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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 H. Jurisdiction H encompasses the following states: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas.
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 FAR15.101-1 trade-off processes, which “…allows the Government to consider award to other than the lowest cost 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 six (6) 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 $41.5 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: [email protected] by 10:00 AM EST July 15, 2025. 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 H on or about August 1, 2025, with proposals due approximately September 2, 2025. Award is anticipated to be approximately July 2025. 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.