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HHS RFQ: Retroactive Processing and Payment Validation

RFQ ID: RFQ1602980
Set-Aside Type: Small Business set-aside
MAS Category/SIN: MAS:541611


The purpose of this task order is to:

  • Complete all valid retroactive plan enrollment (including plan benefit package changes) and disenrollment adjustments submitted by Plans;
  • Complete all valid LIS adjustments submitted by Plans;
  • Complete analysis of plan discrepancies and provide results to CMS’ Central Office (CO) Regional Offices (RO), including at a consolidated “Parent Organization” level;
  • Conduct proactive data analysis to identify enrollment trends and determine national, regional, and plan-type norms to establish baselines for Plans;
  • Identify vulnerabilities that are emerging in Medicare Advantage Organizations (Part C) and Prescription Drug Plans (Part D) ;
  • Establish and maintain positive working relationships with internal and external stakeholders, (i.e. plans).
  • Complete all special status category adjustments submitted by Plans.
  • Conduct quality reviews for enrollment transactions submitted by Plans
  • Track and report data relating to the Financial Alignment Demonstration, including costs, separately from other Plan types, and to provide data analysis specific to the Financial Alignment Demonstration, as needed.

Attachment(s)/Link: Yes

Attachment 1 – Statement of Work.1673455484812

Attachment 2 – Quote Instructions and Evaluation Criteria.1673455490162

Attachment 3 – CMS Agency Specific Clauses.1673455497010

Attachment 4 – RFQ 230536 Contractor Conflict of Interest.1673455508590

This topic has 0 replies, 1 voice, and was last updated 2 months, 1 week ago by Jackie Gilbert.

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