CMS to award follow-on contract for QIC Part B South LFO

Re: Contract Number: HHSM-500-2004-00005I

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 South 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.

The original task order (HHSM-500-2004-00005I/HHSM-500-T0005) was competed amongst CMS’ Qualified Independent Contractor (QIC) Indefinite Delivery Indefinite Quantity (IDIQ) contract holders and awarded to C2C in September 2014.

The period of performance for the original task order is July 1, 2014 through August 31, 2019 (inclusive of option periods), with a total value of $39,965,198.

The period of performance for the proposed logical follow-on task order will be September 1, 2019 through August 31, 2020 (inclusive of one option period), with an estimated value of $10,479,359.00 total for both periods.

Under this logical follow-on task order, C2C’s primary responsibility shall be to adjudicate standard and expedited reconsiderations in an accurate, efficient, timely, and consistent manner.

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.

The claims estimates in Section B of this task order include all reconsideration activities under this task order, including Medicare Secondary Payer (MSP), Program Safety Contractor (PSC)/Zone Program Integrity Contractor (ZPIC), and Recovery Audit Contractor (RAC) appeals.

The outcomes of this TO shall include:

  • Timely adjudication of reconsiderations of redeterminations using established protocols;
  • Case management and documentation;
  • Communication of decisions about appeals with appellants and other parties to the Appeal…

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