The Department of Health and Human Services, Centers for Medicare and Medicaid Services has a continuing requirement for Medicare Secondary Payer Systems Contractor services.

Medicare is a nationwide, Federal health insurance program enacted in 1965 as Title XVIII of the Social Security Act (“the Act”; 42 U.S.C. § 301 et seq.) for persons 65 years of age or older, certain younger disabled persons, and persons with end-stage renal disease (ESRD). The Medicare program serves an estimated 46 million beneficiaries and processes over 1.2 billion claims per year. Fee-for-service (FFS), or “traditional,” Medicare consists of two primary parts: Hospital Insurance otherwise known as Part A, and Supplemental Medical Insurance also known as Part B. A third part of Medicare, known as “Part C” or the “Medicare Advantage” (MA) program, was established by the Balanced Budget Act of 1997 (Public Law 105-33) and allows beneficiaries to receive Medicare benefits through private managed care plans. Finally, Medicare prescription drug coverage called “Part D” was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Medicare provides equal access to all contract services to all Medicare beneficiaries in compliance with all applicable civil rights laws, including title VI of the Civil Rights Act, as amended; sections 503 and 504 of the Rehabilitation Act, as amended; the Age Discrimination Act of 1975, as amended; the Americans with Disabilities Act of 1990, as amended; and title IX of the Education Amendments of 1972.

The CMS administers the Medicare program through activities such as: 1) program policy and guidance formulation and promulgation; 2) contract execution, operation and management; 3) utilization record maintenance and review; and 4) general Medicare financing. The CMS performs such administration through a complex set of relationships involving the private insurance industry, state and local governments, and thousands of independent hospitals, physicians, providers, and suppliers. Sections 1816(a) and 1842(a) of the Act provide that public or private entities and agencies may participate in the administration of the Medicare program under contracts or agreements entered into with CMS. These contractors are known as “Fiscal Intermediaries” (FIs) and “carriers.” With certain exceptions, FIs perform bill processing and benefit payment functions for Part A of the program; carriers perform similar functions for Part B. However, the MMA requires that CMS phase out these contractors under Medicare Contracting Reform.

• The contractor shall provide support for the operations, maintenance, enhancements and special projects for the following components of the Coordination of Benefits & Recovery (COB&R) Program systems. Maintenance and enhancement activities shall include, but not be limited to, systems analysis, design, database maintenance support, programming, unit, system/string, and limited regression testing, data analysis, system documentation, special projects, integration between the COB&R subsystems, quality assurance, and general support of CMS Medicare Secondary Payer (MSP) systems activities.
• The contractor shall work cooperatively with other external support staff as designated by CMS. This staff shall consist of CMS, contractor personnel and other CMS Partners. The contractor shall work closely with, but not limited to, the following:
  • CMS staff
  • Benefits Coordination and Recovery Contractor (BCRC)
  • Medicare Secondary Payer Integration Contractor (MSPIC)
  • Commercial Recovery Contractor (CRC)
  • Workers Compensation Recovery Contractor (WCRC)
  • Any other staff or partners as required