The Centers for Medicare & Medicaid Services (CMS) is sponsoring the CMS Provider Screening Innovator Challenge to “to streamline operations, screen providers, and reduce fraud and abuse.” The challenge is part of the Partnership for Program Integrity Innovation and will be overseen by the Federal Center of Excellence for Collaborative Innovation through a partnership between CMS and the National Aeronautic and Space Administration (NASA).
CMS is looking for “reliable, scalable, and cost-effective” software to improve screening of providers across state and program lines:
Specifically, the challenge is an innovation competition to develop a multi-State, multi-program provider screening software application which would be capable of risk scoring, credentialing validation, identity authentication, and sanction checks, while lowering burden on providers and reducing administrative and infrastructure expenses for States and Federal programs.
Entries will be reviewed and judge by a panel of experts from CMS, and high-scoring entries lacking necessary features will have the opportunity to fix their offerings. The prize for the challenge totals between $500,000 and $600,000.
In order to win the prize, an entry must meet seven criteria:
1. Reduced processing and transaction time for submitting and receiving queries to authoritative data sources regarding provider credentials and sanctions.
2. Reductions in time needed by providers to submit information and resolve discrepancies.
3. Administrative/infrastructure savings from a multi-tenant provider screening solution.
4. Improved availability of key provider data relevant for program participation and oversight.
5. Improved timeliness and accuracy in provider participation, oversight, and enrollment decisions.
6. Improved ability to implement sections of the Social Security Act, as amended by the Patient Protection and Affordable Care Act.
7. Assist in better driving alignment of the Medicaid Information Technology Architecture (MITA) 3.0 framework to the Information and Technology Architecture levels.
Each criterion comes with its own set of sub-criteria.
The challenge begins officially at 6:ooPM EDT on May 30, 2012 and ends sometime in October or November of this year.
The complete notice is available on the Federal Register. For more information, contact John “Chip” Garner, (410) 786-3012.
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