CMS Awards Sparksoft with a 4-Year $53M Prime Contract to Maintain and Evolve the Eligibility Appeals Operations Support (EAOS)

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CMS Awards Sparksoft with a 4-Year $53M Prime Contract to Maintain and Evolve the Eligibility Appeals Operations Support (EAOS) – Digital Services Support (DSS)

Columbia, MD, July 25, 2024 – The Centers for Medicare & Medicaid Services (CMS) has awarded Sparksoft Corporation with a 4-year, $53 Million prime contract to maintain and evolve the Eligibility Appeals Operations Support (EAOS) - Digital Services Support (DSS), which enables the business operations and IT needs of the Patient Protection and Affordable Care Act (ACA) Marketplace eligibility appeals adjudication process filed on Healthcare.gov. CMS Office of Hearing and Inquiries (OHI), Marketplace Appeals Group (MAG) oversees the administrative adjudication process that was established for consumers and employers appealing eligibility determinations made by the Federally-Facilitated Exchange (FFE) and State-Based Exchanges (SBE). Approximately 1,000 EAOS users support the adjudication of up to 15,000 eligibility appeals per month from all 50 States, the District of Columbia, in the individual market, large employer, and Small Business Health Options Program (SHOP).

Under this contract, Sparksoft will provide management and technical expertise to support OHI/MAG in implementing national health care transformation through impartial consultation and review of detailed technical solutions and process improvements, determining the number of interfaces, understanding key engineering challenges early on, providing options for reuse and integration to existing systems, enterprise standards and engineering approaches, and facilitate discussion between EAOS Contractors, the MAG, and Business partners within the CMS Office of Information Technology (OIT), Office of Communications (OC), and Center for Consumer Information and Insurance Oversight (CCIIO). Sparksoft will perform full lifecycle modern digital services that support the following EAOS objectives:

Development and enhancement of the Pega-based Eligibility Appeals Case Management System (EACMS)

Maintenance of the Appellant Portal (AP), the public-facing portal/hub integrated with EACMS

Verification of appeal information, validation and classification of appeal requests

Receiving additional information from appellants for appeals processing

Information resolution through CMS systems such as Marketplace Change Utility (MCU), Marketplace Consumer Record (MCR), Electronic File Transfer (EFT) via TIBCO, Enterprise Identity Management (EIDM), Health Insurance Casework System (HICS), and Federally Facilitated Marketplace (FFM) Eligibility Appeals Support (FEAS)

Correspondence and communications support, including API connections and workflow maintenance for DocuSign Contract Lifecycle Management (CLM) and Document Storage and Retrieval System (DSRS)

Effectuation of appeal decisions

Hearings support (scheduling, notices of hearings, correspondence and communication, hearings preparation, review and mailing of hearing decisions)

"We are honored and humbled that the government continues to entrust us with support on some of the most mission-critical public health programs that impact our families and communities. It is truly a privilege to be such a trusted partner to our CMS clients, who are some of the most dedicated public servants leading transformational missions.” said Sparksoft’s President Ms. Siva Sivaraman. Sparksoft’s CEO, Mr. Mike Finkel stated that “With Sparksoft managing multiple agency-wide shared services, we take our responsibility to drive value and ROI for CMS very seriously. It is our obligation to continue seeking out holistic synergies, meaningful efficiencies, and technological breakthroughs at an enterprise scale to ensure that the Marketplace is sustainable for generations to come.”

This award builds on Sparksoft’s certified ISO 9001 Quality Management System (QMS) and experience with high-volume contact center operations such as the Marketplace Service Desk (MSD), which provides assistance to CMS Application Development Organizations (ADO), issuers, agent brokers, Health Insurance Marketplaces, State agencies, insurance companies, Third-party Administrators (TPA), and other healthcare stakeholders with the implementation and operational issues of the ACA; and Independent Quality Assurance (IQA), which monitors Customer Service Representatives (CSR) at 1-800-MEDICARE Contact Center Operations (CCO). To learn more about Sparksoft’s Contact Center Operations capabilities and how we can help support your needs based on proven tools, processes, and people, please visit https://sparksoftcorp.com/contact-ctr.html. The EAOS award also expands Sparksoft’s footprint supporting vital pillars of the ACA Marketplace on CCIIO programs like the Multidimensional Insurance Data Analytics System (MIDAS), Federal Data Services Hub (Hub), and Marketplace Open Modernization and Optimization Technologies (MOMOT). To learn more about Sparksoft’s role in supporting CMS with the ACA Marketplace during the Coronavirus pandemic, please visit https://www.sparksoftcorp.com/articles/sparksoft-supports-aca-marketplace.html.

About Sparksoft Corporation

Sparksoft is a Capability Maturity Model Integration (CMMI) Services and Development Maturity Level 3, ISO 9001:2015, ISO 20000-1:2018, ISO 27001:2013, and Federal Wide Assurance for the Protection of Human Subjects certified consulting organization with a proven record of successfully delivering modern digital health solutions for more than a dozen Federal, State, and Commercial customers. As evidenced by our 20+ active prime contracts and subcontracts, and further supported by our excellent Contractor Performance Assessment Reports (CPARs), Sparksoft is a highly mature and capable partner trusted by the government and industry. We bring to bear the essential institutional knowledge, contract vehicles, certifications, experienced personnel, and process maturity to deliver the requirements in compliance with Federal regulations, industry best practices, and agency governance needs.

Through our focused mission “to ignite innovation, inspire transformation, and implement digital solutions for a healthier nation” we specialize in DevOps Delivery, Data Science, Contact Center Operations, Life Sciences, and Test Automation. Since 2004, our exceptionally skilled people, proven leadership, and optimized processes all work together to relentlessly push for more efficient solutions for our HHS, Military Health, and Life Sciences clients. We have developed a support structure of Innovation Centers designed to collect our enterprise-wide lessons learned and identify project-specific opportunities for improvement. SparkLabs, where our Research & Development teams explore ideas and turn them into real-world solutions is an important impetus in our drive for innovation. We continually pull from our experience and combine this with forward-thinking technology from our certified partners like Red Hat, Microsoft, AWS, Okta, Google, Databricks, and ServiceNow to conceptualize novel and effective solutions such as our SparkLoader® RPA Data Pipeline, SparkGrid® Snowflake GUI, MockSpider® Virtual Sandbox, ScriptHive® for TDD/BDD automation, SparkMarker® Website Accessibility Platform, 508bee® Accessibility Validation, and many more.

Sparksoft’s website is updated regularly with news of product launches, contract awards, certification and vehicle changes, key hires, and corporate milestones. Visitors are encouraged to explore the website and also connect with us on Social Media