The Department for Health and Human Services, Centers for Medicare and Medicaid Services has a requirement for the consolidation of Jurisdiction 5 and Jurisdiction 6 into Jurisdiction G.

The purpose of this acquisition is to procure a Medicare Part A and Part B (A/B) MAC to provide Medicare FFS benefit and claims administration services and to perform numerous Medicare Program functions. These functions include making healthcare claims-related payments on behalf of Medicare beneficiaries and establishing relationships with institutional and professional providers and suppliers of healthcare services for the defined geographic areas shown below. MACs must perform the requirements of these contracts in accordance with applicable laws, regulations, Medicare manuals, and CMS’s financial and program integrity requirements. The attached Statements of Work (SOW) for the JG MAC provides a current snapshot of contract requirements. While this sources sought notice is targeted to the JG A/B MAC jurisdiction, CMS may consider the results of this market research when determining the acquisition approach for these services for other MAC jurisdictions.

Part A/B JG is a combination of J5 and J6 and is comprised of the following states: Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, and Wisconsin

• Under this contract, the Contractor will perform numerous functions to support health care services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of health care services, both institutional and professional, for a defined geographic area or “jurisdiction.” The Contractor will perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals, and CMS requirements to ensure the financial integrity of the Medicare program. The Medicare program’s legal, policy, and operating environment is complex, and the Contractor will utilize or interact with certain CMS-required payment schedules, systems, equipment, and operational capabilities in the performance of its functions.
• Further, the Contractor will coordinate its activities not only with the CMS, but also with a broad range of agencies (at the federal, state, and local levels of government), other CMS partners and Contractors, and a diverse range of stakeholders within the health care system of the United States. The Contractor will receive and control Medicare claims from institutional and professional providers, suppliers, and beneficiaries within its jurisdiction and will perform standard or required editing on these claims to determine whether the claims are complete and should be paid.
• In addition, the Contractor will calculate Medicare payment amounts and arrange for remittance of these payments to the appropriate party. The Contractor also will enroll new providers; conduct redeterminations on appeals of claims; operate a Provider Customer Service Program (PCSP) that educates providers about the Medicare program’s rules, regulations, and billing procedures; respond to provider electronic, telephone, and written inquiries; respond to complex inquiries from Call Center Operations (CCOs); and make coverage decisions for new procedures and devices in local areas.
• The Contractor shall furnish services to all the providers CMS designates as within the Contractor’s workload. The Contractor’s workload will, from time to time, contain out-of-jurisdiction providers. Outof-jurisdiction providers will be moved to their destination workloads at a later date when CMS systems are capable of supporting the move. The mission of CMS is to ensure health care security for beneficiaries. This contract specifically applies to that mission by fostering excellence in the design and administration of CMS’ programs.