# CMS Advances Medicare Claims Modernization

The Centers for Medicare and Medicaid Services (CMS) is pursuing a significant modernization effort to overhaul Medicare claims processing by integrating artificial intelligence and real-time fraud detection capabilities. This initiative aims to reduce improper payments substantially and enhance payment accuracy through advanced technology. CMS is considering awarding a potential seven-year contract with a ceiling exceeding $1 billion to prime contractors including HealthEdge and Peraton, with Tegria providing management and technical implementation support. This modernization effort represents a major opportunity for healthcare IT contractors specializing in claims systems, AI-driven analytics, and fraud prevention technologies.

- CMS's focus on real-time payment and fraud review capabilities signals a shift toward proactive claims management and risk mitigation.
- The large contract ceiling (over $1 billion) indicates substantial funding and long-term engagement potential for qualified contractors.
- Procurement professionals should prepare for complex requirements involving AI integration, data analytics, and system modernization.
- Companies with expertise in healthcare IT modernization and fraud detection technologies may find competitive opportunities in this evolving CMS procurement landscape.

**Jurisdictions:** federal
**Industries:** Healthcare, Information Technology
**Topics:** Artificial Intelligence, Digital Infrastructure, Regulatory Compliance
**Published:** September 28, 2026

### Government Entities
- Centers for Medicare and Medicaid Services (CMS)

### Vendors
- HealthEdge (potential prime contractor)
- Peraton (potential prime contractor)
- Tegria (contract awardee for management and technical implementation support)

### Key Quotes
> If we can reduce that documentation improper payment, that would drop our entire improper payment rate down by, at least in Medicare, as much as two percentage points, which is huge.
> — Kimberly Brandt, Deputy Administrator, CMS

### Sources
- [CMS eyes new technologies to reduce improper payments and fraud - Nextgov/FCW](https://www.nextgov.com/digital-government/2026/09/cms-eyes-new-technologies-reduce-improper-payments-and-fraud/416286) - Nextgov/FCW
- [CMS eyes new technologies to reduce improper payments and fraud - Nextgov/FCW](https://www.fcw.com/digital-government/2026/09/cms-eyes-new-technologies-reduce-improper-payments-and-fraud/416286) - Nextgov/FCW