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Tricare Claims Review Service (TCRS)   4

ID: HT940224R0002 • Type: Synopsis Solicitation

Description

Posted: Aug. 9, 2024, 1:53 p.m. EDT

August 9, 2024: The purpose of this notice is to release the Government's responses to Industry's Questions and to officially close the questions and answer period. This notice also releases Amendment 0001, please replace Attachment 6 and Exhbit 8 with the amended versions. The proposal due date is hereby extended to August 26, 2024.

July 26, 2024: The purpose of this notice is to extend the TCRS proposal due date to Monday, August 19, 2024, while the Government contiues to repond to Industry's RFP Questions and make revisions to the RFP. An amendment is forthcoming that will include DHA's reponses to Industry's questions as well. The proposal due date may be reevaluated during that time but it will not be earlier than Monday, August 19, 2024.

DHA's mission is to achieve greater integration of the direct and purchased health care delivery systems with contract performance objectives developed that support the accomplishment of the overarching Military Health System's Quadruple Aim: Achieve medical readiness, improve the health of our people, enhance the experience of care, and lower healthcare costs.

The Improper Payment Evaluation Branch (IPEB), which is under the DHA Budget & Resource Management Division, Contract Resource Management, oversees DHA 's implementation, enforcement, and compliance with key provisions of the Payment Integrity Information Act of 2019 (PIIA). The PIIA requires agencies to examine the risk of improper payments in all programs and activities by identifying and reporting improper payment findings to the Office of Management and Budget (OMB) for publication in the annual DoD Agency Financial Report (AFR).

In support of the DHA IPEB, the TCRS contractor will audit compliance and assess the accuracy of the claims processing for the following TRICARE purchased care contracts: the Managed Care Support Contracts (MCSCs), TRICARE Medicare Eligible Program (TMEP), TRICARE Pharmacy (TPHARM) Program, TRICARE Overseas Program (TOP) and the Active Duty Dental Program (ADDP).

Posted: July 26, 2024, 3:47 p.m. EDT
Posted: June 21, 2024, 2:33 p.m. EDT
Background
The Defense Health Agency (DHA) supports the delivery of integrated, affordable, and high-quality health services for more than 9.6 million beneficiaries of the Military Health System (MHS) and is responsible for shared services, functions, and activities of the MHS and other common clinical and business processes in support of the Military Services. The MHS is a complex integrated healthcare system that consists of healthcare delivery, medical education, public health, private sector partnerships, and innovative medical research and development. The MHS has two major care delivery systems: the direct care system provides care through military treatment facilities (MTFs), and the purchased-care system, TRICARE, is comprised of two health care options, Select and Prime.

Work Details
The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items necessary to perform TRICARE Claims Review Services (TCRS). The TCRS contractor will audit compliance and assess the accuracy of the claims processing for TRICARE purchased care contracts including Managed Care Support Contracts (MCSCs), TRICARE Medicare Eligible Program (TMEP), TRICARE Pharmacy (TPHARM) Program, TRICARE Overseas Program (TOP), and the Active Duty Dental Program (ADDP). The objectives include providing independent reviews of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors, assessing compliance with TRICARE policies and directives, monitoring claims processing performance of DHA TRICARE purchased-care support contractors, evaluating the accuracy of claims payment and payment record coding for the six purchased-care contractors.

Period of Performance
The anticipated period of performance is a base period/transition-in of six months plus seven 12-month option periods. It also includes transition-in/transition-out periods.

Place of Performance
The work shall be performed at the contractor’s facility or in a remote environment as long as required security precautions are documented and followed. The contractor is required to travel within the Continental United States (CONUS) to attend meetings held by DHA.

Overview

Response Deadline
Aug. 26, 2024, 12:00 p.m. EDT (original: Aug. 5, 2024, 12:00 p.m. EDT) Past Due
Posted
June 21, 2024, 2:33 p.m. EDT (updated: Aug. 9, 2024, 1:53 p.m. EDT)
Set Aside
None
Place of Performance
United States
Source
SAM

Current SBA Size Standard
$24.5 Million
Pricing
Likely Fixed Price
Est. Level of Competition
Average
Est. Value Range
Experimental
$1,000,000 - $5,000,000 (AI estimate)
On 6/21/24 Defense Health Agency issued Synopsis Solicitation HT940224R0002 for Tricare Claims Review Service (TCRS) due 8/26/24. The opportunity was issued full & open with NAICS 541611 and PSC R702.
Primary Contact
Name
Gregory R. Stephens   Profile
Phone
None

Secondary Contact

Name
Alexander Hardie   Profile
Phone
None

Documents

Posted documents for Synopsis Solicitation HT940224R0002

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Additional Details

Source Agency Hierarchy
DEPT OF DEFENSE > DEFENSE HEALTH AGENCY (DHA) > DEFENSE HEALTH AGENCY
FPDS Organization Code
97DH-HT9402
Source Organization Code
100142347
Last Updated
Sept. 11, 2024
Last Updated By
gregory.r.stephens3.civ@health.mil
Archive Date
Sept. 10, 2024