ATT013_TPA_ProcessFlow_Certification.pdf
PDF 187 KB Posted
- Solicitation number
- 75D301-24-RFI-WTCHP-TPA
About this file
This document contains information related to a federal contract opportunity for a Third-Party Administrator (TPA) for the World Trade Center (WTC) Health Program. It includes a draft Performance Work Statement (PWS) that outlines the key responsibilities of the TPA, such as processing enrollment applications and certification requests, maintaining member demographic information, managing a call center, administering benefits, and processing medical claims.
The document indicates that the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH) are the federal agencies involved in this acquisition. The intended solicitation release date is mid-January 2025, with a contract award expected in September 2025. CDC/NIOSH is seeking industry feedback on the draft PWS, as well as information needed for proposal development, potential incentives, contract structure and compensation, and evaluation factors. Interested parties are invited to provide written responses by October 25, 2024, and may also request one-on-one feedback sessions with the agency.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ATT101_TPA_SummaryVolumeData_Shell.xlsx | XLSX spreadsheet | |
| ATT015_TPA_ProcessFlow_Transfer.pdf | ||
| ATT012_TPA_ProcessFlow_Enrollment.pdf | ||
| Questions and answers template.xlsx | XLSX spreadsheet | |
| WTC Health Program TPA draft PWS.docx | DOCX document | |
| ATT001_TPA_Glossary.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
World Trade Center Health Program – End‐to‐End Certification Process
N
IO
SH
Th ird
‐P ar ty A dm in ist ra to r (
TP
A)
TP
A M ai l C en te r
CC
E / N
PA Start Complete the WTC‐3
Certification Request(s)
Fax Certification Request? Yes
Retrieve CCE‐Posted WTC‐3 Packages
Fax WTC‐3 Package to Mail Center for
Processing
No
Transfer WTC‐3 Package for Processing
Assign WTC‐3 Packages for Processing
Submit WTC‐3 Package for
Certification Review
CARE
Conduct the Initial Health Evaluation or Annual Monitoring
Exam for the Member and Assess
Condition(s)
Document WTC‐3 Package Information (Number Received, etc.)
Send Confirmation to Cert Processing
Team
Review WTC‐3 Package to Ensure
Validity
Enter WTC‐3 Information and Attach Documents
Send Certification Decision Report to Each CCE/NPA
Receive Certification Information and
Decisions
Generate Certification Letter for Member
Use Certification Information and
Decisions to Manage Benefits & Eligiblity
Retrieve and Process WTC‐3 Certification
Package
Make Files Available to Cert Processors
CARE
Finalize Decision on Certification Request
Assign Certification Request to Reviewer(s)
Review Certification Request
CARE CARE CARE
Review “Sent” Confirmation from CCE and Send “Received” Confirmation to Each
CCE
B
B
Receive Cert Confirmation
Receive Weekly Certification Report End
End
A
Valid Request? Yes
Document WTC‐3 Details into
Unprocessable Log
No
End Unprocessable
A
Clinics currently send confirmation via email, detailing how many records were sent via SFTP or fax
TPA & CCE reconcile lists to ensure that all certification requests are received for processing
CARE
Review includes QA and follow up actions, as applicable
Decision report complied once per week; currently sent via SFTP; includes unprocessable certification requests
Letters generated on a routine cadence
Secure file transfer (currently: SFTP) on routine cadence
Most CCEs/NPA transmit the WTC‐3 Package electronically as a PDF. Currently, submissions are via Secure File Transfer Protocol
(SFTP)
The CARE system is a CDC‐hosted platform under development for certifications. It will be live prior to SHCD for TPA. Currently, the system is developed for manual data entry of certification fields. Modifications to the CARE system can be discussed upon award.
The summary list of unprocessable certifications are currently communicated to the CCEs in the Certification Decision
Report
Includes data entry verification step;
sent for review in real‐time upon submission
Certification decisions and information are transmitted daily from CARE to the TPA
Each CCE has its own unique way of processing and documenting certification requests. Additionally, medical documentation needs differ per request. As a result, beyond the cover page, all WTC‐3 Package contents are unique.
A single WTC‐3 Certification Request may contain 1 or more conditions for certification
Legend
Start/End
Activity Step
Decision Step
Predefined Process/ Subprocess
Annotation
On‐page ConnectorSystem[Name]
A U T O
Automated Activity
Text
E2E Certification Process�
File details come from the government source that posted it. Updated .