Name | Type | Posted | Actions |
|---|---|---|---|
MCA_Bridge_JOFOC_8.4_Unusual_and_compelling_urgency_Redacted.pdf | May 5, 2026 |
Medical Claims Adjudication System Services
Contact and place of performance
Paul Brown
Washington, DC 20007
USA
The Federal Bureau of Prisons (Bureau) currently provides healthcare to approximately 160,000 inmates in 120 prisons (institutions) geographically dispersed throughout the contiguous United States, Hawaii, and Puerto Rico. For the contract award, all federal inmates are considered to have a single benefit plan and are members of this plan. Inmate access to healthcare benefits is applied universally throughout the Bur...
View more1) Federal Operating Rate Medicare rates for the applicable area for inpatient facility services;
2) Medicare fee schedule amounts for the area for outpatient facility services;
3) Skilled nursing facilities, and
4) Medicare fee schedule amounts for the area for physician services.
Healthcare providers, when negotiating rates for the Bureau are expected to propose a discount from or a premium to Medicare benchmarks. The Bureau has successfully awarded most comprehensive medical contracts based on structured Medicare rates. However, there are locations where the Bureau has been unsuccessful in awarding contracts based on Medicare rates. In those cases, contracts are typically awarded at a percentage of billed charges or the fee schedule. Only Bureau institutions with contracts that are structured using Medicare rates shall participate in claims adjudication process under this contract.
The Bureau is the sole payer for all healthcare services rendered to inmates in Bureau custody. The number of claims processed each year may vary based on healthcare services provided. Most healthcare providers are using electronic billing via ANSI 837 format consistent with the industry standard. For the purpose of contract award, a claim for contracted healthcare services reimbursed using the Medicare model is defined as electronic claims that conform to Medicare and Health Insurance Portability and Accountability Act (HIPAA) electronic billing standards (see http://www.cms.hhs.gov/ElectronicbillingEDITrans/01 overview.asp) from a contracted facility, physician’s office, or other healthcare provider.
In summary, each institution has separate and unique contract(s) with healthcare providers in their area. Therefore, the “network of healthcare providers” shall be those healthcare providers with current Bureau contracts and agreements. These contracts and agreements shall each have formally negotiated and contract payment rates.
The vendor shall met DOJ/FBOP IT information security requirements and is able to continue reviewing and adjudicating community medical billing for accuracy and fraud detection without lapses in service and has developed the necessary information network with community providers to allow for receipt of digital claims and processing against the negotiated rate structures at each FBOP facility. Any system that shall connect to or be hosted in a non-FBOP cloud service shall use cloud service providers (CSP) that have been independently evaluated by an authorized FedRAMP 3PAO and are FedRAMP-certified. The vendor shall provide a MCA system environment hosted within a vendor instance of Amazon Web Services (AWS) GovCloud. This MCA system shall inherit various Federal Risk and Authorization Management Program (FedRAMP) certified functions and services, such as CloudWatch, CrowdStrike, and CloudTrail.
The Federal Bureau of Prisons has awarded a sole-source firm-fixed-price task order for Medical Claims Adjudication (MCA) System Services, acquired against General Services Administration’s (GSA) MAS contract GS-00F-392GA, NAICS 541519, Other Computer Related Services, and Product Service Code, Q601, Medical Coding and Auditing.
The approved Justification is attached.
The Federal Bureau of Prisons (BOP) has issued a Justification and Approval for a sole-source, firm-fixed-price task order to maintain Medical Claims Adjudication (MCA) system services. This system supports healthcare delivery for approximately 160,000 inmates across 120 federal institutions located in the contiguous United States, Hawaii, and Puerto Rico. The contractor must provide an MCA system environment hosted within a vendor instance of Amazon Web Services (AWS) GovCloud that is FedRAMP-certified and complies with Department of Justice information security requirements. The scope of work includes reviewing and adjudicating community medical billing for accuracy and fraud detection, utilizing an established information network to process digital claims against negotiated rate structures without service lapses.
The adjudication process handles claims for healthcare services rendered to inmates, where the Bureau serves as the sole payer. While primary care is provided by federal employees, external medical services are secured through comprehensive contracts structured primarily around Medicare benchmarks, including inpatient and outpatient facility services, skilled nursing facilities, and physician services. The MCA system processes electronic claims in ANSI 837 format that conform to Medicare and HIPAA billing standards. Performance is centered in Washington, DC, and the system must integrate security functions such as CloudWatch, CrowdStrike, and CloudTrail to ensure data integrity and compliance.
This procurement, identified under solicitation number 15BPCC26F00000069, was acquired against GSA MAS contract GS-00F-392GA. The opportunity is classified under NAICS 541519 for Other Computer Related Services and PSC Q601 for Medical Coding and Auditing. Documentation regarding the award rationale is provided in a redacted justification for unusual and compelling urgency. Administrative oversight for this requirement is managed by the Federal Prison System/Bureau of Prisons under the direction of point of contact Paul Brown.
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