Avalere Health
An Inovalon Company
Insights

Feb 28, 2014

First Coast Once Again Awarded the Part A/B Medicare Administrative Contract for Jurisdiction N

Published

Feb 28, 2014

Last week, CMS awarded First Coast Service Options, Inc. (First Coast) the contract for the administration of Medicare Part A and Part B fee-for-service claims in Jurisdiction N, which encompasses Florida, Puerto Rico, and the U.S. Virgin Islands.

First Coast held the expiring contract for Jurisdiction N, formerly Jurisdiction 9, and the new contract became active on Feb. 14.  Jurisdiction N comprises approximately 8.2 percent of the overall national fee-for-service claims. First Coast has now secured the contract for the jurisdiction until CMS conducts the next rebidding cycle, which happens every five years.

Under Jurisdiction N, First Coast is responsible for administering Medicare claims processing services for approximately 300 hospitals, 54,000 Medicare physicians, and 2.6 million fee-for-service beneficiaries. First Coast will also perform operational functions such as enrollment, education, and audits of Medicare providers in their jurisdiction.

If First Coast meets all of the base requirements of their agreement with CMS, the contract could be worth as much as $313.3 million. This amount is dependent on First Coast’s performance on certain measures, evaluated through on-site performance reviews, data reviews, protocol-driven quality assurance reviews, and independent audits.

First Coast will continue to play an influential role in the local coverage decision landscape.    Additionally, since First Coast was re-awarded a contract, they could also win contracts for other jurisdictions moving forward.  As of Feb. 12, the re-compete process for Jurisdiction J (formerly Jurisdiction 10) was also underway.  Cahaba currently holds the contract for Jurisdiction J, but it remains unclear if Cahaba will continue to be the contractor, or if another contractor like First Coast could win this jurisdiction.  Past performance and technical evaluations will be major factors in the contractor selection process for Jurisdiction J.

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