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D -- COORDINATION OF BENEFITS (COB) SOL HCFA-99-0004/DSS POC Debbie Strittmatter, Contract Specialist (410)786-5136 The Health Care Financing Administration (HCFA) is soliciting proposals for award of the Medicare Integrity Program's (MIP) Coordination of Benefits (COB) Contract. BACKGROUND: The Health Insurance Portability and Accountability Act of 1996 (HIPAA), (Public Law 104-191) was enacted on August 21, 1996. Section 202 of HIPAA adds a new section 1893 to the Social Security Act establishing the "Medicare Integrity Program" (MIP). This Program is funded from Medicare's Federal Hospital Insurance Trust Fund for activities related to both Medicare Parts A and B. Specifically, section 1893 enables HCFA to contract with an expanded pool of eligible entities to carry out the Medicare program integrity activities that are currently performed under contracts with Fiscal Intermediaries and Carriers. Section 1893 identifies Medicare secondary payment (MSP) determinations as one of five enumerated activities that comprise the MIP. MSP generally refers to those situations where a party other than Medicare has primary responsibility to pay for the health care expenses incurred by a Medicare beneficiary. The MSP process was developed to safeguard against making mistaken Medicare primary payments and thus ensuring that the Medicare program pays only what the statute requires. Under this solicitation, HCFA is seeking to consolidate activities that would support the collection, management, and reporting of all health insurance coverage of Medicare beneficiaries for the purpose of implementing an improved plan of coordination of Medicare benefits with other insurance coverages. HCFA intends to develop a centralized coordination of benefits operation that will provide quality customer service to its providers and beneficiaries by streamlining the payment process while assuring the integrity of the Medicare Trust Funds. To further that goal, HCFA is seeking a single entity to maintain a comprehensive insurance profile on all Medicare beneficiaries. This entity, called the Coordination of Benefits (COB) Contractor, will be tasked with consolidating the following programs: a) Initial Enrollment Questionnaire (IEQ); b) IRS/SSA/HCFA Data Match (referred to simply as Data Match); c) First Claim Development (FCD); d) Trauma Code Development (TCD); e) 411.25 Notices (a mandated-by-law notice whereby an insurer notifies HCFA that an erroneous primary payment has been made by Medicare); f) Secondary Claims Development; g) Coordination of Benefits Agreement (COBA) (A new HCFA initiative relating to trading partner agreements currently negotiated between Medicare contractors and health plans for the exchange of paid claims data); and h) PAYERID (the proposed national health plan identifier) Registry. The COB Contractor will perform a variety of functions including, but not limited to, the following: a) conduct beneficiary surveys (IEQ) requesting information on the existence of health insurance coverage, other than Medicare, on approximately 200,000 newly enrolled Medicare beneficiaries monthly in accordance with Public Law 103.432 (Medicare Secondary Payer Reforms); b) conduct an annual survey on approximately 250,000 employers soliciting other health insurance coverage of selected Medicare beneficiaries in employer group health plans (GHPs) in accordance with 42 U.S.C. 1395y(b)(5) (Data Match); c) conduct development of other health insurance on controlled work items (FCD, TCD, 411.25 Notices, Secondary Claims) received from HCFA as the result of HCFA Medicare claims processing; d) tabulate and evaluate the information resulting from these surveys and forward the pertinent information to HCFA on an ongoing basis; e) negotiate and maintain agreements (COBA) between HCFA and other health insurers (and Medicaid State Agencies, and their fiscal agents) for the exchange of eligibility and paid claims data for purposes of coordinating correct health claim benefit payments by Medicare and other insurers; f) via issuance of task orders: potentially performing requirements analysis; developing; maintaining; and, operating the PAYERID registry that will enumerate all health plans in the United States; and g) maintain customer service staff to validate insurance information to resolve discrepant information and electronically update beneficiary records at HCFA with other insurance information. ABOUT THE COB SOLICITATION DOCUMENT: HCFA will be soliciting offers with the intent of awarding a hybrid Cost- Plus- Award- Fee/Indefinite Delivery, Indefinite Quantity (IDIQ) Contract with a base year and four option years. This procurement is a full and open competition with a Standard Industrial Classification (SIC) of 7374 which has a size standard of $18 million (See FAR 19.102). Subcontracting with small, small disadvantaged, small women owned, and small HUBzone businesses is encouraged. ABOUT THE HCFA MIP INTERNET WEBSITE: HCFA has provided information about the Medicare Integrity Program (MIP) and the Draft COB RFP on the Internet (WWW.HCFA.GOV/MEDICARE/MIP/). HCFA intends to use this same site to provide information about the Formal COB RFP as well. HOW TO OBTAIN THE COB RFP: The COB RFP will be available about Jan 22, 1999, on the Internet at www.hcfa.gov/medicare/mip/. Since the COB RFP is large and includes numerous attachments available only in electronic format, HCFA will NOT be providing the COB RFP to the public in an all-paper form. The following formats are available: 1) Internet downloading (see above); and 2) for interested sources who do not have Internet access, a paper copy of the RFP will be provided with RFP attachments and SOW appendices available for viewing at the HCFA library from 8:00 a.m. to 4:00 p.m. daily M-F (contact Elnora Scott at 410-786-7804 if you intend to visit the HCFA library). Requests for available hard copy sections of the RFP will only be entertained from vendors who can demonstrate that they do not have Internet download capability. COB INTERESTED PARTIES DATABASE: This database will provide organizations with information about other organizations interested in the COB effort so that partnering, teaming, subcontracting, etc. relationships can be developed. This site will allow the vendor to enter its company information into the Database. It is IMPORTANT that the information provided is accurate. NOTE: If you registered during the Draft RFP phase, you DO NOT need to reregister. The Database will be available for viewing on the web site at all times. Questions concerning this synopsis may be directed to Debbie Strittmatter at (410)786-5136. Posted 01/11/99 (I-SN286949). (0011)

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