contact, email address and phone number. Offerors shall submit questions in a Microsoft Excel spreadsheet, as set forth in Attachment J.29.

Answers to questions CMS determines to be necessary for proposal preparation will be conveyed in the Final solicitation.

CMS anticipates releasing the Final solicitation for Jurisdiction 8 on or about October 1, 2026, with proposals due approximately November 2, 2026. Award is anticipated to be approximately September 2027. It will be the offeror’s responsibility to check the same site where the Draft solicitation is posted for the Final solicitation and closing date.

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

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