ABACUS PWS Draft.pdf

ABACUS PWS April 2026

Department of War

Defense Health Agency (DHA)

On Behalf Of

Portfolio Acquisition Executive Medical Device Systems (PAE MDS)

Armed Services Billing and Collection Utilization Solution (ABACUS) Sustainment

Performance Work Statement

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract: To support continued operations of Armed Services Billing and Collection Utilization Solution (ABACUS), the legacy Software-as-a- Service (SaaS) cloud service offering for Medical Treatment Facility (MTF) billing and collections following the Outpatient Pharmacy Billing (OPPB) Production Implementation Date

(PID).

1.2 Description of services/introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to operate, maintain and support all aspects of ABACUS as an offering to the Government as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

1.3 Background:

All U.S Codes, Code of Federal Regulations (CFRs) and DoD/DoW directives described as follows in this paragraph remain in effect for the duration of this contract. Various portions of U.S. Code (USC), the Code of Federal Regulations (CFR) and Department of War (DoW) directives require the Services to bill certain payers for the cost of healthcare delivered to persons who are seen in MTFs. Specifics of the statutory/regulation/instructional requirements can be found in 10 USC 1079b (requires designated non-DoW beneficiaries be billed for healthcare delivered in MTFs – referred to as Medical Services Account (MSA), 10 USC 1095 (requires DoW MTFs to bill third party payers for the costs of healthcare delivered to non-Active Duty DoW beneficiaries with other health insurance (OHI) – referred to as Third Party Collections (TPC), 42 USC 2651-2653 (requires DoW MTFs to bill insurance companies, individuals, auto policies, home owners’ policies, etc., as tort-feasors, for costs of medical and dental services provided to DoW Beneficiaries as a result of illness or injury incurred due to negligence or civil wrong doing – referred to as Medical Affirmative Claims (MAC), and the DoD 6010.15-M (MTF UBO Manual).

1.4 Objectives:

• The Contractor shall provide continued support and maintenance for ABACUS in a

FedRamp certified, safe, and secure cloud-based environment compliant with DoW Cyber Security policies and guidelines.

• The Contractor shall provide help desk support, incident management and problem resolution Monday through Friday 0800 through 1200 midnight Eastern Time with a minimum 24-hour response time. The ABACUS Knowledge base shall be available, on-line 24 hours a day x 7 days per week x 365 days per year.

• The Contractor shall maintain Enterprise and Billing and Collections Reporting to generate auditable monthly, quarterly and annual financial statements in accordance with:

o The Chief Financial Officer Act of 1990 o The Affordable Care Act o DoW Financial Management Regulation Volume 1, Chapter 3 o Generally Accepted Accounting Principles (GAAP) o Uniform Business Office User Guide.

• The Contractor shall integrate DoW-specific clinical data, patient demographics, billing data, cost allocation, and accounting data to generate bills, metrics and financial reports.

• The Contractor shall ensure ABACUS maintains system internal controls necessary for:

o Complete disclosure of financial results o Adequate financial information for management o Effective control and accountability of MTF assets o Reliable accounting and financial reporting.

• The Contractor shall ensure ABACUS:

o Maintains complete and accurate billing and collections data for reporting o Provides data export functions in user-specified formats requirement for manual entry into external accounting systems o Prevents duplicate transactions in financial reporting to ensure audit compliance

• The Contractor shall modernize the ABACUS authentication and authorization mechanisms to fully align with DoW Enterprise Identity, Credential, and Access Management (ICAM) architecture and policies, ensuring secure, streamlined, and auditable access for all users until fully transitioned.

• The contractor shall provide documentation demonstrating compliance including updated system design artifacts, ICAM integration plans and verification of interoperability services.

1.5 Scope:

This section of the PWS describes the ABACUS requirements post Outpatient Pharmacy Billing (OPPB) Production Implementation Date (PID):

• Post OPPB Implementation: The Contractor shall continue providing the original ABACUS “as is” functionality and service levels as offered in previous contracts and described in section 5.1 of this PWS. Full ABACUS functionality shall continue until the Government Contracts Office provides the Contractor with 30 business days' advance written notice to transition to one of the two ABACUS Lite versions described in Section

5.3 of this PWS.

• Post ABACUS Lite Transition: A transition from ABACUS Lite back to fully functional ABACUS is not in the scope of this PWS.

ABACUS full functionality shall remain available until OPPB is live. Upon OPPB implementation, ABACUS functionality may be reduced. Period of reduced functionality will allow UBOs to: (1) complete pharmacy claims processing for charges interfaced from MHS GENESIS to ABACUS prior to OPPB implementation; (2) review and close out existing legacy backlog data; and (3) cleanup aged accounts receivables.

The Contractor shall provide all labor and equipment required to certify, operate and maintain ABACUS in accordance with this PWS. The Contractor shall provide CAC-enabled public internet access to ABACUS. Upon transition to ABACUS Lite, the Contractor shall continue to receive pharmacy and medical 835 remits from MHS GENESIS. This requirement includes all modernization efforts and software improvements as required by changes in governing directives, policies and any system change requests submitted by the Services. The Contractor shall host a dedicated, logically separate, environment for cloud-based ABACUS access at a commercial facility within the United States. The Contractor shall support and maintain functionality in ABACUS to manually produce bills, claims, and/or invoices for patients receiving direct healthcare in the MTFs. The Contractor shall also maintain the ABACUS reporting functionality that allows users to produce detailed reports for each of the UBO medical billing sub-programs. The Contractor shall maintain ABACUS as a healthcare industry standard accounts receivable management tool that allows the Government to assign, track, and report status, to include disputed claims for further review and processing. The Contractor shall maintain daily data back-up and archival of data on closed claims older than 3 fiscal years. The Contractor shall ensure continued support of ABACUS functionality that provides for manual posting to accounts and allows the Government to implement and assign roles, responsibilities, and business rules. The Contractor shall maintain the computer-based training (CBT) environment in the ABACUS Production Portal until ABACUS functionality transitions to ABACUS Lite. A test environment for testing business rules, changes, Information Assurance Vulnerability Alerts (IAVAs) and other processes shall continue to be maintained. In addition, the Contractor shall provide help desk support and maintenance services in accordance with this PWS. The Contractor shall coordinate all downtime with the Government in advance of any planned outage. The Contractor shall not remove any features without prior notification to and approval by the Government.

ABACUS, its business rules (current and future), and methodologies constitute a government solution containing subsidiary records. As such, the Contractor shall ensure that ABACUS is available for pre-approved and periodic review by Government auditors and examiners.

The Contractor shall fulfil all requirements for certification and accreditation in accordance with the DoW Information Risk Management Framework (RMF) certification process as specified in Part 6 (Information Technology and Security) of this PWS.

The Contractor shall provide access to a Government-approved knowledge base of frequently asked questions, claim templates, best practices, and other supporting information for use by UBO functional community and end users.

1.6 Period of Performance (PoP): The PoP is comprised of a six (6) month base period and two (2) six-month option periods.

1.6.1 Transition: Transition-in/transition-out period

1.6.1.1 Transition-in period: Transition-in performance is defined as continuing operations without causing disruption of any services that remain the responsibility of ABACUS (i.e., billing and collection, reporting or any other aspect of ABACUS functionality) for ABACUS users. All activities associated with incoming transition shall be transparent to users. During the transition-in period, the contractor shall prepare to meet all contract requirements and ensure incoming personnel are functionally trained and qualified on the full performance start date except cybersecurity requirements, which must be fully adhered to during transition and full performance periods

1.6.1.1.1 The contractor shall comply with transition-in requirements of the DHA, as listed in paragraph 1.11.1, for contractors needing to be issued Common Access Card (CAC) identification, including Department of War (DoW) and DHA-directed training and forms submission, prior to network access.

1.6.1.2 Transition-out period: The transition-out plan shall facilitate the accomplishment of a seamless transition from the incumbent to an incoming contractor/Government personnel member at the expiration of the contract.

1.6.1.2.1 The contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC or who generate “records”, as defined by DoW (records manual), including DoW-directed disposition of records, and others displayed on the In/Out (I/O) Processing Portal.

1.7 Administrative specifications

1.7.1 Place of performance: The work shall be performed at a Contractor-determined and Government approved location. The system shall be available for use by the UBOs, legal offices, TPC contract hub/home offices, and MTF personnel at facilities worldwide.

1.7.2 Recognized Federal holidays: The Contractor is not required to perform services on recognized Federal holidays as listed below:

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Day Christmas Day Independence Day

1.7.3 Hours of operation: The contractor is responsible for conducting business Monday through Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons.

1.7.4 Emergency Services: On occasion, services may be required to support an activation or exercise of contingency plans outside the normal duty hours.

1.8 Contractor travel: RESERVED.

1.9 Other Direct Costs (ODC): RESERVED.

1.10 Quality

1.10.1 Quality Control (QC): The contractor shall develop and maintain an effective QC program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services. The contractor’s QC program is the means by which the work complies with stated requirements.

1.10.2 Quality assurance (QA): The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan provides a systematic method for the Government to evaluate performance and to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.11 Contractor personnel

1.11.1 CAC requirements: For all contractors who will work in Government facilities, the Facilities Security Officer (FSO)/Company's Security point of contact (POC) will provide the Government all the required information per the DHA CAC request process current version 2.1, January 2018, or more recent when updated. See process attached at Part 7 Section 7.1.1 of the PWS. A CAC is the standard identification for eligible DoW contractor personnel.

1.11.1.1 The contractor shall return all CACs to the COR upon the departure of the contractor(s).

1.11.2 Contractor onboarding and training. The contractor shall complete all requirements, training, and forms as prescribed in the following requirements:

1.11.2.1 RESERVED

1.11.2.2 The DHA’s contractor training instructions embedded at Part 7 Section 7.1.2.

1.11.2.3 The contractor shall comply with onboarding requirements of the DHA for contractors needing to be issued CAC identification, including DoW- and DHA-directed training and forms submission, prior to network access.

1.11.3 Physical Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use.

1.11.4 RESERVED

1.11.5 RESERVED

1.12 Key personnel:

Government:

DHMSM ABACUS Product Manager DHMSM ABACUS Contract Office Representative (COR) DHA UBO Program Manager DHA UBO Deputy Program Manager DHMSM Information Systems Security Manager (ISSM)

Contractor: RESERVED

1.13 Data rights:

1.13.1. All data and associated materials deemed relevant to the Government, which have been generated by the Contractor in the performance of this contract, with the exception of software, shall remain the exclusive property of the Government. The ABACUS software is owned by the Contractor and sub-Contractor.

1.13.2. All other tools (i.e., in Microsoft Word, Access, Excel, PowerPoint, or other software developed databases) acquired by the Government for use in ABACUS shall remain the property of the Government and shall have no effect or impact on monies owed to the Contractor by the Government. All data remains the property of the Government and shall be surrendered upon demand.

1.14 Reporting

1.14.1 Contractor Manpower Reporting (CMR): RESERVED.

1.14.2 Non-Disclosure Agreement (NDA): All contractor personnel who will obtain access to proprietary, classified, or confidential information or any information release of which is protected or governed by law or regulation associated with DHA acquisitions shall be required to complete and sign a DHA contractor NDA (DHA Form 49) prior to beginning work on the subject contract. The contractor shall execute an NDA on behalf of the company and shall ensure that all staff assigned to, including all subcontractors and consultants, or other personnel performing on contract/Task order execute an NDA protecting the procurement sensitive information of the Government and the proprietary information of other contractors. The NDA shall be executed not later than first day of employment and to be renewed upon exercising a contract option period. Assignment of staff who have not executed this statement or failure to adhere to this statement shall constitute default on the part of the contractor. The contractor shall maintain originally signed NDAs of individual employees and provide copy to the COR. (Non- Disclosure Agreement (NDA) – Deliverable 10, Part 7, Technical Exhibit 1 Deliverables Schedule)

1.14.3 Government’s COR: The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the contractor performs the technical requirements of the contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor contractor's performance and notifies both the CO and contractor of any deficiencies; coordinate availability of government furnished property; and provide site entry of contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting contract.

1.14.4 Post award conference/periodic progress meetings: The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with FAR Subpart 42.5. The CO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance.

At these meetings the CO will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.15 Contractor Identification

1.15.1 Contractor personnel performing services in a contractor capacity in a government facility are required to possess and wear an identification badge that displays his or her name and the name of their company. All contractor personnel shall identify themselves as contractor support personnel in all forms of communication with all entities with whom the Assistant Secretary of War for Acquisition and Sustainment (ASW A&S) have business dealings. The contractor shall:

Answer all telephone calls and have a personalized voice message with an introductory statement that includes the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting the ASW A&S understand that the person is contractor support personnel. Include a title block in all emails that states the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting ASW A&S understand that the person is contractor support personnel.

1.15.2 Contractor personnel will be required to attend meetings or otherwise communicate with Government and/or other contract representatives to meet the requirements of this order.

Contractor personnel shall make their contractor status known during introductions.

1.15.3 Contractor personnel, while performing in a contractor capacity, are prohibited from using their retired or reserve component military rank or title in any written or verbal communications associated with the contracts in which they provide services.

1.16 RESERVED

1.17 Personnel Security

1.17.1 The contractor shall comply with DoD 8570.01-M, “Information Assurance Workforce Improvement Program, CH4” November 10, 2015 as amended; 8500.01, “Cybersecurity”, dated March 14, 2014; DoD Manual (DoDM) 6025.18, “Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Compliance in DoW Health Care Programs” dated March 3, 2019, Department of Defense Instruction (DoDI) 6025.18 “HIPAA Privacy Rule Compliance in DoW Health Care Programs”, dated March 13, 2019; and DoDM

5200.02 “Procedures for the DoW Personnel Security Program (PSP),” incorporation change 3, effective September 24, 2020. Contractor’s responsibilities for ensuring personnel security include, but are not limited to, meeting the following requirements:

1.17.1.1 Follow the DHA Personnel Security Office guidelines for submitting security clearances. Contact the DHA Personnel Security Office for guidance on the appropriate background investigation required for personnel on the contract. The DHA Personnel Security Office can be reached at (703) 275-6038.

1.17.1.2 Initiate, maintain, and document personnel security investigations appropriate to the individual’s responsibilities and required access to Controlled Unclassified Information (CUI).

1.17.1.3 DHA Personnel Security Office does not deny any access to any automated information system (AIS), network, or Controlled Unclassified Information (CUI). If a contractor receives an unfavorable background investigation, the request for access will be sent back to the FSO for further action. Any unfavorable adjudication will result in DHA Personnel Security Office not signing off on any access request.

PART 2

2.0 DEFINITIONS, ACRONYMS, AND APPLICABLE

PUBLICATIONS/INSTRUCTIONS

2.1 Definitions:

BALANCE BILL Certain categories of patients are required to be balance billed for services not paid by their primary payer. The invoice for the remaining balance of a medical service charge is described as a balance bill.

BILLABLE DATA Billable data, for the purposes of ABACUS Billing and Collection, consists of TPC eligible encounter data, MSA encounter data, and potential MAC encounter data. TPC eligible data consists of encounter data attributable to patients in the ABACUS Billing Categories 1 and 2, as well as 4 and 4a if OHI exists. MSA data consists of encounter data attributable to patients in the ABACUS Billing Categories 3, 3a, 5-31, and 4 and 4a if no OHI exists. MAC data consists of encounter data attributable to patients in the ABACUS Billing Categories 1, 2, 4, 4a, and 32 if treatment is related to an injury. Updates to the Patient Category Table and the ABACUS Billing Category Table will be provided as required

CATEGORY D Information Technology and Telecommunications Services (called D-Services)

CATEGORY R Support (Professional/Administrative/Managements) Services (called R-Services)

CHAMPUS

MAXIMUM

ALLOWABLE

CHARGE

TRICARE Management Activity (TMA) UBO CHAMPUS Maximum Allowable Charge (CMAC) rates are developed for reimbursement in the purchased care community, however not all services furnished in an MTF setting are included; therefore, TMA UBO develops rates for each outpatient encounter, service, procedure, or supply provided within an MTF. Rates are billed as a line-item charge. The majority of outpatient, itemized charges are based on the CMAC fee schedule and other government furnished rate tables. CMAC reimbursement rates, established under Title 32, Section 199.14(h) of the Code of Federal Regulations, are used to determine the appropriate charge for the professional and technical components of services based on the Healthcare Common Procedure Coding System (HCPCS) methodology, which includes the Current Procedural Terminology (CPT) codes. CMAC rates pertain to professional services (e.g., office and clinic visits) and ancillary services (e.g., laboratory and radiology). UBO CMAC rates differ from standard TMA CMAC rates in that UBO CMAC rates are formatted for military billing systems and include rates for additional services not reimbursed by TRICARE. UBO CMAC rates are calculated for 91 distinct “localities”. These localities recognize differences in local costs to provide health care services in the different geographic regions in which MTFs are located. The CMAC table is further categorized by provider class. The Component rate table specifies which rates to use for CPT codes, which can be provided as distinct professional and technical components, or as a combined professional and technical service. A separate rate is provided for each component, further categorized by provider class.

CLAIMS

SCRUBBER

A claims scrubber analyzes the data that is on the claim and compares the data to its rules engine before the claim is submitted.

COMPONENT

RATE TABLE

The Component Rate Table specifies the technical (TC) and professional (PC) components and/or the combined technical and professional service for CPT codes.

CONTRACTING

OFFICER (CO)

A person with authority to enter into contract; administer or terminate contracts. Make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

CONTRACTING

OFFICER'S

REPRESENTATIVE

(COR)

An individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the CO to perform specific technical or administrative functions.

This individual does NOT have authority to change the terms and conditions of the contract.

CONTRACTOR The term as used in this contract refers to the prime.

COORDINATED

UNIVERSAL TIME

UTC is the primary time standard by which the world regulates clocks and time. Computer servers, online services and other entities that rely on having a universally accepted time use UTC for that purpose. Time zones around the world are expressed as positive or negative offsets from UTC.

DEFENSE

MEDICAL

INFORMATION

SYSTEM

IDENTIFIER

DMIS ID is a unique identification code assigned by TMA to facilities, catchment areas, and other entities.

DISPUTED

CLAIMS

TPC claims that have been unacknowledged or incorrectly paid and have failed to be resolved by UBO with the payer. The payer may be wrongfully withholding payment to the MTF.

Once the MTF UBO has exhausted its efforts, the incorrectly processed claims are referred to MEDCOM Office of the Staff Judge Advocate which provides guidance and legal support to the TPCP by pursuing collection of claims inappropriately paid or denied by third-party payers.

DUNNING LETTER A Dunning Letter, also referred to as a delinquent and/or follow-up letter, is a notification sent to a debtor or insurer, stating that the debtor or insurer is overdue in paying an account receivable to the provider of services. Dunning Letters typically follow a progression from polite reminders to more strident demands for payment, if the customer continues to be non-responsive in paying. Generally, the UBO shall send demand letters 30 days and 60 days after the payment due date. The due date for a receivable is normally 30 days from the date of the invoice or notice of indebtedness.

ELECTRONIC

CLEARING HOUSE

An Electronic Clearing House (ECH) accepts the electronic file from a medical provider, checks the claim for errors (scrubbing), alerts the user of required fixes, and then securely transmits the electronic file to the specified payer with which it has already established a secure connection that meets the strict standards as dictated by a HIPAA.

EXPLANATION OF

BENEFITS (EOB)

An EOB is a statement sent by a health insurance company explaining what medical treatment and/or services were paid.

An EOB typically describes the service performed such as the date of the service, the provider of the service, and the name of the patient, the allowed amount, and the amount the patient is responsible for.

FAMILY MEMBER

PREFIX

A two-digit code used to identify a patient and his/her relationship with the sponsor. Examples include, 20-Sponsor, 30-1st Spouse, 31-2nd Spouse, 01-1st Child, 02-2nd Child, 40- Mother or Stepmother, 45-Father or Stepfather, 50-Mother-in-law, 55-Father-in-law, 98-Civilian Emergency. It is used in combination with the sponsor's Social Security Number; 20/123- 45-6789 indicates that the sponsor is the patient while 01/123- 45-6789 indicates that the 1st child of the sponsor is the patient.

FEDERAL RISK

AND

AUTHORIZATION

MANAGEMENT

PROGRAM

The FedRAMP is a government-wide program that provides a standardized approach to security assessment, authorization, and continuous monitoring for cloud products and services.

FISCAL YEAR A fiscal year, or financial year, is a period used for calculating annual financial statements in businesses and other organizations. The US Government fiscal year starts October 1 and ends September 30 of each year.

FULL

DEPLOYMENT

The functionality provided by ABACUS in accordance with the Sustainment Plan such that the MSA and MAC modules are fully capable. ABACUS can be accepted by the Government as completely deployed.

GOVERNMENT

BILLING

CALCULATION

FACTORS

Government Billing Calculation Factors are discounts for International Military Education & Training (IMET) and Interagency/Other Federal Agency Sponsored Rate (IOR) calculated based on previous year expense and workload data from all DoW MTFs that offer outpatient and inpatient services.

IMET and IOR adjustments are calculated by removing from the Full Reimbursable Outpatient Rate (FOR) those expenses which are excluded from consideration in IMET and Interagency billing. A government discount or billing calculation factor (percentage discount) is applied to the FOR when billing for IMET and IOR services.

GOVERNMENTAL

BILLING FORMS

Term used to encompass billings forms used by UBO to bill both DoW and other Federal Agencies. These forms include Standard Form 1080, DD Form 7, and DD Form 7a.

INITIAL

DEPLOYMENT

The functionality provided by ABACUS in accordance with the Sustainment Plan is such that the TPC module is fully capable and deployed.

KNOWLEDGE

BASE

Knowledge Bases are databases designed to allow people to retrieve and use the knowledge they contain. They are commonly used to complement a help desk or for sharing information among employees within an organization. They might store troubleshooting information, articles, white papers, user manuals, or answers to frequently asked questions. Typically, a search engine is used to locate information in the system, or users may browse through a classification scheme.

LINES OF

BUSINESS

UBO Lines of Business are the Third-Party Collection, Medical Services Account, and Medical Affirmative Claims Programs.

LOCALITY UBO CMAC rates are calculated for 91 distinct “localities”.

These localities recognize differences in local costs to provide health care services in the different geographic regions in which MTFs are located. For each CMAC locality, the UBO creates two sub-tables of rates: CMAC and Component. The CMAC rate table specifies the rates to use as payment for professional services and procedures identified by CPT and HCPCS codes, which cannot be separately provided as component services.

MEDICAL

AFFIRMATIVE

CLAIMS

A sub-program of the UBO. MAC activities involve billing all areas of liability insurance, such as automobiles, products, premises and general casualty, homeowner’s, renter’s, medical malpractice (by civilian providers), and workers' compensation (other than Federal employees).

MEDICAL

EXPENSE and

PERFORMANCE

REPORTING

SYSTEM

MEPRS is the standard cost accounting system for the Military Health System (MHS), containing Tri-Service financial, personnel, and workload data from reporting medical and dental treatment facilities worldwide. From a UBO perspective, the MEPRS code identifies the clinic/ancillary site in which services take place.

MEDICAL

SERVICES

ACCOUNT

A sub-program of the UBO. MSA activities involve the first-payer billing of individuals and other Government Agencies for services rendered in MTFs to include, but not limited to, the U.S.

Coast Guard, the National Oceanic and Atmospheric Administration, and the U.S. Public Health Service.

MHS GENESIS

ELECTRONIC

HEALTH RECORD

(MHS GENESIS

EHR)

MHS GENESIS EHR – is an enterprise electronic health record system that is used by all DoW military health care centers.

MHS GENESIS PharmNet module is used to dispense pharmacy prescription fill/refills, capture charges and/or credits associated with the prescription and interface the charges to ABACUS for processing claims and payments capture until Outpatient Pharmacy Billing capability is implemented. Additionally, MHS GENESIS interfaces 835 remits for legacy medical charges processing in ABACUS prior to the deployment of the Revenue Cycle Expansion Cerner Patient Accounting deployment.

NONPERSONAL

SERVICES

CONTRACT

A contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

OTHER HEALTH

INSURANCE (OHI)

Third Party Insurance carried by DoW eligible beneficiaries, as well as non-DoW beneficiaries. OHI is any health insurance received through an employer or private insurance program. Any OHI held in addition to TRICARE or MEDICARE coverage is the primary health policy.

PATIENT

CATEGORY

(PATCAT)

PATCAT codes are closely linked to entitlements under the Uniformed Services Health Benefits Program (USHBP).

PATCATs allow identification and grouping of patients by ‘types’ of interest such as Sponsor Service, Beneficiary Category, and Special Interest patient groups. PATCATs are directly linked to UBO Billing because they determine the rate to charge and method of billing.

PHYSICAL

SECURITY

Actions that prevent the loss or damage of government property.

PROVIDER CLASS The four provider classes are 1) Physicians, 2) Psychologists, 3) Other Mental Health Providers, and 4) Other Medical Providers.

QUALITY

ASSURANCE

SURVEILLANCE

PLAN

An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance. The Government may either prepare the QASP or require the offerors to submit a proposed quality assurance surveillance plan for the Government’s consideration in development of the Government’s plan.

QUALITY

ASSURANCE

The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

QUALITY

CONTROL

All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

REMITTANCE

ADVICE

Health Care Claim Payment/Advice in the HIPAA 835 format.

As remittance advice, the 835 provides detailed payment information relative to a health care claim(s) and, if applicable, describes why the total original charges have not been paid in full. This remittance information is provided as “justification” for the payment, as well as input to the payee’s patient accounting system/accounts receivable (A/R) and general ledger applications.

SOFTWARE AS A

SERVICE (SaaS)

Software that is developed and hosted by the SaaS vendor and which the end user customer accesses over the Internet. Unlike traditional packaged applications that users install on their computers or servers, the SaaS vendor owns the software and runs it on computers in its data center. The customer does not own the software but effectively rents it. SaaS is sometimes also known as hosted software or by its more marketing-friendly cousin, “on-demand.”

SUBCONTRACTOR One that enters into a subcontract and assumes some of the obligations of the primary Contractor.

SUBSISTENCE IN

KIND

Food furnished to enlisted personnel at government expense (also known as meal card or Rations in Kind)

THIRD PARTY

COLLECTION

PROGRAM

A sub-program of the UBO. TPC activities involve billing third-party payers on behalf of non-active-duty dependents for treatment provided in MTFs.

UNIFORM

BUSINESS OFFICE

(UBO)

TRICARE Management Activity (TMA) UBO Program Office is responsible for setting policy and providing program oversight for the Military Health System's (MHS’s) three health care cost recovery programs and providing overall revenue cycle direction. The Services establish and operate UBO offices at MTFs throughout the world that administer TPC, MSA, and MAC Programs. UBO offices focus on ensuring that billable services are identified; payer information is available; accurate and complete claims are generated; and appropriate collections are received.

VALID Other Health Insurance (OHI)

Valid OHI is a policy that is defined as a UBO billable policy.

Valid billable policy submissions include the effective date, expiration date, plan type, coverage type (e.g., medical, dental, vision, etc.), policy ID, group ID, bin, other covered dependents, and patient level benefits. A valid billable policy cannot be older than two years from the expiration date at the time of submission. Plan types CANNOT be TRICARE, TRICARE Supplement, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, or Medicaid.

WORK WEEK Is defined as Monday through Friday.

2.2 Acronyms:

AAL Authenticator Assurance Level ABAC Attribute-Based Access Control ABACUS Armed Forces Billing and Collection Utilization Solution ACAS Assured Compliance Assessment Solution ACOR Alternate Contracting Officer’s Representative ADM Ambulatory Data Module AF Air Force AFB Air Force Base AFMS Air Force Medical Service AIS Automated Information System AO Authorizing Official AODR Authorizing Official Designated Representative AOR Area of Responsibility API Application Programming Interface APL Approved Products List APL APV Ambulatory Procedure Visit AQL Acceptable Quality Level AR Army Regulations ARRT Acquisition Requirements Roadmap Tool A/R Accounts Receivable ARRA American Recovery and Reinvestment Act of 2009 ASA Adjusted Standard Account ASW (HA) Assistant Secretary of War (Health Affairs) ATC Authority to Connect ATCTS Army training and Certification Tracking System ATO Authority to Operate AUP Acceptable Use Policy AWG Advisory Work Group B2B Business-2-Business BAA Business Associate Agreement BCAP Boundary Cloud Access Point BER Billing Events Repository BUMED Navy Bureau of Medicine and Surgery

CAC Common Access Card CAO Contract Administration Office CAP Cloud Access Point CAPER Comprehensive Ambulatory/Professional Encounter Record CBA Capability Based Assessment CCE Coding Compliance Editor CCEVS Common Criteria Cybersecurity Evaluation and Validation Scheme CCV Cash Collection Voucher CDI Covered Defense Information CDM Charge Description Master CDR Contract Discrepancy Report CDT Current Dental Terminology CE Computer Environment CDRL Contract Data Requirement List CFO Chief Financial Officer CFOIC Chief Financial Officer Integrating Council CFR Code of Federal Regulations CHAMPUS Civilian Health and Medical Program of the Uniformed Services CIO Chief Information Officer CITPO Clinical Information Technology Program Office CJCSM Chairman of the Joint Chiefs of Staff Manual CLN Clinical (Nursing, Physical and Allied Health) CMAC CHAMPUS Maximum Allowable Charge CMBB Charge Master Based Billing CMMC Cybersecurity Maturity Model Certification CMR Contractor Manpower Reporting CMS Centers for Medicare and Medicaid Services CMS 1500 CMS 1500 Claim Form CNC Currently Not Collectible CNDSP Computer network Defense Service Provider CNSS Committee on National Security Systems CNSSI Committee on National Security Systems Instruction CO Contracting Officer(s) CONOPS Concept of Operations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer's Technical Representative COTS Commercial-Off-The-Shelf CPA Cerner Patient Accounting CPT Current Procedural Terminology CS Contract Specialist CSET Cosmetic Surgery Estimator Tool CSO Cloud Service Offering CSP Cloud Service Provider CSSP Cyber Security Service Provider CST Central Standard Time

CVS Contractor Verification System CUI Controlled Unclassified Information DA Department of the Army DAD-A Deputy Assistant Director for Acquisition DAD-IO Deputy Assistant Director – Information Operations DC3 DoW Cyber Crime Center DCMO Debt and Claims Management Office DD Form 254 Department of War Contract Security Requirement List (if applicable) DB Design-Build DBB Design-Bid-Build DCQ Disputed Claims Queue DEAMS Defense Enterprise Accounting and Management System DEERS Defense Enrollment Eligibility Reporting System DFARS Defense Federal Acquisition Regulation Supplement DFAS Defense Finance and Accounting Services DHA Defense Health Agency DHP Defense Health Program DHMSM DoD Healthcare Management Systems Modernization DISA Defense Information System Agency DISCO Defense Industrial Security Clearance Office DMDC Defense Manpower Data Center DME Durable Medical Equipment DMIS Defense Medical Information System DMIS ID Defense Medical Information System Identifier DoD Department of Defense DoDD Department of Defense Directive DoDI Department of Defense Instruction DoW Department of War DSAs Data Sharing Agreements DSAA Data Sharing Agreement Application DMZ Demilitarized Zone DoDM Department of Defense Manual DPCLO DHA Privacy and Civil Liberties Office DRG Diagnosis Related Group DTS Defense Travel System DUA Data Use Agreement EAS IV Expense Assignment System Version 4 ECH Electronic Clearing House ECS Elective Cosmetic Surgery EFT Electronic Funds Transfer E & M Evaluation and Management eMSM Enhanced Multi-Service Markets EOB Explanation of Benefits EOP Explanation of Payments ERA Electronic Remittance Advice ERP Enterprise Resource Advice

ESD Enterprise Service Desk ESS Endpoint Security Solutions EULA End User License Agreement EVM Earned Value Management FAR Federal Acquisition Regulation FCI Federal contract information FE Facilities Enterprise FedRAMP Federal Risk Authorization and Management Program FIPS PUB Federal Information Processing Standards Publication FISC Fleet and Industrial Supply Center FISMA Federal Information Security Modernization Act FLEX Flexible Rate FLXO Flexible Outpatient Rate FMP Family Member Prefix FMR Family Member Rate FMR Financial Management Regulation FOIA Freedom of Information Act FOC Full Operational Capability FOR Full Outpatient Rate FRCS Facility Related Control Systems FRR Full Reimbursable Rate FSC Federal Service Code FSO Facilities Security Officer FY Fiscal Year GAAP Generally Accepted Accounting Principles GBF Governmental Billing Forms GFEBS General Fund Enterprise Business System GL General Ledger HA Health Affairs HB&FP Health Budgets and Financial Policy HCPCS Healthcare Common Procedure Coding System HHS Health and Human Services HIPAA Health Insurance Portability and Accountability Act HCA Head of the Contracting Activity HIT Health Information Technology HL 7 Health Level 7 HSPD Homeland Security Presidential Directive IGCE Independent Government Cost Estimate IA Information Assurance IAB Inter-Agency Billing IAF Information Assurance Fundamentals IAL Identity Assurance Level IAT Interagency/Other Federal Agency Sponsored Rate IASAE Information Assurance System Architect and Engineer IAT Information Assurance Technology IAVM Information Assurance Vulnerability Management

IAW In Accordance With ICAM Identity, Credential, and Access Management ICD International Classification of Diseases ICD-9 International Classification of Diseases – Ninth Revision ICD-10 International Classification of Diseases – Tenth Revision ID Identification IGA Identity Governance and Administration IM Information Management IM/IT Information Management/Information Technology IMO International Military Education & Training Outpatient Rate IMET International Military Education & Training Rate IO Initial Outfitting I/O In/Out Processing Portal IOC Initial Operational Capability IOR Interagency/Other Federal Agency Sponsored Outpatient Rate IPAC Intra-Governmental Payment and Collection IPR In-Progress Review IPV Internet Protocol Version I&R Invoice and Receipt IRAPT Invoicing, Receipt, Acceptance, and Property Transfer IRD Integrated Requirements Design IS Information System ISP Internet Service Provider ISSO Information Systems Security Officer IT Information Technology ITT Information Technology and Telecommunications ISCM Information Security Continuous Monitoring IV&V Independent Verification & Validation JAG Judge Advocate General JFTR Joint Federal Travel Regulations JPAS Joint Personnel Adjudication System JPG Joint Photographic Experts Group JTF Joint Task Force (National Capital Regional Medical) JTR Joint Travel Regulation LAB Laboratory LOA Line of Accounting LOB Line of Business MAC Medical Affirmative Claims Program MCP Managed Care Program MCRP Medical Cost Recovery Program MedCOI Medical Community of Interest MEDCOM Medical Command MEPRS Medical Expense & Performance Reporting System MHS Military Health System MHSRR Military Health System Requirements Repository MIL-STD Military Standard

MRT Medical Records Tracking MSA Medical Services Account MTBF Mean Time Between Failures MTFs Military Treatment Facilities NAC National Agency Check NACLC National Agency Check with Local Agency and Credit Check NAVMEDLOGCOM Navy Medicine Logistics Command NCPDP National Council for Prescription Drug Programs NCR National Capitol Region NDA Non-Disclosure Agreement NDC National Drug Codes NH Naval Hospital NHC Naval Health Clinic NIAP National Information Assurance Partnership NIST National Institute of Standards and Technology NMC Naval Medical Center NPI National Provider Identifier NPI-1 National Provider Identifier Type 1 (Provider) NPI-2 National Provider Identifier Type 2 (Facility) NRV Net Realizable Value OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs OHI Other Health Insurance OIB Outpatient Itemized Billing OMB Office of Management and Budget OPM Office of Personnel Management OPSEC Operations Security OSW Office of the Secretary of War OTC Over the Counter OTSG Office of the Surgeon General, U.S. Army OV Operational View PAA Privileged-Level Access Agreement PAD Patient Administration Division PAM Privileged Access Management PAS Patient Appointment and Scheduling PATCAT Patient Category P-ATO Personal Authorization to Operate PC Professional Component PCO Procuring Contract Office P&R Personnel and Readiness PGI Procedures, Guidance and Information PDF Portable Document Format (Adobe Acrobat) PDT Project Delivery Team PHI Protected Health Information PHR Pharmacy

PIA Privacy Impact Assessment PII Personally Identifiable Information PIT Platform Information Technology PIV Personal Identity Verification PK Public Key PKI Public Key Infrastructure POA&M Plan of Action and Milestones POC Point of Contact PMO Program Management Office POM Program Objective Memorandum PoP Period of Performance PP Personal Property PPSM Ports, Protocols, and Services Management PRS Performance Requirements Summary PSP Personnel Security Program PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan RAD Radiology RAPIDS Random Access Personnel Information Dissemination System RBAC Role-Based Access Control RFP Request for Proposal RFQ Request for Quotation RM Resource Manager RMF Risk Management Framework RPO Recovery Point Objective RTO Recovery Time Objective SaaS Software as a Service SADR Standard Ambulatory Data Record SCR System Change Request SFIS Standard Financial Information Structure SFFAS Statements of Federal Financial Accounting Standards SIDR Standard Inpatient Data Record SIT Standard Insurance Table SMO Security Management Office SOD Separation of Duties SOP Standard Operating Procedures SOR Statement of Reason SOR Systems of Records SORN Systems of Records Notices SP Special Publication SPEAR Strategic Planning Enterprise Architecture and Requirements SPRS Supplier Performance Risk System

SR Subsistence Rate SRM Sustainment, Restoration and Modernization SRG Security Requirements Guides SSBI Single Scope Background Investigation SSN Social Security Number SSO Single Sign-On STIG Security Technical Implementation Guides TA Trusted Agent TC Technical Component TE Technical Exhibit TIF Tagged Image Files TMA TRICARE Management Activity TOOLS FileMan TOS Terms of Service TPC Third Party Collection TPCP Third Party Collection Program UB-04 Universal Billing Form 04 UBO Uniform Business Office UCF Universal Claim Form US United States USC United States Code UFC Unified Facilities Criteria USAMITC United States Army Medical Information USNS United States Naval Ship UTC Coordinated Universal Time VA Depart of Veterans Affairs VMS Virtual Memory System VPN Virtual Private Network VTC Video Telecommunication WFMA Workflow Management Coalition WAM Workload Assignment Module WRNMMC Walter Reed National Military Medical Center XML Extensible Markup Language

2.3 Applicable Publications, DHA Administrative Instructions (AI), etc.

2.3.1 DoD Financial Management Regulation (DoD 7000.14-R)

See: http://comptroller.defense.gov/fmr/

2.3.2 DoD Uniform Business Office User Guide Manual

See: Uniform Business Office | Health.mil

2.3.3 DoD Patient Category Table

-Current edition will be provided as needed

2.3.4 DoD UBO Rate Tables

-Current edition will be provided as needed

2.3.5 Various Forms (DD-1131, SF-1049, SF-1080)

http://comptroller.defense.gov/fmr/ https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Uniform-Business-Office

Available from: https://www.gsa.gov/reference/forms/

2.3.6 DoDI 8510.01, Risk Management Framework (RMF) for DoW Information

Technology (IT), as amended

2.3.7 DoDI 8520.02, Public Key Infrastructure (PKI) and Public Key (PK) Enabling, as amended

2.3.8 DoDI 8520.03, Identity Authentication for Information Systems, as amended

2.3.9 DoDI 8551.01, Ports, Protocols, and Services Management (PPSM), as amended

2.3.10 DoDI 8580.01, Information Assurance (IA) in the Defense Acquisition System, as amended

2.3.11 DoD Cloud Computing SRG, V1R6, as amended

2.3.12 DoDI 8580.02, Security of Individually Identifiable Health Information in DoW

Health Care Programs, as amended

2.3.13 DoDI 8582.01, Security of Unclassified DoD Information on Non-DoW Information

Systems, as amended

2.3.14 NIST SP 800-171, as amended

2.3.15 National Institute of Standards and Technology Special Publication 800-37, “Guide for

Applying the Risk Management Framework to Federal Information Systems: A Security Life Cycle Approach,” February 2010, as amended

2.3.16 Subchapter III of chapter 35 of Title 44, United States Code (also known as the “Federal Information Security…