Administrative Services

Broadway Ventures is an experienced Centers for Medicare and Medicaid Services (CMS) prime contractor and multi-MAC subcontractor providing Program Integrity and Fraud, Waste, and Abuse (FWA) support across national Medicare initiatives. Our past performance spans claims review, provider enrollment, appeals, reimbursement, transaction processing, and account resolution across Medicare Part A, Medicare Part B, Durable Medical Equipment (DME), Home Health and Hospice, and Railroad Retirement Board (RRB) jurisdictions. We support prime contractors including Palmetto GBA, CGS Administrators, Wisconsin Physicians Service (WPS), and Noridian Healthcare Solutions, and we serve as prime contractor for the CMS End-Stage Renal Disease Quality Incentive Program (ESRD QIP) under the CMS Center for Clinical Standards and Quality (CCSQ).

Medicare and Medicaid Claims Review

Broadway Ventures provides credentialed Registered Nurses (RNs) and Medical Claims Reviewers to support CMS Medicare Administrative Contractor (MAC) and Special Medicare Administrative Contractor (SMAC) claims review operations. Our team performs pre-payment and post-payment medical reviews, pre-claim reviews (PCRs), Additional Documentation Request (ADR) reviews, reopenings, and appeals support. Reviews are conducted against National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), the CMS Medicare Benefit Policy Manual (IOM Pub. 100-02), and the Medicare Program Integrity Manual (IOM Pub. 100-08).

Services include:

• MAC and SMAC Subcontracting: Clinical review staffing supporting CMS MAC and SMAC programs through prime contractors Palmetto GBA, CGS Administrators, Wisconsin Physicians Service (WPS), and Noridian Healthcare Solutions.
• DME MAC Jurisdictions B and C: Pre-payment and post-payment clinical review of Durable Medical Equipment (DME) claims under the CMS Medicare Integrity Program (MIP). Appeals support at the Administrative Law Judge (ALJ) and Qualified Independent Contractor (QIC) levels.
• Home Health, Hospice, and Review Choice Demonstration (RCD): Pre-claim review, pre-payment ADR review, post-payment ADR review, and reopenings for Home Health (HH) and Hospice claims under CMS Jurisdiction M. Evaluation of face to face documentation, physician certification, plan of care, homebound status, and skilled service need.
• Inpatient Rehabilitation Facility (IRF) Review: Pre-claim reviews and complex medical reviews under the CMS Review Choice Demonstration (RCD) for Jurisdiction J A/B MAC Inpatient Rehabilitation Facilities, including issuance of Unique Tracking Numbers (UTNs) and documented provider outreach for non-affirmed determinations.
• Railroad Retirement Board (RRB): Prepayment and postpayment medical review of Part B claims for Railroad Retirement beneficiaries under the CMS Special Medicare Administrative Contractor (SMAC) contract.
• Appeals and Redeterminations: First level Medicare appeals review for Part A and Part B claims under the Government Health Administrators (GHA) CMS MAC contract administered by Wisconsin Physicians Service, including medical necessity determinations and clinical justification letters.
• VA External Clinical Peer Review: Board certified physician reviewers providing audit reviews, Facility Requested Reviews (FRRs), Management Other Reviews, and Medical Advisory Opinions (MAOs) for the Department of Veterans Affairs Veterans Health Administration (VHA) External Clinical Peer Review Program, with URAC compliant credentialing across more than 60 specialties.
• Quality Assurance and Training (QAT): Reviewer quality assurance, technical training, error trend analysis, and Corrective Action Plan (CAP) recommendations for CMS MAC Jurisdictions J (JJ) and M (JM).

Program Integrity and Fraud, Waste, and Abuse (FWA) Support

Broadway Ventures supports CMS Center for Program Integrity (CPI) initiatives by identifying, analyzing, and preventing improper payments. Services span claims validation, pre-edit reviews, and data driven fraud detection, with an investigative approach applied across enrollment, review, and reimbursement workflows.

Services include:

• Claims Validation and Pre-Edit Review: Review of claim submissions for billing anomalies, medical necessity, and compliance with Medicare coverage policy. Pre-edit screening to prevent improper payments before adjudication.
• Data Driven Fraud Detection: Analysis of claims, enrollment, and transaction data for patterns indicating fraud, waste, or abuse. Coordination with CMS Program Integrity, Unified Program Integrity Contractors (UPICs), and MAC partners.
• Enrollment Anomaly Detection: Application of an investigative mindset during provider enrollment review to detect anomalies and confirm compliance with FWA, HIPAA, FISMA, and CMS security standards.

Provider Enrollment

Broadway Ventures supports CMS Medicare provider enrollment through qualified Provider Enrollment Analysts who process applications using the Provider Enrollment, Chain, and Ownership System (PECOS) and the CMS-855 series forms. We support CMS Jurisdictions J and M through Palmetto GBA.

Services include:

• Initial Enrollment, Revalidation, and Updates: Review and processing of initial enrollments, revalidations, reassignments, voluntary withdrawals, ownership updates, practice location changes, and retroactive corrections in PECOS and via the CMS-855 series and CMS-20134 forms.
• Additional Development Requests (ADRs) and Coordination:Handling of ADRs, coordination with the Site Visit Contractor (SVC), site visit (SV), data verification (DV), and fingerprinting (FP) requirements per IOM Pub. 100-08, Chapter 10.
• Performance to CMS Timeliness and Accuracy Standards: Processing to CMS mandated timeliness benchmarks ranging from 15 to 100 calendar days based on application type, with accuracy targets of 80 to 95 percent depending on scenario.
• Compliance and Training: Adherence to Section 508, FISMA, CMS security and privacy requirements, and Fraud, Waste, and Abuse (FWA) training standards. Refresher training on new CMS policy changes and error trends.

Call Center and Help Desk Operations

Broadway Ventures provides call center and help desk services that support Medicare beneficiaries, providers, and CMS programs.

Services include:

• Medicare Beneficiary Support: Trained call center agents handling first level telephone inquiries related to Medicare claims, benefits, provider services, and coverage, with integration into the CMS info call tracking system.
• Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Support: Monitoring, reporting, and communication support for the CMS RSNAT prior authorization model. Tracking of required metrics, beneficiary communication, and coordination of transportation resources when prior authorization is not affirmed.
• EDI and Technical Help Desk: First and second level technical support for external submitters and internal stakeholders on EDI transactions, enrollment processing, and CMS system use.

Transaction Processing

Broadway Ventures provides Medicare transaction processing services covering billing, accounting, payer relations, and data validation.

Services include:

• Billing and Accounting: Processing of Medicare and Medicaid healthcare payments, cost report inputs, and payer transactions in accordance with CMS financial standards.
• CMS Change Request (CR) and System Update Support: Evaluation and testing of CMS Change Requests (CRs) and Technical Direction Letters (TDLs), validation of system updates, and coordination of file transfers across CMS Fiscal Intermediary Shared Systems (FISS) and related platforms.
• Operational Reporting: Timely and accurate reporting to support contract deliverables, CMS reporting cycles, and partner oversight.

Account Resolution

Broadway Ventures provides Account Resolution Specialists who support CMS MAC business operations, financial reconciliation, and debt resolution under the Medicare Trust Fund.

Services include:

• Financial Analysis and Reconciliation: Monthly, quarterly, and annual reconciliation reporting to CMS. Analysis of system generated reports for departmental and contractual timeliness, validation of data sources, and resolution of inconsistencies.
• Debt Resolution and Escalation: Coordination with the U.S. Department of the Treasury for escalated collections and untimely debts, issuance of Intent to Refer letters for unresolved overpayments, and review of supplier documentation for Extended Repayment Schedule (ERS) approvals or denials.
• Business Project Analysis: Systems analysis in support of CMS Change Requests (CRs), new system releases, documentation, user acceptance testing, and operational compliance with CMS regulations.

Reimbursement Services

Broadway Ventures provides Reimbursement Specialists who manage Medicare cost reports, payment rates, and provider settlements across CMS systems including the Fiscal Intermediary Shared Systems (FISS), Healthcare Integrated General Ledger Accounting System (HIGLAS), STAR, and WPM.

Services include:

• Medicare Cost Report Processing: Review, processing, and analysis of Medicare cost reports including tentative and final settlements, interim rate updates, per diem rate analysis, and pass through payment evaluation.
• Provider Reimbursement Management: Management of provider reimbursement activity including accelerated payment requests, cost limited reimbursement scenarios, and special provider classifications across Medicare Part A and Part B providers.
• Regulatory Change Implementation: Implementation of CMS Change Requests (CRs), Technical Direction Letters (TDLs), and regulatory updates affecting reimbursement policy.
• Audit and Compliance Coordination: Support for compliance checks, timely cost report submissions, and coordination with enrollment, call center, audit, and recoupment teams to resolve reimbursement issues.

World Trade Center (WTC) Health Program Support

Broadway Ventures provides data validation, quality assurance, and program support services to the Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) World Trade Center Health Program, supporting accurate clinical and enrollment information for 9/11 responders and survivors receiving care through the program.

Staff Augmentation

Federal programs fail when the right people are not in the right seats at the right time. Broadway Ventures closes that gap with qualified, mission ready personnel who integrate directly into your team and contribute from day one.

We staff across the disciplines that drive our customers’ missions, including IT and cybersecurity, clinical and healthcare support, program management, engineering and environmental research, and operational roles. Whether you need a single specialist or a full team to surge through peak demand, we scale to the requirement and recruit against the standards our customers set.

As an SDVOSB, HUBZone, and SDB certified small business, Broadway brings the same program management rigor to staffing that we bring to every contract, while helping prime contractors and agencies meet small business subcontracting goals.

Why Choose Broadway Ventures

Broadway Ventures is a Service-Disabled Veteran-Owned Small Business (SDVOSB), HUBZone, and Small Disadvantaged Business (SDB) headquartered in a federal HUBZone in Vicksburg, Mississippi, with proximity to USACE ERDC. Broadway graduated from the SBA 8(a) Business Development Program on February 1, 2026 and continues to provide 8(a) contract access for federal customers through the 8(a) STARS III Governmentwide Acquisition Contract (GWAC) and the General Services Administration (GSA) Multiple Award Schedule (MAS). Broadway holds a Top-Secret Facility Security Clearance (TS FCL), operates on a Government Community Cloud (GCC) High network, and complies with NIST SP 800-171 and Cybersecurity Maturity Model Certification (CMMC) 2.0 requirements. Broadway is a prime contractor to the U.S. Air Force Secretary of the Air Force Concepts, Development, and Management Office (SAF/CDM) and the Centers for Medicare and Medicaid Services (CMS), with additional active subcontract performance across the Department of Defense (DoD), the U.S. Army Corps of Engineers (USACE), the Department of Veterans Affairs (VA), and the Railroad Retirement Board (RRB). Our small business certifications, security posture, past performance, and federal contract vehicles make Broadway a strong partner for federal capture and subcontracting opportunities.