Specifications include, but are not limited to: The Contractor is required to develop a Framework that benchmarks payer reimbursements to the current MPFS. A proposal must include preliminary CPT® and HCPCS code configurations that demonstrate how the Framework, once developed, will provide a means to assess payment adequacy by provider taxonomy and include supporting justification for the design construct. The MHCC seeks to maintain transparency during the development of the Framework by keeping stakeholders involved in the process. The Contractor must engage at least three representatives from payers and three from provider organizations to consider proposed CPT® and HCPCS code configurations for primary care and behavioral health services based on an analysis of data from MHCC’s APCD. The MHCC will supply the Contractor with taxonomy codes and output files from the APCD. The output files will consist of private payer claims for Aetna Health & Life Insurance Company; CareFirst BlueCross BlueShield, Inc.; CIGNA Health and Life Insurance Company; Kaiser Foundation Health Plan of The Mid-Atlantic States, Inc.; MAMSI Life and Health Insurance Company, Optimum Choice, Inc., United Healthcare of the Mid-Atlantic, Inc., United Healthcare Insurance Company; and the recent available Maryland Medicaid data. The APCD does not include ERISA-exempt self-insured health plans but does include certain non-ERISA self-insured plans principally offered by State and local governments. Offerors must include a copy of their data management policy and the names of individuals that will have access to the output files.
