UPDATE: CMS Encounter Data Processing System (EDPS)
Posted (Last updated )
** Update November 29, 2016 **
This Notice concerns the potential requirement for a contractor to build, test, implement, and maintain the operations of a claims processing system to validate Encounter Data Records (EDRs) against industry and CMS standards submitted by Medicare Advantage organizations (MAOs) and other organizations offering Medicare private health plans (Program for All-Inclusive Care of the Elderly (PACE) organizations, cost plans, and the Medicare-Medicaid demonstration plans); and to provide reporting services to…
Sources Sought: CMS Encounter Data Processing Systems (EDPS) – After some starts and stops and an extension to the incumbent, CMS has released this notice for what promises to be one of the more competitive bids at CMS in FY 17.
The who, what when and where is still very much up in the air. This notice is certain to receive a lot of attention as firms work to persuade CMS that their vehicle, certification, socio-economic designation set-aside, etc. is the best choice CMS can make.
** Update October 17, 2016 **
“The Centers for Medicare and Medicaid Services (CMS) intends to negotiate an extension of the period of performance of the “Encounter Data Processing System” (EDPS) contract… with Northrop Grumman Information Technology, Inc. on a sole source basis.”
The Encounter Data Processing System (EDPS) is the nation-wide “back-end” processing system for Medicare Part C encounter data…”
“The extension beginning on January 1, 2017 and continuing through June 30, 2019, executable as a 12- month base with three (3) six-month option periods, will provide CMS the flexibility and agility to safeguard our statutorily mandated payment operations, while facilitating a smooth transition between contractors. In addition to maintaining uninterrupted services, this extension will allow CMS to further define EDPS requirements to meet the Agency’s operational needs.
CMS intends to engage in a competitive procurement and award a new contract in 2017…”
G2X TAKE: The Centers for Medicare & Medicaid Services Announced late last week that they are extending the current Encounter Data Processing System (EDPS) Contract for up to 30 months, but that will not stop them from "engaging in a competitive procurement" in FY 2017 for this important nation-wide “back-end” processing system for Medicare Part C encounter data. This contract was awarded in 2011 at a value of $91M, but based on a recent mod which ends 7/17, the total contract value has risen to more than $132M for Northrop Grumman. For what it is worth, the FY16 CMS forecast estimated the total contract value for the recpmpete at between $50 and $100M.
In lieu of having a dedicated contracting vehicle, CMS continues to spread their tasks around. Having a plan A, B and C for any task released in FY 17 is critical.
Northrop Grumman remains the favorite, but several other firms bring expertise and/or relationships including CNSI, CCS Global Tech, Optum, Cognosante, Accenture, HPE, NewWave and CSRA.
Should you or someone else be on this list? Let us know below.
** Posted January 21, 2015 **
CMS Encounter Data Processing System (EDPS) – Posted January 20, 2015, fbo.gov.
CMS’ objectives for this RFI include but are not limited to obtaining the following information regarding: 1) available commercial claims adjudication software and hardware, and/or approaches to leveraging CMS current translators and adjudication editors; 2) interested vendors and any existing contracting vehicles that may benefit CMS in its investment planning; 3) feedback on potential systems design/build, development, testing, and implementation; 4) timeframes for implementation of proposed solution(s), including transition to operations and maintenance; and, 5) estimates for level of effort and labor mix by business function (Providing this information is optional and not a response. Responses due February 17th
G2X TAKE: CMS is on the hunt for claims adjudication COTS software or approaches (open source?) for leveraging CMS current functionality in the existing EDPS to develop the next version of the solution. Another buy or build decision is under consideration, and the buy and configure option is growing in attractiveness because of the ability to deliver the solutions as a SaaS solution. Companies like AthenaHealth, Trizetto, and Capterra are among those likely to propose their claims adjudication solutions. Federal Health IT contractors may consider making calls to these guys while the RFI is in process.
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