ClaimsCore Request for Information

Summary (Newest Update)

Background The Centers for Medicare & Medicaid Services (CMS) is seeking information regarding large-scale claims processing and adjudication vendors to enhance beneficiary experience, reduce provider burden, and improve administrative efficiency in Original Medicare. This Request for Information (RFI) aims to gather insights before issuing a formal solicitation. The ClaimsCore program is intended to replace outdated COBOL-based systems with a modern, interoperable claims processing platform. Work Details The contractor will be responsible for replatforming the Medicare Fee-for-Service (FFS) claims adjudication environment by replacing four legacy systems: Multi-Carrier System (MCS), Fiscal Intermediary Shared System (FISS), ViPS Medicare System (VMS), and Common Working File (CWF). Key tasks include: 1. Implementing a Commercial-Off-The-Shelf (COTS) solution that supports sub-second adjudication and real-time fraud prevention. 2. Ensuring interoperability through HIPAA X12 and FHIR/REST APIs. 3. Consolidating separate systems into a unified solution for Part A, Part B, and Durable Medical Equipment (DME). 4. Supporting CMS's strategic goals for cost deflation, transparency, and policy agility. 5. Providing comprehensive APIs for real-time claims status and reducing provider burden through improved transparency and consistency. Period of Performance The contract will have multiple periods of performance starting from September 1, 2026, with options extending up to November 30, 2033. Place of Performance The work will primarily be performed at the contractor's facilities; specific geographic locations were not detailed.