Breast and Cervical Cancer Program (BCCP) Provider Fee For Service Contract

Tender summary

Eligible healthcare providers are invited to participate in this Request for Applications to become a primary or secondary provider of breast or cervical cancer screening services for the Mississippi Breast and Cervical Cancer Program (MS-BCCP). Through support provided by the Centers for Disease Control, National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and non-federal funding sources, the Mississippi Breast and Cervical Cancer Program (MS-BCCP) is a screening program that supports and promotes breast and cervical cancer screening for medically underserved women that are considered high risk. The goal of the program is to screen medically underserved women to reduce morbidity and mortality from breast and cervical cancer in Mississippi. These groups include underinsured, uninsured, medically underserved, minority, and women 40 years old and older. Often by the time symptoms appear and these women present to a healthcare provider, the disease has advanced, reflecting differences in access to screening and care. MS-BCCP continues its efforts in filling the gap for women to ensure adequate and quality health care access as it relates to breast and cervical cancer screenings. This goal is accomplished in tandem with a broad network of healthcare partners, by addressing patient barriers to screening, improving clinic processes to better identify women in need of screening, and enrolling women in MS-BCCP for screening and diagnostic tests. The NBCCEDP target population is uninsured or underinsured women who are at or below 250% of the federal poverty level, aged 50 to 64 years for breast cancer services, and aged 21-64 years for cervical cancer services. High priority populations for MS-BCCP are underinsured Black, Hispanic, and Asian/Pacific Islander women who are at or below 250% of the federal poverty level, aged 50 to 64 years for breast cancer services, aged 21-64 years for cervical cancer services, and from rural and urban communities. MS-BCCP aims to increase breast and cervical cancer screenings and diagnostic services across Mississippi among disproportionately affected populations, including racial and ethnic minority women through population-based approaches, which engage the support of health systems partners through the State. This Request for Applications (RFA) is issued to solicit applications from health systems who can increase breast and cervical cancer screenings rates throughout the State. This is a non-competitive opportunity, open to any medical provider meeting the required qualifications. Providers are expected to provide the following breast and cervical cancer screening and early detection services to Mississippi Breast and Cervical Cancer Program (MS-BCCP) eligible and enrolled individuals : 1. SERVICES TO BE PROVIDED The provider must identify which among the following services it intends to offer enrolled MS-BCCP patients under this contract. A Primary Provider agrees to provide a comprehensive cancer screening, (pap tests, pelvic exams, clinical breast exams, counseling, and health education services) according to program guidelines, which may also include diagnostic services and consultation to the eligible population as deemed necessary by the physician. If appropriate, the patient maybe referred to another participating physician for some of these examinations. The Primary Provider will have the sole responsibility of determining patient eligibility for services based on program policies, protocols, and guidance. A Primary Provider is also responsible for timely and properly enrolling eligible individuals in the MS-BCCP per program criteria. The Screening Intake Form 718 and the Consent/Release of Information Form 701 must be completed and submitted to MS-BCCP within 5 business days of the date of service. All providers listed below are considered secondary or auxiliary screening and/or diagnostic providers. Secondary or auxiliary screening providers may enroll patients on a case-by-case basis provided all program criteria for patient eligibility, enrollment documentation, and patient navigation can be met. B. An OB/GYN agrees to provide the necessary consultation and appropriate diagnostic tests or procedures as listed in the fee schedule and agreed to by both parties. The referring primary provider will have the responsibility of determining patient eligibility for services based on program protocol and manual. C. A Surgeon agrees to provide the · necessary consultation and appropriate Diagnostic test or procedures to determine a diagnosis of cancer. The referring primary provider will have the responsibility of determining patient eligibility for services based on program protocol and manual. D. A Mammography Facility agrees to provide breast cancer services to include screening and diagnostic mammograms and other related diagnostic procedures listed in the fee schedule as agreed by both parties. E. A Hospital/Outpatient Surgery Facility agrees to provide outpatient diagnostic services as listed in the fee schedule and agreed to by both parties. F. A Radiologist agrees to provide services for cancer indicated above that may include interpretation. G. A Pathologist or Laboratory/Pathology Facility agrees to provide related diagnostic lab services as listed in the fee schedule as agreed to by both parties. H. An Anesthesiologist agrees to provide anesthesiology services to outpatient surgery patients as listed in the fee schedule as agreed to by both parties. I. A Certified Registered Nurse Anesthetist (CRNA) agrees to provide anesthesia services to outpatient surgery patients under the direction of a physician licensed to practice medicine. The nurse anesthetist is qualified in accordance with Section §73-15-20(2) of the Code of Mississippi 1972 and must be licensed by the Mississippi Board of Nursing. 2. PATIENT NAVIGATION The ENROLLING PROVIDER of the patient, whether it is the primary provider or a secondary/auxiliary provider, agrees to provide timely and appropriate patient navigation, which may include referral to MSBCCP for financial assistance in covering medical costs, education, and consultation and support to resolve patient barriers and/or arrange diagnostic services and treatment assistance as appropriate. 3. STANDARDS OF CARE All services pursuant to this agreement shall be performed to the satisfaction of the MS-BCCP, and in accordance with all applicable federal, state, and local laws, ordinances, rules, and regulations, as well as MS-BCCP program policies, protocols, and guidance. Contractor will maintain documentation of all MS-BCCP-related screening and diagnostic activities in the patient’s medical record and will make records available for review, audit, or inspection to authorized agents of MS-BCCP and/or the Mississippi State Department of Health as needed or required. 4. REFERRAL OF PATIENTS Patients must be enrolled by a contracted, participating MS-BCCP provider and must be further referred to and served by other MS-BCCP contracted, participating providers for screening and diagnostic services as appropriate. Reimbursement of services is allowable only when enrolled patients are provided breast and cervical cancer screening and diagnostic services by contracted, participating MS-BCCP providers. Services provided by non-contracted providers will not be reimbursed and patients may be billed for services rendered by non-contracted providers. 5. THIRD-PARTY PROVIDERS Providers (i.e., surgeons, laboratories, radiologists, etc.) who are affiliated with or provide services at the site of the contracted provider but independently submit claims using a different tax ID number than the contracted provider MUST ALSO be contracted with MS-BCCP to be eligible for reimbursement. 6. LABORATORIES A Primary Provider/Surgeon/Hospital/Outpatient Surgical Facility agrees to obtain results of laboratory services, to include pathology, from a Clinical Laboratory Improvement Act(CLIA) certified laboratory. 7. CANCER DIAGNOSIS If a breast and/or cervical cancer is found, the Primary Provider and Surgeon agree to provide the MS-BCCP with start of treatment information within 14 days of the initiation of cancer treatment. The provider agrees to share necessary information related to the diagnosis and treatment of the breast or and/or cervical cancer with the MS-BCCP for CDC data surveillance and program performance indicator purposes. 8. SUBMISSION OF INVOICES, PROGRAM FORMS AND REPORTS Contractor agrees to submit an invoice or demand for payment and substantiating documentation for the reimbursable medical procedure(s) performed or service(s)provided within forty-five (45) days of the date(s) of service with the exception of services provided in the month of June. Claims, invoices, or other demands for payments for dates of service in the month of June (with supporting documentation) must be received by close of business on the second Friday of July. This shortened timeframe is necessary to assure all payments are finalized and liquidated before closeout financial reporting is due to the federal funding agency. Invoices or demands for payment received after the second Friday of July for work and labor performed are subject to denial, will not be paid, and are forfeited. With the exception of laboratories, Contractor will complete all necessary forms applicable to services provided and required by the MS-BCCP to include Screening/Intake Forms, Consent Forms, Mammogram Voucher, Breast /Cervical Follow-Up Referral Forms and will provide copies of progress or medical notes relevant to MS-BCCP related services. Contractor will provide the primary (or enrolling) provider and the MS-BCCP with the results of all screenings, tests, pathological procedures, surgical procedures, and recommendations for follow-up. All necessary documentation must be on file with MS-BCCP before a claim is processed for payment. Any claim, invoice, or demand for payment must contain the pertinent minimum information to include patient’s name, date of birth, social security number, CPT code(s), date(s) of service, amount(s) charged for each procedure, provider name, billing address, and Provider’s Federal Tax ID number. Alternatively, a spreadsheet or statement may be submitted for batched claims. Handwritten claims forms or handwritten spreadsheets will not be accepted and will not be processed for reimbursement. Contractor agrees to follow the MS-BCCP’s prescribed method for submitting claims, program forms, and reports, which includes secure fax and U.S. Postal mail, and other alternative methods as approved by MS-BCCP. Mailing Address: MS State Department of Health Attention: MS-BCCP 570 Woodrow Wilson Jackson, MS 39216 Fax: (601)576-8030 9. PAYOR OF LAST RESORT MS-BCCP will serve as the payor of last resort for uninsured and underinsured program-eligible participants enrolled in the program prior to or at time of provision of services. For underinsured patients, contractor agrees to provide documentation identifying the patient’s financial responsibility (i.e., co-insurance, copay, and/or deductible) and/or a list of covered benefits, services, or procedures under the patient’s insurance at the time of referral to MS-BCCP for enrollment. Contractor agrees to bill private insurance or the Mississippi Division of Medicaid applicable program for all services. Should private insurance or Medicaid claims be denied, the Contractor reserves the right to resubmit those claims to the MS­BCCP program. The contractor must include a copy of the denial with the resubmitted claims. 10. RATE OF REIMBURSEMENT Contractor may bill MS-BCCP at their usual, customary, and reasonable (UCR) rate for services, but agrees to accept a rate of reimbursement for approved procedures from Attachment E on the date of service not to exceed the Centers for Medicare and Medicaid Services (CMS) published Medicare Part B Participating Health Care Provider rate or fee for the date of service. The fee reimbursed to the provider is to be based on the applicable CMS Medicare rate or fee schedule effective on the date of service for Mississippi providers. Rates and fee schedules are updated by CMS periodically and are located at: Physician fee schedule: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup ( Physician Fee Schedule Look-Up Tool | CMS ) Hospital fee schedule: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates (Addendum A and Addendum B Updates | CMS) Ambulatory outpatient fee schedule: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates (ASC Payment Rates - Addenda | CMS) The list of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Allowable Procedures and the corresponding Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System --(HCPCS) codes for the use in the NBCCEDP under these general conditions and provided by CDC under the CDC-RFA-DP22-2202 (NBCCEDP) grant is available in Attachment E. Contractor agrees not to bill women and participant individuals participating in the MSBCCP for any difference between provider fees for MS-BCCP covered services and the amount reimbursed by the MS-BCCP. Contractor shall have the right to bill individuals for services related to breast cancer and cervical cancer screenings which are not covered under this agreement but must notify the women and participant individuals of their financial responsibility prior to delivering the service. Contractor agrees to clearly explain to the patient which services are and are not covered by MS-BCCP and to obtain separate patient consent to provide non-covered services. 11. PAYMENT REQUESTS Payment requests will be processed by the MS-BCCP program staff upon receipt of all claims and supporting documentation, including enrollment forms, consent forms, and reports or results of procedures. The request to issue payments will be processed through the MSDH Office of Finance and Accounts with final release of funds granted from the State of Mississippi Department of Finance and Administration. 12. RECORD OF PAYMENTS Contractor may request directly from the MS-BCCP a record of payments processed for reconciliation purposes. Requests must be in writing and submitted to the MS-BCCP general correspondence email address: bccpcontracts@msdh.ms.gov 13. CHANGES TO PROVIDER INFORMATION Contractor agrees to promptly notify the MS-BCCP in writing of any changes to Provider’s corporate name, tax identification number, address, status of license to provide services, within thirty (30) days of such changes. Failure to notify MS-BCCP may result in denial of payment for requested services provided after any effective changes. A contract modification to update information may be necessary. 14. CORRESPONDENCE Contractor agrees to submit all general correspondence concerning this contract, updates to contractor information, requests for record of payments, requests for technical assistance, provider questions, and other MS-BCCP related matters to: Email: bccpcontracts@msdh.ms.gov

What to check before bidding

• Issued by Mississippi Department of Health.
• Located in United States.
• Source notice msdh:2025-REQ-147 on US OpenGov.
• Notice published 11 Sept 2025; Tenqual indexed it 30 Apr 2026.
• Deadline listed as 31 Mar 2027.
• Source documents portal identified.
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