CMS to merge Medicare claims systems

The Centers for Medicare and Medicaid Services has issued two requests for proposals related to modernization of its Medicare infrastructure and services. CMS, an agency of the Health and Human Services Department, posted the solicitations yesterday on FedBizOpps.

One contract would provide for the maintenance of its consolidated Medicare claims system to process payments for physician services and assist in migration to a new financial system. The other calls for a single vendor to perform production, integration and performance testing for Medicare claims processing systems and the Common Working File, the single data source where claims processors verify beneficiary eligibility and receive claims approval.

Each of the new contracts is for one base year with four option years. CMS will award the contracts next summer.

CMS contracts with fiscal intermediaries and carriers, who use the Multi-Carrier System, to process Part B claims for Medicare benefits. Currently, there are two Part B claims systems. The eight carriers on the other system will convert to the Multi-Carrier System by late summer 2005.

CMS will require the contractors to update and maintain the shared-system software that performs data collection and validation, claims control, pricing, adjudication, correspondence, online inquiry, file maintenance, reports, reimbursement and financial processing. The contractors would also provide tested software and documentation and maintenance service for software upgrades as they're released to carriers.

The Multi-Carrier System is made up of about 3,100 programs in an IBM OS 390 operating environment. The shared-system contractor will develop, test and release all changes to the Medicare Part B claims processing system, including all related services and documentation required to support the system.

The shared-system contractor would also assist CMS in the implementation and transition in 2005 to the new Healthcare Integrated General Ledger Accounting System, a separate component of HHS' recently deployed United Financial Management System.

HIGLAS will replace many of the financial functions housed in the shared systems that Medicare Part B claims processors use. Data will need to be converted and transferred to the HIGLAS database as the functions that support them will be transferred to HIGLAS. The shared-system contractor will assist with analysis, data mapping, crosswalk, creation of interim formats and programs, and file conversions.

CMS may also tap the shared-system contractor to provide maintenance and technical services related to centralizing Medicare data centers, which will be consolidated into four Enterprise Data Centers.

Bids are due Jan. 10.

About the Author

Mary Mosquera is a reporter for Federal Computer Week.

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