Reston, Va.-based NCI Inc. announced July 28 that its wholly-owned subsidiary AdvanceMed has been awarded the first task order under the $2.5 billion Centers for Medicare and Medicaid Services (CMS) IDIQ Unified Program Integrity Contractor (UPIC) contract.
The UPIC IDIQ combines and integrates the functions of the former Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC) and Medicaid Integrity Contractor (MIC) contracts into a single contract with five jurisdictions to be competed. The first task order for the Midwestern Jurisdiction, valued at $76.8 million, includes a 12-month base period with four 12-month option periods.
“NCI is proud and excited to take the lead role in the new UPIC initiative for our long-time CMS customer through the award of the UPIC Midwestern task order,” NCI’s President and CEO Brian J. Clark said. “Combining the work of multiple contracts into the UPIC IDIQ will enable NCI to draw on its more than 17 years of experience with CMS and better support the agency in meeting its mission requirements through coordinated audits, investigations and data analyses while reducing the burden on providers. CMS anticipates this integrated and data-driven approach will lay the groundwork for fostering further program integrity coordination with other private and government payers across the entire health care industry.”
NCI will perform fraud, waste and abuse (FWA) detection and prevention activities for Medicare and Medicaid claims processed within the Midwestern Jurisdiction. This covers the states of Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio and Wisconsin.
NCI will focus on analysis of managed care encounter and claims data, and coordination with appropriate partners for referral and resolution of identified issues for Medicare and Medicaid managed care FWA. NCI’s specific work will include lead screening; investigation; medical review; remedy implementation; and collaboration with CMS, federal, state and local government, law enforcement, and other CMS partners and contractors. The company will also detect and deter risks and broader vulnerabilities resulting from historic billing approaches, payment reforms and health care innovations such as the use of electronic health records. NCI will support necessary hearings and testimony that may result from the investigations conducted. Finally, it will integrate new tools and technologies to enhance results and provide IT infrastructure support.