Kristen Smith 
- CMS has awarded nearly $2 billion in contracts for Medicare claims modernization effort
- HealthEdge and Peraton were selected to help replace legacy fee-for-service processing systems
- The ClaimsCore initiative aims to deliver a unified, commercial-based claims processing platform
HealthEdge Software and Peraton have secured contracts totaling $1.98 billion under the Centers for Medicare & Medicaid Services’ ClaimsCore initiative, a modernization effort to replace multiple legacy Medicare fee-for-service claims processing systems with a commercial platform.
According to award notices posted on SAM.gov on Monday, CMS awarded a $1.15 billion contract to HealthEdge Software and an $825.9 million contract to Peraton on May 29.
The modernization goals driving initiatives such as ClaimsCore reflect broader priorities across the federal healthcare landscape. To learn more about how agencies are leveraging technology, AI and data-driven tools to transform healthcare delivery, join senior government and industry leaders at the Potomac Officers Club’s 2026 Healthcare Summit on Dec. 3. Register now!
What Is CMS Seeking Through ClaimsCore?
According to the ClaimsCore solicitation issued in February, CMS seeks to replace four legacy COBOL-based processing systems: the Multi-Carrier System, the Fiscal Intermediary Shared System, the ViPS Medicare System and the Common Working File.
CMS said the ClaimsCore program is intended to acquire a commercial-off-the-shelf, configurable and interoperable claims processing platform capable of supporting sub-second claims adjudication, enhanced real-time fraud prevention capabilities and interoperability through Health Insurance Portability and Accountability Act X12 and Fast Healthcare Interoperability Resources/REST application programming interfaces.
The platform should unify disparate systems into a single, cohesive architecture, supporting broader goals related to cost efficiency, transparency and policy agility while serving as the foundation for future Medicare fee-for-service claims processing operations.
How Is the Contract Structured?
Peraton and HealthEdge Software received firm-fixed-price contracts. The solicitation established an initial proof-of-concept period running from May 4 through Nov. 4, followed by software and services option periods that could extend performance through November 2033.
