Attach_J-16_Transition_Amend_1.doc

Attachment J-16

Transition Requirements

1.0 CONTRACT TRANSITION-IN

1.1. Transition-In Requirements. The incoming contractor will have many time-critical tasks to perform during the twelve month transition-in period that must be accomplished before the contractor can begin providing required ADDP services on the first day of Option Period One. Some of these tasks can be accomplished concurrently with others; however, certain tasks must be accomplished, and certified as complete, before the contractor can proceed. These critical sequential tasks include:

· Safeguarding Unclassified Sensitive DoD Information Certification The incoming contractor shall obtain certification of acceptable security risk for their system infrastructure via completion of the NIST Certification Process (see Section C.22 and TSM Chap 1, Section 1.1) and fulfill all system access requirements prior to accessing DoD data or interconnectivity with the Government system and/or initiation of integration testing.

· Military Health System (MHS) B2B Gateway After the contractor has obtained certification of acceptable security risk for the system infrastructure, the contractor will work with the Government to establish the B2B gateway required to interface with the MHS Data Repository (reference Section J Attachment J-13), and DMDC. The MHS B2B Gateway must be established and tested before the contractor can begin testing the MHS Data Repository and DMDC interfaces

· Defense Manpower Data Center (DMDC) Interface Once the MHS B2B Gateway is operational, the contractor can begin interface testing with Government IT systems required to verify eligibility (reference C.4.3.), submit provider and member utilization data reports, etc.

1.2. Transition-In Plan. The incoming contractor shall submit a comprehensive Transition-In Plan to the Contracting Officer no later than 10 calendar days following contract award. The plan shall address all events and milestones that need to occur for each functional area described in this contract to enable the start of dental service delivery under this contract. This plan shall include a timeline and key positions responsible for such areas as resource acquisition, staff training, file conversion and testing, eligibility verification, enrollment, interface with the Defense Manpower Data Center (DMDC), education and public relations, support services, benefit policy and claims processing systems.

1.3. Post-Award Conference. Within 10 calendar days following contract award, the incoming Contractor shall attend a post-award conference with the Contracting Officer and other TMA representatives in a location determined by TMA. The Contracting Officer will notify all parties of the conference date.

1.4. Transition Specifications Meeting. Within 30 calendar days following contract award, the incoming contractor shall attend a three day meeting with TMA at a location designated by TMA. Contractor representatives attending this meeting shall have the experience, expertise, and authority to provide approvals and establish project commitments on behalf of their organization. The purpose of this meeting is to finalize the schedule of events associated with the incoming contractor’s assumption of responsibilities and receipt of files from the Government and outgoing contractor and also the outgoing contractor's phase-out of activities and workload. TMA and the contractor will also agree on the format and submission dates for all recurring management reports. TMA will notify all parties of the meeting dates and provide a draft transition schedule to all parties prior to the meeting followed by a revised schedule within 10 calendar days after the meeting. The incoming contractor shall incorporate all specifications of the final transition schedule into its Transition-In Plan and submit the revised plan within 15 calendar days or as agreed to by TMA. The final plan will be incorporated into the contract at no cost.

1.5. DMDC Interface Meeting. Within 60 calendar days following contract award, the incoming contractor shall attend a three-day meeting with representatives of DMDC, and TMA in a location determined by TMA. TMA will notify all parties of the meeting dates. The purpose of this meeting is to discuss the implementation and testing of the DMDC interface applications. The incoming contractor and the Government shall identify functions, technical details, other areas of the interface application, and telecommunications needs that require clarification. This meeting will also be used to determine a schedule of activities for a timely and successful implementation of the interfaces. Prior to the meeting, the incoming contractor and the Government may participate in technical interchange discussions as needed. The incoming contractor shall submit an agenda and list of questions to be addressed to TMA no later than five working days prior to the meeting. Within three working days following the meeting, the incoming contractor shall submit minutes of the meeting to TMA for approval. The incoming contractor shall incorporate all events and milestones established for the DMDC interfaces into its Transition-In Plan.

1.6. TMA Finance Interface Meeting. Within 10 calendar days following the DMDC Interface Meeting, the incoming contractor shall submit suggested dates for the Finance Interface Meeting. For this meeting the incoming contractor shall attend a meeting with representatives of TMA in a method determined by TMA. The meeting time and frequency will be mutually agreed upon by all parties. TMA will notify all parties of the meeting times. Participation at the meeting may be conducted telephonically. The purpose of this meeting is to discuss the method in which the contractor shall interface with TMA for submission of the contractor’s invoices. The incoming contractor and the Government shall identify functions, technical details, other areas of the interface application, and telecommunications needs that require clarification. The incoming contractor shall submit an agenda and list of questions to be addressed to TMA no later than five working days prior to the initial meeting. Within three working days following each meeting, the incoming contractor shall submit minutes of the meeting to TMA for approval. The incoming contractor shall incorporate all events and milestones established for the finance interfaces into its Transition-In Plan.

1.7. Outgoing/Incoming Transition Meeting. The incoming contractor shall attend a meeting with TMA and the outgoing contractor within 90 calendar days following contract award. Contractor representatives attending this meeting shall have the experience, expertise, and authority to provide approvals and establish project commitments on behalf of their organization. The purpose of this meeting is to finalize the schedule of events associated with the transfer of responsibilities and information to the incoming contractor and the phase-out of activities and workload under the ending contract. TMA will notify all parties of the meeting date and provide a draft transition schedule to all parties prior to the meeting followed by a revised schedule within 10 calendar days after the meeting. The outgoing contractor will incorporate the applicable specifications of the final transition schedule into its Phase-Out Plan.

1.8. Travel costs. All transition related contractor travel costs shall be at the expense of the contractor.

2.0. START-UP REQUIREMENTS

Note: Time periods referenced in the remainder of this attachment are placeholders only. Dates to be determined during the Transition Specifications Meeting and will be dependant on the Government’s acceptance of the contractor’s security assessment plan and report for safeguarding unclassified sensitive DoD information and the establishment of the B2B Gateway.

2.1. Contractor Weekly Status Reporting. Beginning the first month following contract award and continuing through the sixth month following the start of dental care delivery under this contract, the incoming contractor shall submit weekly status reports of transition-in and operational activities to TMA. The Contracting Officer may revise this reporting schedule based on the status of the transition and other operational factors. These reports shall cover the status of all activities and milestones in the incoming contractor’s Transition-In Plan and the performance and inventory information required in the Weekly Management Reports described in Section J Attachment J-15.

2.2. Receipt of Files. The incoming Contractor will receive the files and information as indicated in the table below entitled, “Transition-In/Information Files Transfers” and complete any necessary conversion and testing as necessary to meet the schedule requirements established in the Transition Specifications, DMDC Interface, and Outgoing/Incoming Transition meetings, and the incoming contractor’s Transition-In plan as approved by TMA. The listing in the table below is not all-inclusive or absolute. It is provided here as a guideline and may be revised by mutual agreement of the involved parties at the Transition Specifications Meeting. The details of the information and data to be transferred to the incoming contractor will be determined at that meeting. To the extent possible, these files will be transmitted via electronic file transfer methods.

Transition-In/Information Files Transfers

File/

Information Type

Receipt Date General Description

2.3 Transfer of Automated Data Processing (ADP) Files. The outgoing contractor will prepare in non-proprietary electronic format and transfer to the incoming contractor, by the 60th calendar day following the Outgoing/Incoming Transition Meeting unless, otherwise negotiated by the incoming and outgoing contractors, all specified ADP files, in accordance with specifications in the official transition schedule and will continue to participate in preparation and testing of these files until they are fully readable by the incoming contractor or TMA.

2.3.1. Contractor File Conversions and Testing. The incoming contractor shall perform initial conversion and testing of all ADP files NLT 30 calendar days following receipt of the files from the outgoing contractor. ADP file conversions testing shall be initiated prior to the Benchmark Test and fully tested, loaded and operational prior to the start of dental care delivery. Integration testing will be conducted to validate the contractor’s internal interfaces. This testing will verify the contractor’s system integration, functionality, and implementation process. The incoming contractor shall be responsible for the preparation and initiation of Integration Testing prior to the start of Benchmark Testing. TMA Test Managers will work with the contractor to plan, execute and evaluate the Integration Testing efforts. The contractor shall identify a primary and a back-up Testing Coordinator to work with the TMA Test Managers. The Testing Coordinator is responsible for contractor testing preparations, coordination of tests, identification of issues and their resolution, and verification of test results. A web application will be available for use by contractor Test Coordinators to report and track issues and problems identified during integration testing.

2.4. Systems Development. Approximately 60 calendar days prior to the initiation of dental care delivery, the non-claims processing systems and the telecommunications interconnections between these systems shall be reviewed by TMA or its designees, to include a demonstration by the contractor of the system(s) capabilities, to determine whether the systems satisfy the contract requirements. This includes the telecommunications links with TMA and Defense Enrollment Eligibility Reporting System (DEERS). This review is in addition to Benchmark testing. The contractor shall make any modifications required by TMA prior to the initiation of services.

2.5. Execution of Agreements with Contract Providers.

2.5.1. All contract provider agreements shall be executed, and loaded to the contractor’s system, 60 calendar days prior to the start of dental care delivery date, or at such other time as is mutually agreed between the contractor and TMA.

2.5.2. The contractor shall begin reporting on network adequacy on a monthly basis three months prior to the first day of dental care delivery.

2.6. Memorandum Of Understanding (MOU) with TMA Beneficiary Education and Support (BE&S) Directorate. The contractor shall meet with the TMA BE&S Directorate within 60 calendar days after dental care contract award to develop a MOU, including deliverables and schedules. The MOU shall be executed within 90 days of the MOU meeting with the BE&S. The contractor shall provide copies of the executed MOU to the Contracting Officer and the Contracting Officer Representative within 10 calendar days following the execution of the MOU.

2.7. Transition-In of Remote ADDP Enrollment.

2.7.1. No later than 45 calendar days prior to the start of dental care delivery, DMDC will provide the Gold File to the incoming contractor identifying ADSMs who are newly eligible for remote care by virtue of moving into an area that has an MTF but no DTF. No later than 10 calendar days prior to the start of dental care delivery, DMDC will provide any updates to the file. The timing of this file transfer may be modified as needed during the Outgoing/Incoming Transition Meeting.

2.7.2. No later than 30 days prior to the start of dental care delivery, the incoming contractor shall contact all current remote ADDP enrollees by mail to inform them of the new contractor’s assumption of the ADDP contract, its effective date, enrollment and transition provisions.

2.8 Outgoing Contractor’s Weekly Shipment of History Updates and Dual Operations.

2.8.1. Ongoing Transfer of Claims History Updates. The outgoing contractor will transfer to the incoming contractor, in a mutually agreed format, all processed claims history in accordance with the specifications in the final transition schedule. The transfer will occur at least weekly, or in accordance with the specifications in the final transition schedule, until such time that all claim-related processing is completed by the outgoing contractor.

2.8.2. Claims Processing Dual Operations. During the period in which both the incoming contractor and the outgoing contractor are processing claims (365 calendar days after the start of dental care delivery under this contract), the outgoing contractor will transfer to the incoming contractor processed claims files following each processing cycle or according to a schedule determined during the Outgoing/Incoming Transition Meeting. The incoming contractor shall utilize the processed claim history files received from the outgoing contractor for claim adjudication beginning with the first claims processing cycle.

2.8.3. Transition-In Requirements Related To Transitional Cases. In notifying beneficiaries of the transition to another contractor, the incoming and outgoing contractors shall include instructions on how the beneficiary may obtain assistance with transitional care. If the outgoing contractor succeeds itself, costs related to each contract will be kept separate for purposes of contract accountability.

2.8.4. Health Insurance Portability and Accountability Act of 1996 (HIPAA). The incoming contractor, as a covered entity under HIPAA, may honor an authorization or other express legal document obtained from an individual permitting the use and disclosure of protected health information prior to the start of dental care delivery date (HHS Privacy Regulation, §164.532).

2.8.5. Residual Processing. The outgoing contractor will process all residual claims with dates of service prior to the start of dental care delivery and received up to 365 days after the date of service. The filing deadline for residual claims is one year from the date of service. The outgoing contractor will also complete processing of written and telephonic inquiries, appeals and grievances related to dental care provided prior to the start of dental care delivery.

2.9. Web-Based Services And Applications. NLT 60 days prior to the start of dental care delivery, the incoming contractor shall demonstrate to TMA successful implementation of all web-based capabilities as described in the contract.

3.0 READINESS DEMONSTRATION.

The incoming contractor shall arrange to provide a demonstration of its readiness to perform all requirements of this contract no later than 60 days before the date of dental care delivery. The demonstration shall take place at the incoming contractor’s primary business location and shall include the TMA Contracting Officer, Contracting Officer's Representative and Program Office representative(s). The demonstration shall include, but is not limited to, review of enrollment and eligibility processes, authorization and referral.

3.1. Instructions for Benchmark Testing.

3.1.1. Prior to the start of dental care delivery, the incoming contractor shall demonstrate the ability of its staff and its automated enrollment, authorization and referral, and claims processing systems to accurately process TRICARE claims in accordance with current requirements. This will be accomplished through a comprehensive Benchmark Test. The Benchmark Test is administered by the contractor under the oversight of TMA and must be completed NLT 60 days prior to the start of services delivery. In the event that an incumbent contractor succeeds itself, the extent of Benchmark testing may be reduced at the discretion of the TMA Contracting Officer.

3.1.2. A Benchmark Test shall consist of at least 300 but not more than 1,000 network and non-network claims, testing a multitude of claim conditions including, but not limited to, ADDP covered/non-covered services, network/non-network providers, and eligible/non-eligible beneficiaries. This Benchmark Test will require a TMA presence at the contractor’s site.

3.1.3. A Benchmark Test is comprised of one or more cycles or batches of claims. When more than one cycle is used, each cycle may be submitted on consecutive days. Each cycle after the initial one will include new test claims, as well as claims not completed during preceding cycles. At the Government’s discretion, any or all aspects of claims processing may be tested, e.g., provider file development and maintenance including interface with the National Provider System when implemented, screening, coding, data entry, editing, pricing, data management, data linking, record building, and access control.

3.1.4. The contractor shall demonstrate its ability to conduct enrollment, authorization and referral, and claims processing functions to include: claims control and development, accessing and updating internal and external enrollment data, accessing and updating DEERS for eligibility status, submitting and modifying provider and pricing records, issuing referrals, applying allowable charge parameters, performing duplicate checking, applying prepayment utilization review criteria, adjusting previously processed claims, demonstrating recoupment and offset procedures and producing the required output for paper and electronic transactions (Dental Explanation of Benefits (DEOB), summary vouchers, payment records, checks, and management reports). Clerical functions will be evaluated including correctly coding procedures and accurately resolving edit exceptions. Enrollment functions may also be included in the benchmark. At the Government’s discretion, the Benchmark Test may include testing of any or all systems (internal and external) used by the contractor to process claims. Contractor compliance with applicable HIPAA requirements and security requirements will be included in Benchmark tests as appropriate.

3.1.5. The Benchmark Test will be comprised of both paper and electronic claims. The contractor can provide test scenarios with any internal conditions they feel appropriate for testing.

3.1.6. A Benchmark Test of a current contractor’s system may be administered at any time by TMA upon instructions by the Contracting Officer. All contractor costs incurred to comply with the performance of the Benchmark Test are the responsibility of the contractor.

3.2. Conducting the Benchmark Test.

3.2.1. At the time of the scheduled Benchmark Test a TMA Benchmark Team comprised of up to 12 people will arrive at the contractor’s work site to conduct the testing and evaluate the Benchmark Test results.

3.2.2. The amount of time a contractor shall have to process the Benchmark Test claims and provide all of the output to the Benchmark Team for evaluation will vary depending on the scope of the Benchmark and volume of claims being tested.

3.2.3. The contractor will be informed at the pre-benchmark meeting of the exact number of days to be allotted for processing the benchmark claims and test scenarios and providing all of the output to the Benchmark Team for evaluation.

3.2.4. The Benchmark Team will provide answers to the contractor’s written and telephonic development questions related to the test scenarios provided by TMA and will evaluate the contractor’s output against the Benchmark Test conditions.

3.2.5. The Benchmark Team will require a conference room that can be locked with table(s) large enough to accommodate up to 12 people. The conference room must also be equipped with two telephones with access to internal and outside telephone lines.

3.2.6. The incoming contractor shall provide up-to-date copies of the TRICARE Operations Manual (TOM), TRICARE Systems Manual (TSM), TRICARE Policy Manual (TPM) and a current American Dental Association’s Current Dental Terminology (CDT), in either hard copy or on-line, whichever is used by the contractor, explanations of the contractor’s DEOB message codes, edits, and denial reason codes, and any overlays required to evaluate DEOBs, checks, or summary vouchers.

3.2.7. The incoming contractor shall provide an appropriate printer and a minimum of three computer terminals in the conference room with on-line access to all internal and external systems used to process the Benchmark Test claims to include, but not limited to: provider files , including the contracted rate files for each provider; pricing files, DEERS; and any other files used in processing claims, predeterminations, and enrollments. The contractor’s requirements for issuing system passwords for members of the Benchmark Team will be discussed at the pre-benchmark meeting.

3.2.8. The contractor shall provide an organizational chart and personnel directory including telephone numbers. A listing of the contractor’s staff involved in performing the Benchmark Test by function (e.g., data entry, development, review, etc.) is also required. Claims flow/decision diagrams including authorization and referral requirements will be provided prior to the Benchmark Test.

3.3. Benchmark Test Procedures.

3.3.1. Approximately 60 calendar days following award to the Contractor, representatives from TMA will meet with the incoming contractor’s staff to provide an overview of the Benchmark Test and discuss the dates of the test and information regarding the administration of the Benchmark Test. TMA will provide the first set of test claims and supporting documentation to the contractor no later than three business days prior to the arrival of the TMA Benchmark team. At TMA’s discretion, the test must be completed NLT 60 days prior to the start of dental care delivery to allow time to make any needed corrections. The pre-benchmark meeting will be conducted at the incoming contractor’s claims processing site. Provider and beneficiary data, to include enrollment forms and referrals, will be coordinated at the pre-benchmark meeting to ensure that the contractor adequately prepares all files prior to the Benchmark. Electronic transaction requirements shall be discussed to include timing and logistics.

3.3.2. On the first day of the Benchmark Test, a brief entrance conference will be held with contractor personnel to discuss the schedule of events, expectations and administrative instructions.

3.3.3. During the Benchmark Test the contractor shall process the claims and provide TMA with all output, including DEOB, summary vouchers, suspense reports, checks, and claims histories. Paper checks and DEOB may be printed on plain paper, with DEOB and check overlays. Electronic output is required for electronic transactions.

3.3.4. The contractor shall provide output for evaluation by the TMA Benchmark Team as the claims are processed to completion. The specific schedule for claims processing and the procedures for providing the output to the Benchmark Team will be discussed with the contractor at the pre-benchmark meeting.

3.3.5. TMA personnel will compare the Benchmark Test claim output against the benchmark test conditions for each claim processed during the test and provide the findings to the contractor. All appropriate contractor and Benchmark Team personnel shall be present to answer any questions raised during the Benchmark Test claims review.

3.3.6. At the conclusion of the on-site portion of the Benchmark Test, an exit conference may be held with the contractor staff to brief the contractor on all findings identified during the Benchmark. The initial test results will be provided to the contractor. The initial Benchmark Test Report will be forwarded to the contractor by TMA within 20 calendar days of the last day of the onsite test. For any claims processing errors assessed with which the contractor disagrees, a written description of the disagreement along with any specific references must be included with the claims. The contractor’s response to the Initial Benchmark Test Report shall be submitted to the TMA Contracting Officer within 20 days. Following the contractor’s response, TMA shall provide the Final Benchmark Test Report to the contractor within 20 calendar days.

3.4. Operational Aspects of the Benchmark Test.

3.4.1. The Benchmark Test may be conducted on the contractor’s production system or an identical copy of the production system (test system). Whichever system is used for the Benchmark, it must meet all TRICARE requirements and contain all the system interconnections and features of the production system in the contractor’s proposal. When the Benchmark Test is conducted on the contractor’s production system, the contractor shall prevent checks and DEOBs from being mailed to the beneficiaries and providers.

3.4.2. Certain external test systems and files (e.g., DEERS) are an integral component of the Benchmark Test and the contractor is expected to perform all necessary verifications and queries according to TRICARE procedures and policy. The contractor shall coordinate through TMA, Purchased Care Systems Integration Branch (PCSIB), to ensure that direct interface with any required external test systems (i.e., DEERS) is established and operational prior to the Benchmark Test.

4.0. CONTRACT PHASE-OUT.

Note: The contract phase-out requirements listed below are for this contract in the future, and therefore do not necessarily match the requirements of the outgoing contractor for the previous contract.

4.1. If the contractor is not the successful offeror for the successor contract, the outgoing contractor shall work to achieve a smooth and efficient transition of activities to the incoming contractor and to facilitate minimal disruption of services to enrollees and providers. The services required by the Phase-out CLINS will only be exercised in the event of a transition; therefore, the Government will only exercise this CLIN once if and when a transition occurs. If the contractor succeeds itself in successor contract, no phase-out will occur, thus the CLIN will not be exercised.

4.2. Phase-Out Plan. The outgoing contractor shall provide to TMA a proposed Phase-Out Plan within 60 calendar days following award of a successor contract. This plan shall include a timeline of major events and provide names of key individuals responsible for each of the functional areas involved in the phase-out of inventories, staffing and other resources, and activities under this contract, e.g., claims processing, appeals, grievances, support services, finance.

4.3. Outgoing/Incoming Transition Meeting. The outgoing contractor shall attend a meeting with TMA and the incoming contractor within 90 calendar days following award of a successor contract. Contractor representatives attending this meeting shall have the experience, expertise, and authority to provide approvals and establish project commitments on behalf of their organization. The purpose of this meeting is to finalize the schedule of events associated with the transfer of responsibilities and information to the incoming contractor and the phase-out of activities and workload from the outgoing contractor. TMA will notify all parties of the meeting date and location, and provide a draft transition schedule to all parties prior to the meeting followed by a revised schedule within 10 calendar days after the meeting. The outgoing contractor shall incorporate the applicable specifications of the final transition schedule into its Phase-Out Plan and submit the revised plan within 15 calendar days or as agreed to by TMA.

4.4. Travel costs. All transition related contractor travel costs shall be at the expense of the contractor.

4.5. Transfer of Information. The outgoing contractor shall provide to TMA (or, at the option of TMA, to the incoming contractor) any information as TMA shall require to facilitate transition from the outgoing contractor’s operations to operations under the incoming contract. Such information may include, but is not limited to, the following: enrollment information, claims processing history, active cases, active third-party liability cases, and information about the management of the outgoing contract that is not considered, under applicable Federal Law, to be proprietary to the contractor. The outgoing contractor shall provide samples and descriptions of applicable files at the Outgoing/Incoming Transition Meeting and, subsequently, any documentation (e.g., record layouts with specifications, formats, definitions of fields and data elements, access keys, etc.) necessary for read capability and conversion of any electronic files that may be transferred as determined at that meeting. In addition, the table below is provided as a guideline and is not all inclusive or absolute. It may be revised by mutual agreement of the involved parties at the Outgoing/Incoming Transition Meeting.

Information Files Transfers

File/

Information Type

Receipt Date General Description

4.6. Transfer Of ADP Files (Electronic). The outgoing contractor shall prepare in non-proprietary electronic format and transfer to the incoming contractor or TMA, by the 60th calendar day following the Outgoing/Incoming Transition Meeting unless, otherwise negotiated by the incoming and outgoing contractors, all specified ADP files, in accordance with specifications in the official transition schedule and will continue to participate in preparation and testing of these files until they are fully readable by the incoming contractor or TMA.

4.7. Ongoing Transfer of Claims History Updates. The outgoing contractor shall transfer to the incoming contractor, or other party as directed by the Contracting Officer, in a mutually agreed format all processed claims history in accordance with the specifications in the final transition schedule. The transfer shall occur at least weekly, or in accordance with the specifications in the final transition schedule, until such time that all claim-related processing is completed by the outgoing contractor.

4.8. Outgoing Contractor Monthly Status Reporting. Until all inventories have been processed, the outgoing contractor shall submit a monthly status report of inventories and phase-out activities to TMA beginning the 10th calendar day of the second month following the end of the contract period, until otherwise notified by the Contracting Officer to discontinue. This shall be done in accordance with specifications of the final transition schedule.

4.9. Final Processing Of Outgoing Contractor. The outgoing Contractor shall complete processing of its claims, adjustments, telephone inquiries, written correspondence, appeals, and grievances related to services under this contract within the contractually established standards until the start of dental care delivery. The outgoing Contractor is not required to comply with the contract standards after the start of dental care delivery by the incoming contractor (i.e. beginning the day after the end of the last option period).

4.9.1. Residual Processing. The outgoing contractor shall process all residual claims with dates of service prior to the start of dental care delivery and received up to 365 days after the date of service. The filing deadline for residual claims is one year from the date of service. The outgoing contractor shall also complete processing of written and telephonic inquiries, appeals and grievances related to dental care provided during the period of this contract.

4.10. Subcontractor Services. The Contractor shall be liable, after the termination of services under this contract, for any payments to subcontractors of the Contractor arising from events that took place during the period of this contract.

4.11. Phase-Out Requirements Related to Transitional Cases. In notifying beneficiaries of the transition to another contractor, both the incoming and outgoing contractors shall include instructions on how the beneficiary may obtain assistance with transitional care. The instructions must include at a minimum the date and amount the care is paid up to and the incoming contractor’s contact information. If the outgoing contractor succeeds itself, costs related to each contract will be kept separate for purposes of contract accountability.

4.12. The outgoing contractor shall maintain reduced toll-free lines and web-based customer service capabilities, accessible to the public during the 365 calendar days (Monday – Friday, 8 hours per day) following the expiration of the contract in order to properly respond to inquiries related to claims processed for services incurred during the period of their respective liability. Beneficiary inquiry lines will continue to be staffed in order to provide adequate customer service. The outgoing contractor shall maintain their IVR for beneficiary calls for the 365-day period and it will include information on how to contact the incoming contractor. The outgoing contractor is not required to comply with the contractually established telephone standards during this 365-day period.

4.13. Cost Accounting. If the outgoing contractor succeeds itself, costs related to each contract shall be kept separate for purposes of contract accountability, according to the above guidelines.

4.14 Records Disposition. The outgoing contractor shall comply with the provisions of TOM Chapter 2 in final disposition of all files and documentation. The contractor shall include a records disposition plan as part of their Phase-Out Plan.

HT9402-13-R-0001, Amendment 0001 J-5