The A/B MAC Statement of Work (SOW) for Jurisdiction H details the responsibilities and requirements for a Medicare Administrative Contractor (MAC) to administer Medicare claims processing and payment services. The contractor, operating under the Centers for Medicare & Medicaid Services (CMS), must deliver administrative services for both Medicare Part A and Part B, ensuring compliance with relevant laws, regulations, and policies. Key functions include handling claims, provider enrollment, customer service, and performing quality assurance measures to minimize errors. The SOW outlines essential tasks, such as risk management, infrastructure requirements, and financial oversight, emphasizing the importance of serving Medicare beneficiaries, providers, and the integrity of the Medicare Trust Fund. It also highlights the collaboration necessary between the contractor and various governmental and healthcare stakeholders. This document serves as an integral framework within the context of government RFPs and grants, guiding contractors toward maintaining compliance, operational excellence, and innovation in delivering Medicare services while ensuring fiscal responsibility and stakeholder engagement.

The Centers for Medicare & Medicaid Services (CMS) issued a Sources Sought Notice for Medicare Administrative Contractor (MAC) Services related to Medicare Parts A & B, aiming to assess small businesses' capabilities to provide essential fee-for-service health insurance administration, including claims processing and payment services. This market research informs CMS's acquisition strategy regarding potential contracts, particularly for Jurisdiction H (Arkansas, Colorado, New Mexico, Oklahoma, Texas, Louisiana, Mississippi). Key requirements include processing and paying Medicare claims, provider enrollment, conducting appeals and inquiries, and adhering to performance standards in claims accuracy and timeliness. Businesses are encouraged to respond by demonstrating their ability to fulfill specific operational functions outlined in the attached Statement of Work. The notice emphasizes the importance of compliance with federal regulations and CMS security practices for safeguarding sensitive data. Responses are due electronically by 11:00 AM EST on October 4, 2024, with a maximum submission of 10 pages. This notice is for research purposes only, not a solicitation or proposal request.