This is a grouper software that is integrated within the Epic billing platform for processing of outpatient Medicare claims, CGS CMS Medicare APC Grouper with Medicare HOPD Reimbursement.

Outpatient Groupers are intended to take individual services (CPT codes) and group them to allow outpatient services to be analyzed / paid at the visit level, rather than as individual services. These groups were developed based on studies of (millions of) outpatient bills where the intent was to try to determine resource consumption at the visit level and then establish appropriate reimbursement rates for each group (APC or EAPG). There are currently around 800 APCs and 575 EAPGs - out of approximately 17,000 CPT codes, so payment based on these groups is a bit more manageable for payers. Payment logic gets complicated. CPT codes on an O/P claim can be:

- Paid (can be >1 per claim) - Discounted (when certain procedures on claim together) - Not Paid (when certain procedures on claim together) - Not paid (packaged when present on a claim with certain other codes) - Paid on a system other than APC/EAPG - Many other factors to consider

The university, on information and belief, has concluded that only one vendor can meet its need or can meet the need economically. That vendor is 3M, Inc. The university has provided detailed justification to support its conclusion as shown on the attached Sole Source Justification Form.

Although the university has presented this as a sole source procurement, we are seeking competitive information from firms with the capability of meeting the university's need (even if performed in a manner different from what has been presented) to contact us and provide sufficient information to show the need can be met. If we receive that information, the Chief Procurement Officer will offer a public hearing to consider the matter. Hearing information is described below.

All sole source hearings under the jurisdiction of the Chief Procurement Officer for Higher Education will be conducted by tele-conference only until the in-person option is reinstated.

The University has determined that this purchase is only economically available from this source because the procurement is software license, upgrade or maintenance.