CMS Partner Request: Medicare Part D claim expertise (e.g., NCPDP, X12, and trade agreement claim transactions)

An 8(a) small business and rapidly emerging partner to the Centers for Medicare & Medicaid Services is seeking a partner who has demonstrated capability to interface with CMS systems in a secure environment and the ability to process all Medicare Part D claim types, including NCPDP, X12, and trade agreement claim transactions.

This need is in response to an active RFI posted to GSA eBuy.

Opportunity Background – Medicare Transaction Facilitator

This task order is for an entity that will be responsible for assisting with certain aspects of activities related to the IRA, including the ability to furnish transaction and customer support services to facilitate the exchange of data between pharmaceutical supply chain entities to support the verification of an MFP-eligible individual who is dispensed a selected drug.

CMS is seeking an entity with the ability to furnish transaction and customer support services to facilitate the exchange of data between pharmaceutical supply chain entities to support the verification of an MFP-eligible individual who is dispensed a selected drug.

At a minimum, the following knowledge and experience may be required:

• Extensive knowledge and experience with the Medicare Part D and Medicare Part B programs and associated payment systems, the Average Sales Price (ASP) pricing file, Wholesale Acquisition Cost (WAC) methodology, and the 340B program and reimbursement process.
• Extensive knowledge and experience dealing with National Council of Prescription Drug Programs (NCPDP) claim transactions, Medicare Part D plan sponsors, Pharmacy Benefit Managers (PBMs), pharmacy switches, Medicare Part B claims processing entities, Durable Medical Equipment (DME) claims processing entities, Health Insurance Portability and Accountability Act (HIPAA) 835 transactions, Automated Clearing House (ACH) bank transactions, accounting ledgers, and secure file transmissions.
• Extensive knowledge and experience dealing with the Medicare Part D and Part B claims processing systems and process. Understanding and knowledge of the IRA and its program instructions and guidance as they relate to the Medicare Drug Price Negotiation Program and to MFP timing, effectuation, and eligible entities.
• Extensive knowledge and experience in sending claims batches on a scheduled cadence and sending claim responses to multiple stakeholders.
• Experience creating and sending Electronic Remittance Advice (HIPAA 835 transactions) and ACH bank transactions from a general fund.
• Knowledge and experience with Medicare Part B and Durable Medical Equipment (DME) claims processing.
• Extensive knowledge and experience creating and sending flat file transaction sets to multiple entities using accepted secure transfer processes.
• Extensive knowledge of applicable federal law and regulations regarding the handling of PHI/PII and IT security standards such as the Federal Information Security Management Act of 2002.
• Extensive knowledge and experience enrolling entities in an exchange platform, supporting account management for payment, and creating an electronic portal for data exchange and account management. This includes receiving batch files from an entity with multiple onboarding and individual signups through a portal and experience with help desk and 24/7 technical support.

Looking for an IT and consulting firm to partner with at CMS? Click Here  You can filter the list by several key indicators, including socio-economic status, NAICS, Contract vehicle, etc.   

Firms drawing the most attention:    

Below is a list of more than three dozen large and small companies we have noted as drawing the most views by Government and industry leaders on the OrangeSlices AI consultant directory over the 2nd half of 2023 and that bring direct past performance and/or related relationships in support of CMS.     

• Sparksoft **  
• RELI Group **  
• Skyward IT Solutions **  
• Softrams **  
• Ventech Solutions **  
• Index Analytics **  
• Ad Hoc **  
• C-HIT   
• eSimplicity **  
• Next Phase  
• CVP **  
• Nava **  
• Tantus Tech  
• Maximus ** 
• Nimbus Consulting  
• ICF **  
• Think Systems  
• Radiant Infotech  
• Global Alliant **  
• ERP International **  
• Unissant **  
• Signature Consulting Group (SCG)   
• Truss  
• Sprezzatura Management Consulting  
• Coforma **  
• SoftDev **  
• Akira Technologies  
• Williams Consulting **  
• iAdeptive  
• International Consulting Associates (ICA)  
• DAS Federal **  
• IT Concepts **  
• Sky Solutions **  
• J29 **  
• VITG  
• Sierra7 **  
• LMI  
• Mathematica  
• AIR  
• Fu Associates  
• CGI Federal  
• Mettle Solutions  
• For People **  
• Abt Associates 

** An Elev8 GovCon Honoree, noted for a corporate culture that demonstrates excellence, making the company a beacon for talent, for partners, and for clients.             

We cannot and will not speculate here as to the reasons for the increased interest, but whether it is a company evaluating them as a potential partner; a federal acquisition leader doing their due diligence; or a consultant weighing their next job move, this group of companies has been receiving increased interest.     

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