TMA_TDEFIC_Solicitation_Questions_pending_5-1-13.docx

TRICARE Dual-Eligible Fiscal Intermediary Contract (TDEFIC) HT9402-12-R-0005 TMA TDEFIC Solicitation Questions

The questions and response spreadsheet you referenced in your email were part of the pre-solicitation draft RFP posted on fbo.gov in Jun 2012. TMA did not post the questions received, and they are not releasable.

(a) Should offerors include severance costs in the Transition-Out CLIN?

(b) If the answer is yes,

(1) How should they be submitted?

(2) Are they part of the total evaluated price?

Pending.

(a) Considering the increased workload incurred with claim adjustments with no reimbursement to the contractor, could the Government please provide the cause for this increase and how the Government reimburses a contractor for these types of increased adjustment volumes?

(b) Does the Government expect to experience such spikes in adjustment claims in the future?

(a) Federal Law requires Medicare physician payments to be modified yearly. The increased adjustment workload volume during 2011 was the result of changes to Medicare physician fees signed into law requiring retroactive adjustments. In accordance with DFARS 252.243-7002 contractors may submit requests for equitable adjustment if they believe the work performed is outside the normal contract scope.

(b) Pending.

L.6.6, SUBFACTOR 5, SMALL BUSINESS PARTICIPATION

M.4.6, Subfactor 5, Small Business Subcontracting Participation Exhibit L-3 Solicitation Cross-Reference Sections L and M and Exhibit L-3 refer to small business participation as a technical subfactor, but Table 1 shows the small business plan delivered in Volume I, not in Volume II.

(a) Please clarify where the offerors should deliver the small business plan to be compliant.

(b) If the plan should be in Volume II, please exclude it from the page limit.

As stated in Section L, Table 1, Proposal Volumes, the Small Business Subcontracting goes in Volume I, Executed Offer. Paragraph L.6.6.1. also states, "Large Businesses: Large business offerors shall include their small business subcontracting plan in Volume I ..."

Document Description Page Limit Reference Technical Proposal 150 L.6.

Proposed Enhancements List 3 L.6.1.

The 3 pages of enhancements are not included in the 150-page limit for Volume II.

Volume III, Past Performance L.7 Volume III, Past Performance Information L.4.1. Table 1, Proposal Volumes:

Past Performance Summary L.7.2. Past Performance Narrative

… Also see Section C, Work Statement, paragraph 7.3.10.

and: “Do not use compressed file formats.”

and : “All portions of the electronic documents, including the body of text, tables, charts, and graphs shall be in a format that enables the Government to perform electronic searches of the documents. Electronic versions shall be exact duplicates of the paper copy proposals in both content and format.”

Please provide clear instructions of what Microsoft Word method the offerors must use for integrating graphics (defined as Microsoft Office “shapes” with or without text; rather than photographs, narrative paragraphs, or Word tables) with the narrative text in order to comply with all the various requirements in L.4.2.

Yes. It is acceptable to use pictures tagged with keywords in comments to make them searchable.

Background: We create our graphics in Microsoft PowerPoint. In our experience, the only stable document layout results from inserting graphics as pictures into the Word file, but this method would violate the requirement that to enable the graphics to be searched. Other insertion methods result in unstable page layouts and graphics that “disassemble”, losing or repositioning content depending on the default printer driver on the specific user’s computer. This would violate the requirement for exact duplicates. Files delivered using PDF with OCR, but without compression, will be extremely large because they must be printed, then scanned without loss of fidelity, then processed for OCR.

Would inserting the graphics as pictures tagged with keywords in comments (making them searchable), satisfy the requirement?

(1) For the information of offerors and contractors, the contracting officer shall state a realistic estimated total quantity in the solicitation and resulting contract. This estimate is not a representation to an offeror or contractor that the estimated quantity will be required or ordered, or that conditions affecting requirements will be stable or normal. The contracting officer may obtain the estimate from records of previous requirements and consumption, or by other means, and should base the estimate on the most current information available.

(2) The contract shall state, if feasible, the maximum limit of the contractor’s obligation to deliver and the Government’s obligation to order. The contract may also specify maximum or minimum quantities that the Government may order under each individual order and the maximum that it may order during a specified period of time."

What is the reason for the paper claims? Are they Workers’ Compensation claims?

TDEFIC health care claims may be processed using electronic medical claims or paper claims. Historically, approximately 12% of the TDEFIC health care claims processed are paper. See Section L Exhibit L-2, Workload Volumes. Examples of paper claim submittals include:

· Claims with Other Health Information (OHI) in addition to Medicare

· Claims for services which are not covered Medicare benefits.

· Medicare Part C Claims

Fiscal Year (FY) 2010=32,784;

FY11=28,961

FY12=25,853

180 days from June 3 would be December. That timeframe would not allow for a 10 month transition. Please confirm the transition period will last 10 months.

TMA anticipates a 10-month Transition Base Period.

• The absolute value of the payment errors shall not exceed 2% of the total billed charges for Option Periods 1 and 2, and shall not exceed 1.75% for the remaining option periods.

• The claim occurrence error rate shall not exceed 3% for all types of TED records."

The accuracy rate for payment errors seems to conflict with TRICARE Operations Manual, Chapter 20, Section 8.0, Change 96, which indicates, "...the following wording replaces the Chapter 1, Section 3, paragraph 1.7.1, Claim Payment Errors, requirements: “The absolute value of the payment errors shall not exceed 1.5% of the total billed charges.”

Please confirm the TDEFIC accuracy rate for payment errors.

The Claims Payment Error Standards noted in L.6.2.3 are correct. These are also noted in TOM Chapter 1, Section 3.

Workload Volumes

Workload Volumes

Workload Volumes

Workload Volumes

Workload Volumes

Workload Volumes

Can TMA define the claims that are and aren’t eligible for the Medicare Dual-Eligible Health Care Fund?

How will the contractor identify these claims so as to separate the accounts and submit the separate TEDS?

Information regarding eligibility for the Medicare Dual Eligible Health Care Fund can be found in the TRICARE System Manual (TSM) Chapter 2, Section 8.1- specifically edits 1-000-01F and 2-000-01F.

Can TMA provide the historical data associated with these Medicare Crossover Fees for the past three years by month?

Can TMA confirm that the TDEFIC contractor will issue payment to the Medicare contractors for the Medicare Crossover Fees using one of the Healthcare Claim Bank Accounts?

TRICARE does not maintain this data. Historical data associated with the Medicare Crossover Fees can be found at the following link:

http://www.cms.gov/Medicare/Coordination-of-Benefits/COBAgreement/Downloads/Copy-1-of-Rates.pdf

Yes, all payments listed under Section G, paragraph G.11. OTHER BENEFIT AND RELATED PAYMENTS—NON-TEDS ROUTINE MANUAL VOUCHERS will be processed through one of the bank accounts used for paying claims. The Medicare crossover fees and the HPSA/PSA payments will be paid from the bank account that is for Medicare Dual-Eligible Health Care Fund (MERHCF) transactions. This will be the primary account for this contract since the majority of transactions will go through it.

Can TMA confirm that there is only one COBC and that all TRICARE crossover claims come from this single entity?

Yes. The COBC is a single, centralized, coordination of benefits contractor established by CMS, in part, to make arrangements for transferring the adjudicated claims data automatically to the secondary payer for further processing. Additional information regarding the COBC can be found at: www.cms.gov/Medicare/Coordination-of-Benefits/COBAgreement. Claims received from Medicare will come from the COBC.

However, Section L.6.1.5.3. indicates that...past performance information shall not be addressed in...the technical proposal volume. Does this mean that we cannot use client names or performance based information in the technical volume?

Can the Government please clarify these sections?

Pending.

Can TMA explain why it has included the following clauses in Section I of the RFP? Our understanding is that all of these clauses are triggered because of the CAS coverage and that the contract would be exempt from all CAS requirements as stated above.

I.35. 52.215-15 PENSION ADJUSTMENTS AND ASSET REVERSIONS (OCT 2010)

I.36. 52.215-18 REVERSION OR ADJUSTMENT OF PLANS FOR POSTRETIREMENT BENEFITS (PRB) OTHER THAN PENSIONS (JUL 2005)

I.37. 52.215-19 NOTIFICATION OF OWNERSHIP CHANGES (OCT 1997)

I.38. 52.215-21 REQUIREMENTS FOR COST OR PRICING DATA OR INFORMATION OTHER THAN COST OR PRICING DATA--MODIFICATIONS (OCT 2010)

I.73. 52.230-2 COST ACCOUNTING STANDARDS (MAY 2012)

I.74. 52.230-6 ADMINISTRATION OF COST ACCOUNTING STANDARDS (JULY 2010)

I.75. 252.231-7000 SUPPLEMENTAL COST PRINCIPLES (DEC 1991)

I.90. 252.242-7005 CONTRACTOR BUSINESS SYSTEMS (FEB 2012)

Pending.