Columbia, MD, July 25, 2023 – The Centers for Medicare & Medicaid Services (CMS) has awarded Sparksoft Corporation with a 4-year, $53 Million prime contract to maintain and evolve the Eligibility Appeals Operations Support (EAOS) – Digital Services Support (DSS), which enables the business operations and IT needs of the Patient Protection and Affordable Care Act (ACA) Marketplace eligibility appeals adjudication process filed on Healthcare.gov. CMS Office of Hearing and Inquiries (OHI), Marketplace Appeals Group (MAG) oversees the administrative adjudication process that was established for consumers and employers appealing eligibility determinations made by the Federally-Facilitated Exchange (FFE) and State-Based Exchanges (SBE). Approximately 1,000 EAOS users support the adjudication of up to 15,000 eligibility appeals per month from all 50 States, the District of Columbia, in the individual market, large employer, and Small Business Health Options Program (SHOP).
Under this contract, Sparksoft will provide management and technical expertise to support OHI/MAG in implementing national health care transformation through impartial consultation and review of detailed technical solutions and process improvements, determining the number of interfaces, understanding key engineering challenges early on, providing options for reuse and integration to existing systems, enterprise standards and engineering approaches, and facilitate discussion between EAOS Contractors, the MAG, and Business partners within the CMS Office of Information Technology (OIT), Office of Communications (OC), and Center for Consumer Information and Insurance Oversight (CCIIO). Sparksoft will perform full lifecycle modern digital services that support the following EAOS objectives:
- Development and enhancement of the Pega-based Eligibility Appeals Case Management System (EACMS)
- Maintenance of the Appellant Portal (AP), the public-facing portal/hub integrated with EACMS
- Verification of appeal information, validation and classification of appeal requests
- Receiving additional information from appellants for appeals processing
- Information resolution through CMS systems such as Marketplace Change Utility (MCU), Marketplace Consumer Record (MCR), Electronic File Transfer (EFT) via TIBCO, Enterprise Identity Management (EIDM), Health Insurance Casework System (HICS), and Federally Facilitated Marketplace (FFM) Eligibility Appeals Support (FEAS)
- Correspondence and communications support, including API connections and workflow maintenance for DocuSign Contract Lifecycle Management (CLM) and Document Storage and Retrieval System (DSRS)
- Effectuation of appeal decisions
- Hearings support (scheduling, notices of hearings, correspondence and communication, hearings preparation, review and mailing of hearing decisions)
“We are honored and humbled that the government continues to entrust us with support on some of the most mission-critical public health programs that impact our families and communities. It is truly a privilege to be such a trusted partner to our CMS clients, who are some of the most dedicated public servants leading transformational missions.” said Sparksoft’s President Ms. Siva Sivaraman. Sparksoft’s CEO, Mr. Mike Finkel stated that “With Sparksoft managing multiple agency-wide shared services, we take our responsibility to drive value and ROI for CMS very seriously. It is our obligation to continue seeking out holistic synergies, meaningful efficiencies, and technological breakthroughs at an enterprise scale to ensure that the Marketplace is sustainable for generations to come.”
