Partner Request: Seeking Prime for CMS Contact Center Operations

This established Medicare Administrative Contractor (MAC) serving multiple jurisdictions, is seeking a Prime contractor to lead a partnership for this active CMS RFP intended to acquire continued support of CCO operations with an objective of providing customer service functions which efficiently handle and answer inquiries with a high level of service across the United States and its territories. 

Background: 

The performance objectives for the CCO contract are as follows:  

1. a) Contact centers shall be widely available to receive and respond to inquiries, ensuring low queue times and rare disruptions in services. 
2. b) Contact centers shall provide high-quality customer service, focusing on the accuracy of information provided, the completeness of information, overall knowledge of CMS programs and services, adherence to Privacy Act requirements, and overall professional customer service. 
3. c) Contact centers shall maintain effective and efficient operations, such as high agent occupancy rates, low average handle times (AHT), high customer satisfaction, and prompt turnaround times for written, and web chat inquiries. 
4. d) Contact centers shall maintain a highly qualified workforce by ensuring low agent turnover rates, and high training and quality assurance scores.  

In addition to standard call center operations the CCO contractor shall provide onsite support of technologies used in the contact center, as well as collaborate with and support the CMS designated content development, training development, and independent quality assurance contractors.  

The CCO contractor shall provide accurate and high-quality customer service for all inquiries. The contractor shall operate multi-channel operations to receive and respond to inquiries, providing information and services through various channels including telephone, mail, TDD/TTY, fax, and web chat.  

The CCO contractor shall provide services in all communication channels in both English and Spanish and shall utilize CMS-provided real-time phone translations for other languages as necessary. 

More here.   

The Ask: As an established Medicare Administrative Contractor (MAC) serving multiple jurisdictions, our organization brings extensive experience and capabilities in managing complex healthcare programs and processing large volumes of claims. We are looking for a prime contractor to lead a partnership for the CMS Contact Center Operations (CCO) support contract described in the SOW, while we offer our proven expertise and resources to enhance the team’s overall capabilities. 

Key Strengths and Capabilities: 

Extensive Government Program Management Experience: 

• Medicare Administrative Contractor (MAC) Expertise: 
• Our organization handles comprehensive services including claims processing, provider enrollment, customer service, appeals, medical reviews, audits, reimbursements, and data analytics. 
• We process over 126 million claims annually and manage benefits payouts exceeding $47 billion. This demonstrates our capacity for high-volume, high-quality operations essential for the CCO environment. 

Specialized Healthcare Services: 

• TRICARE Programs: 
• We manage claims and provide customer support for the TRICARE Overseas Program, processing over 750,000 claims annually for nearly 550,000 beneficiaries. 
• Our involvement in TRICARE East and TRICARE For Life programs showcases our ability to handle extensive beneficiary services and maintain high standards of customer satisfaction. 
• Veterans Affairs (VA) Programs: 
• Our experience with the VA Community Care Network (CCN) and Patient-Centered Community Care (PC3) includes processing millions of claims and managing substantial benefits payouts, reflecting our capability to handle complex program requirements. 

Robust Customer Service Infrastructure: 

• Our organization operates multilingual customer support centers, providing services in multiple languages to cater to diverse beneficiary populations. 
• We maintain full-function beneficiary and provider portals, ensuring 24/7 self-service access to claims information and educational materials, aligning with the multi-channel communication requirements of the CCO. 

Proven Track Record in Data Management and Analytics: 

• We have substantial experience in managing and submitting Encounter Data Records, coordinating with various data centers for eligibility verification, and ensuring data integrity and security. 
• Our expertise in data analytics supports effective program management, performance monitoring, and quality assurance. 

Compliance and Innovation: 

• We are committed to maintaining compliance with all relevant regulations and standards, including the Privacy Act and other federal requirements. 
• Our participation in the VHA Integrated Healthcare Transformation (IHT) IDIQ demonstrates our ability to innovate and implement health system transformations, which will be valuable in supporting CMS’s objectives for the CCO contract. 

Why Partners Should Consider Us: 

• Operational Efficiency: Our ability to process high volumes of claims with low error rates and high customer satisfaction. 
• Scalability: Proven capacity to scale operations to meet fluctuating demands and peak periods. 
• Technical Expertise: Advanced IT and telecom support capabilities to ensure seamless integration with CMS’s infrastructure. 
• Customer Focus: Strong emphasis on delivering high-quality, multilingual customer service across various communication channels. 

By partnering with us, potential prime contractors can leverage our extensive experience, robust infrastructure, and commitment to excellence to deliver superior contact center operations for CMS. 

Responding:  

If you have capabilities and/or relationships that can be of value, please contact us here and let us know, with any relevant information and please reference this partner request. We are getting a lot more of these. Please keep it short.          

Note: This has been provided as an anonymous request, so OS AI will not reveal the name of the requestor. We will pass the information along, but there are no promises of a response.        

Alternatively, we always encourage interested firms to share their interest publicly in the form of a comment as there will be many other firms looking for partners. We do share posted comments in our newsletter, so it can be a great way to create awareness about your capabilities in relation to this type of need. Comment below – you must be logged in. 

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