Description
The Centers for Medicare & Medicaid Services (CMS) is seeking information on large-scale claims processing and adjudication vendors to improve beneficiary experience, reduce provider burden, and improve administrative efficiency in Original Medicare. The goal is to acquire a commercial-off-the-shelf (COTS), configurable, interoperable claims processing platform capable of sub-second adjudication, improved real-time fraud prevention, and transparent interoperability through HIPAA X12 and FHIR/REST APIs.
Some key features of the desired platform include:
* Sub-second adjudication
* Improved real-time fraud prevention
* Transparent interoperability through HIPAA X12 and FHIR/REST APIs
* Ability to consolidate separate systems into a unified solution
* Support for CMS strategic goals for cost deflation, transparency, and policy agility