Medical Claims Adjudication System Services
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 Federal Bureau of Prisons (BOP) has awarded a sole-source Firm-Fixed-Price task order for Medical Claims Adjudication (MCA) System Services. This award, justified by "unusual and compelling urgency," ensures continuous processing of inmate healthcare claims and fraud detection, maintaining compliance with Medicare-based rate structures.
Scope of Work
The BOP provides healthcare to approximately 160,000 inmates across 120 institutions. The MCA system is critical for reviewing and adjudicating community medical billing for accuracy and fraud detection, processing electronic claims (ANSI 837, HIPAA compliant) against negotiated rates. Key requirements include:
- Medical Claims Adjudication (MCA) software platform.
- Fraud monitoring and detection capabilities with real-time tracking.
- Customized Explanation of Benefits (EOBs) and analytic tools.
- A customized interface for Bureau systems to transmit/receive information via Amazon Web Services AppStream.
Contract Details
This is a Firm-Fixed-Price Task Order awarded against GSA MAS contract GS-00F-392GA, under NAICS 541519 (Other Computer Related Services) and PSC Q601 (Medical Coding and Auditing). The period of performance includes a 6-month base period and two 3-month option periods. The vendor must meet DOJ/FBOP IT security requirements. The MCA system environment must be hosted within an AWS GovCloud instance, inheriting various FedRAMP-certified functions and services (e.g., CloudWatch, CrowdStrike, CloudTrail).
Set-Aside & Eligibility
This is a sole-source award justified by "unusual and compelling urgency" under FAR Subpart 538.7104-3(b)(i), restricting consideration to a specific Federal Supply Schedule (FSS) contractor.
Evaluation
Price reasonableness was determined based on GSA FSS MAS contract pricing, comparison to historical prices, and Independent Government Estimates (IGE).
Additional Notes
The Bureau is committed to promoting full and open competition and will periodically evaluate market sources. The approved justification will be published on SAM.gov within 30 days.