RFQ ID: RFQ1500082
The purpose of this contract is to obtain computer software services to support the CWF system, including maintenance, production support, developmental enhancements, and special projects as required by CMS.
The CWF system is a significant component of the Medicare claims processing function within CMS. All efforts on this contract shall be performed per CMS requirements and shall meet the objectives of increasing efficiency and effectiveness of claims processing operations and timely implementation of statutory and regulatory requirements. Independently and not as an agent of the Government (except where noted herein), the offeror shall furnish all the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government, as needed to perform the Statement of Objectives below. After this, the offeror shall be called the CWF Contractor or Shared System Maintainer (SSM).
The CWF is a Medicare Part A and Part B benefit coordination and pre-payment claim validation system which uses localized databases maintained by a designated contractor called CWF Host. MACs can be assigned to one or more of the nine (9) CWF Host databases. The DME MACs process claims using beneficiary location data, whereas Part A/B MACs use the provider location. Claims are processed to the point of reimbursement computation. The MAC submits the claims to the CWF Host site to verify entitlement and utilization on the claim.
The CWF software also performs limited Part A/B crossover editing to ensure that the services are not paid twice on different types of claims. The CWF Host provides the MAC with responses to those claims. MACs also submit special transactions such as Medicare Secondary Payment (MSP) data (primary insurer data when Medicare is secondary), End-Stage Renal Disease (ESRD) Method of Reimbursement Computation data (only Part A MACs submit these transactions), and Certificate of Medical Necessity (CMN) (only DME MACs submit these transactions). These transactions are submitted to the CWF Host along with the claims and are identified by transaction type. MACs receive responses to these transactions along with the responses to the claims…
CMS seeks a SSM team that is flexible and competent in solving both infrastructure and application development problems. The SSM team should be well-versed in industry-standard software architecture, development methodologies and practices related to COBOL and Assembler mainframes systems, and modern languages and tools. This will enable more flexible development and real-time system-to-system integrations across CMS. CMS expects the SSM to transform its operations to a more modern/agile approach, so that, it is prepared to nimbly respond to the ever-changing FFS environment.
The primary and over-arching objectives CMS has for this contract are to:
Deliver high-quality software, considering industry-standard factors of quality such as correctness, reliability, efficiency, integrity, usability, maintainability, flexibility, testability, portability, reusability, and interoperability.
Meet the demands of CMS program and policy implementation priorities, to include the ability to scale up release capacity by 10% (currently measured by hours) per release quarter, as this will be funded on a separate contract line item number.
Increase, over the period of performance, the use of modern practices, to include Agile, software development methods, processes, and principles. Additional examples include but are not limited to DevSecOps, automated and shift-left testing, human-centered design, user research, Lean, and product management.
Increase, over the period of performance, the use of modern technology, to include Cloud-based solutions. Additional examples include use of modern tools such as Jira, Confluence, Slack, Git, etc.
Contribute to CMS’s efforts to modernize (including technology, design, and architecture) its fee-for-service ecosystem of systems. Contributions can be through activities such as collaborating with stakeholders that include CMS, system users, other developers and contractors, etc.; developing innovative but viable recommendations to meet CMS goals and objectives; and, delivering products and services that integrate with other products and services to collectively advance modernization.
This SOO provides additional detailed requirements and constraints of CWF software development and maintenance. However, the contractor shall expect that program priorities and other factors will create exceptions to these requirements and constraints from time to time. Other factors may include, but are not limited to, continuous improvement and maturation of CMS’s change management methods, processes, procedures, and tools. The contractor and COR shall mutually agree to changes in specified time-frames, processes, and procedures as needed to meet CMS’s needs or respond to situations and circumstances as they arise.
