$313M Medicare administration contract goes to Noridian
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Noridian Healthcare Solutions has retained its contract to process Medicare claims and root out fraud on behalf of the CMS. The contract has one base year and six option years and is worth more than $313 million, according to an award notice.
The CMS chose Noridian to continue work as the Medicare administrative contractor for Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming, home to 3.1 million Medicare fee-for-service beneficiaries, according to the CMS. More than 500 hospitals and 74,000 physicians are also under this contract
The contract's request for proposals process began in March 2017. Under the agreement, the company will provide Medicare claims processing and payment services. It will also flag potentially fraudulent claims, enroll new providers into Medicare, conduct redeterminations on appeals of claims, operate a customer service program that educates providers about the Medicare program and respond to provider telephone and written inquiries.
National Government Services, another Medicare administrative contractor, protested the solicitation process for the contract to the U.S. Government Accountability Office calling it too restrictive because the CMS caps the amount of work MAC contractors can have. The company said the policy violated the agency's requirement to employ full and open competition, which resulted in "competitive injury to NGS." The GAO denied the claim.
Correction: An earlier version of this story mischaracterized Noridian as an auditor. This error has been corrected.
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