CMS awards sole source follow-on for claims adjudication services

This justification for an Exception to Fair Opportunity supports a logical follow-on task order award to C2C Innovative Solutions, Inc. on a sole-source basis to provide adjudication services in support of the of the Medicare, Medicaid, and State Children’s Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA), Public Law 106-554, Subtitle C – Changes in Medicare Coverage and Appeals Process, Section 521 Revisions to Medicare Appeals Process.

More specifically, the Contractor shall act as a Qualified Independent Contractor (QIC) responsible for conducting reconsiderations of initial Medicare claims determinations in the Part B North jurisdiction. The Part B workload includes, at a minimum, processing reconsideration requests for doctors’ services, outpatient medical and surgical services, diagnostic tests, and ambulatory surgery. It also includes outpatient mental health care, and outpatient physical and occupational therapy.

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