ClaimsCore Combined Synopsis/Solicitation
Overview
Buyer
Place of Performance
NAICS
PSC
Set Aside
Original Source
Timeline
Qualification Details
Fit reasons
- NAICS alignment with historical contract wins in similar service areas.
- Scope strongly matches core technical capabilities and delivery model.
Risks
- Past performance thresholds may require one additional teaming partner.
- Potential clarification needed on staffing minimums before bid/no-bid.
Next steps
Validate eligibility requirements, assign capture owner, and schedule partner outreach to confirm teaming strategy before submission planning.
Quick Summary
The Centers for Medicare and Medicaid Services (CMS), under the Department of Health and Human Services, has issued a Combined Synopsis/Solicitation (RFP 75FCMC26R0022) for the ClaimsCore program. This opportunity seeks to re-platform Medicare Fee for Service (FFS) claims processing by replacing legacy "Shared Systems" (MCS, FISS, DME, CWF) with a flexible, interoperable Software as a Service (SaaS) Commercially-Available-Off-The-Shelf (COTS) product and complimentary configuration and integration services. The goal is to reduce administrative burden, improve beneficiary experience, enable near real-time adjudication, enhance fraud prevention, and increase policy agility. This acquisition is not set-aside for small business concerns (Unrestricted).
Scope of Work
The ClaimsCore program involves:
- Re-platforming legacy COBOL-based FFS claims adjudication systems.
- Acquiring a COTS, configurable, interoperable claims processing platform.
- Supporting sub-second adjudication, real-time fraud prevention, and interoperability via HIPAA X12 and FHIR/REST APIs.
- Developing and implementing an Information System Security Plan.
- Ensuring compliance with Section 508 accessibility standards and HIPAA Business Associate requirements.
- Integrating with numerous external systems and migrating decades of data.
- A challenge-based acquisition process with a Proof of Concept (POC) phase followed by production implementation.
Contract Details
- Contract Type: Firm Fixed Price (FFP)
- Period of Performance: Base period from May 2026 to November 2026, with seven option periods extending through November 2033.
- Set-Aside: Unrestricted
- NAICS Code: 541512 (Computer Systems Design Services)
- Estimated Awards: Up to four (4) awards are anticipated.
- Place of Performance: St James, MD 21244, United States.
Submission & Evaluation
- Questions Due: March 6, 2026, 11:00 AM ET, via email to Lauren Holsey (Lauren.Holsey@cms.hhs.gov) and Candace Straker (Candace.Straker@cms.hhs.gov).
- Phase One Proposals Due: March 13, 2026, 11:00 AM ET, via email to Lauren Holsey.
- Evaluation Process: Two-phased, using a tradeoff process to determine Best Value. The Government may award without discussions.
- Evaluation Factors (descending order of importance):
- Phase 1: Corporate Experience (Mission Focused).
- Phase 2: Performance Work Statement (PWS) & Quality Assurance Surveillance Plan (QASP), Past Performance, Price, Section 508 compliance (ACR/VPAT), and Business Ethics/Conflict of Interest (COI)/Compliance.
Important Attachments & Notes
- Attachment 1: ClaimsCore Statement of Objectives (SOO) provides a full description of requirements.
- Attachment 2: Contractor COI Submission Template, required for all proposals.
- Attachment 3: ClaimsCore Instructions to Offerors details proposal preparation and submission.
- Attachment 4: Past Performance Questionnaire for references.
- Attachment 5: FAR 52.212-5 outlines applicable contract clauses.
- Attachment 6: Beneficiary Quantities and Unit Pricing, detailing estimated volumes and a "True-Up" mechanism for price adjustments.
Points of Contact
- Contracting Officer: Candace Straker (Candace.Straker@cms.hhs.gov, 410-768-8174)
- Contract Specialist: Lauren Holsey (Lauren.Holsey@cms.hhs.gov, 410-786-3746)