TDEFIC Draft Section F Deliveries or Performance .doc

F.1.

52.242-15 STOP-WORK ORDER (AUG 1989)

F.2.

52.242-15 I STOP WORK ORDER (AUG 1989)—ALTERNATE I (APR 1984)

F.3. PERIOD OF PERFORMANCE

F.3.1. Base Period (Date of Award through June 30, 2014 (Note: there will be a minimum 12-month period of performance for transition-in).

F.3.2. Option Periods 1 through 5 (if exercised) will be:

Option Period 1 July 1, 2014 through June 30, 2015

Option Period 2 July 1, 2015 through June 30, 2016

Option Period 3 July 1, 2016 through June 30, 2017

Option Period 4 July 1, 2017 through June 30, 2018

Option Period 5 July 1, 2018 through June 30, 2019

F.4. GEOGRAPHIC AREA OF COVERAGE

The contract covers the United States, Puerto Rico, Guam, the U. S. Virgin Islands, American Samoa and the Northern

Mariana Islands.

F.5. REPORTS AND PLANS

Unless otherwise specified, the Contractor shall electronically submit all Contract Data Requirements List items (CDRL) (contract plans, reports, etc.) in the specified format using Microsoft Office Excel, Word, PDF, or other specified software. If no format is specified, the Contractor may use its own format. Unless otherwise specified, all CDRL items shall be submitted to the Government via the E-commerce Extranet (https://tma- ecomextranet.ha.osd.mil/logon/logon.cfm). (See the TRICARE Operations Manual (TOM) 6010.56-M, February 2, 2008, Chapter 14, Section 2, for report submission requirements).

F.5.1. The contractor shall provide all reports and plans that are specified in this Section. The contractor is accountable for assuring that reports contain accurate and complete data. The Contractor shall prepare written procedures describing the source of information as well as the specific steps followed in the collection and preparation of data for each report. All reports must be supported with sufficient documentation and audit trails. The reports shall be titled as listed. The Contractor shall submit a negative report if there is no data to report. Required reports include:

F.5.1.1. Daily Reports

D010 Payment/Check Issue Report

F.5.1.2. Weekly Reports

W010 Claims Aging Report by Status Location

W020 Claims Processing Statistics Report

W030 Incoming Weekly Status Report

W040 Outgoing Weekly Status Report

F.5.1.3. Monthly Reports

M010 Toll-Free Telephone Report M020 Beneficiary Contact Data M030 HIPAA Privacy Disclosure Report

M040 TRICARE Contractor Cycle Time/Aging Report

M050 TRICARE Contractor Monthly Workload Report

M060 Accounts Receivable Summary Report including Supplemental Reports

M070 Bank Account Reconciliation Report

M080 Bank Cleared Payment Report

M090 Bank Account Statement Report

M100 Internal Quality Management/Quality Improvement Program Report

M110 Present on Admission (POA) Indicators and Hospital Acquired Conditions (HACs) M120 Reserved M130 Productivity Report

M140 Employee Access to DOD IS/Networks

M150 Reserved M160 Case Management Report

F.5.1.4. Quarterly Reports

Q010 Claims Audit Report

Q020 Reserved Q030 Fraud and Abuse Summary Report

Q040 Appeals Quality Assessment Report

Q050 Written Correspondence Quality Assessment Report

Q060 Telephonic Responses Quality Assessment Report

Q070 Retrospective Review Requirements for Other Than DRG Validation Report

Q080 Utilization Management Report

Q090 Evolving Practices Report

F.5.1.5. Annual Reports

A010 Third Party Recoveries by FY Report A020 Fraud Prevention Savings Report A030 Annual Letter of Assurance A040 Contract Releasable Under FOIA

A050 NIST Checklist

C020 Statement on Standards for Attestation (SSAE-16) F.5.1.6. Annual Plans

P010 Internal Quality Management/Quality Improvement Program

P020 Annual Continuity of Operation Plan (COOP) and Annual Disaster Recovery Test

P030 Annual Handling Inappropriate Disclosures of Data Plan

P040 Utilization Management Plan

P050 Education Plan

F.5.1.7. As Required

R010 TMA Preliminary Incident Report

R020 Report of Lost, Stolen, or Compromised Personally Identifiable Information

R030 Plan of Action and Milestones (POA&M) R040 Reserved R050 Start Up Plan

R060 Privacy Impact Assessment R070 Weekly History Updates R080 Executed Crossover Agreement with the Medicare Coordination of Benefits Contractor (COBC)

R090 MOU with Beneficiary Education & Services (BE&S)

R100 MOUs with Each MCS Contractor

R110 Appeals Processing Guidelines, Desk Instructions and Reference Materials

R120 Reserved R130 State Prevailing Annual Update Report

R140 TQMC Findings Response

R150 Congressional and Contacts Summary Report

R160 Accreditation Reports and Documentation

R170 TQMC Validation Report

F.6. TRANSITION-IN.

Transition-In activities outlined in the TOM, Chapter 20, Section 5 are due during the base period of the contract.

F.7.

Transition Out

Transition-Out deliverables are due as outlined in the TOM, Chapter 20, Section 5.

TMA TDEFIC HT9402-12-R-0005