Q A_Set__6_ADDP_Solicitation.docx

SOLICITATION H9402-13-R-0002

ACTIVE DUTY DENTAL PROGRAM (ADDP)

QUESTION AND ANSWER (Q&A) SET #6

1. Reference L.5.4 and L.6.4.1 L.5.4. Offerors shall report any intended performance outside the United States and Canada. The provision at L.1.12, DFAR 252.225-7003 must be completed and submitted in Volume I. In addition refer to TSM Chapter 1, Section 1.1 for ADP/IT II requirements.

L.6.4.1. The offeror shall describe how it will establish and maintain staff, facilities and proposed infrastructure in order to meet the requirements of this contract. If the offeror has existing staff, facilities and infrastructure that will appropriately meet the needs of this contract, it shall describe how these will be maintained. In addition, the offeror shall describe its plan for incorporating the ADDP claims, telephone calls, correspondence, and authorization volumes. (Note: The offeror must comply with Section L.1.12 if it intends to have performance of the contract outside of the United States. Also, note the ADP/IT I and II requirements in the TSM Chapter 1, Section 1.1.)

Request the Government clarify the reference to “L.1.12” in L.5.4 and L.6.4.1. We do not find the referenced paragraph in the RFP.

Answer: L.1.12 was renumbered to L.1.9. This was corrected in Amendment 2.

2. Reference the Data Files. We note a significant number of rejected procedures. In order to develop a realistic cost projection it is critical that offerors understand the data provided:

a. Please confirm the RFP contract substitution table (attachment J-5) exists in the current contract. If not, is a substitutions table applied to the current contract?

b. Does the data provided reflect both the rejected procedure and the covered procedure?

c. If a rejection is overturned on appeal, does the data include both the rejection and approval?

Answer: a. The same substitution table exists in the current contract.

b. The data reflects the covered procedure. The data does not reflect the rejected procedures. As stated in Q&A #2, question 4, “The claims data provided in November 2012 represents all paid claims. There are no denied/rejected claims in this file.”

c. If a rejected claim is overturned on appeal, then as a paid claim it is reported in the claims data that was provided in November 2012. The rejection frequency data provided in March 2013 indicates all rejected claims and the data is not revised when overturned by an appeal.

3. In regards to the Government's Question answer set #5, the question is not related to the utilization of D9999 procedures but is an inquiry on how to price this code. The spreadsheet (Exhibit A) that calculates the total cost for each option period includes utilization for these services. On this spreadsheet we need to enter a fee for each service for each option year. For all other services there is a fixed fee, however for this code (D9999) the fee can vary significantly. Therefore we want to ensure that we and all other offerors are treating these cells consistently. Our recommendation would be to either have all offerors put in a $0 fee for this code or to have the utilization for this code excluded for the analysis of each offeror’s bid.

Answer: We expect offerors to consider these circumstances in pricing this code, i.e, the amount billed by providers may vary significantly depending on the procedure(s) billed under CDT D9999. While the contractor may pay its providers according to its network agreements, the Government will pay the contractor the fixed price proposed for this code (as with all codes) under Exhibit A, which is incorporated into the contract. As with all other CDT codes in Exhibit A, the price for CDT D9999 will be included in the total evaluated price as specified in the RFP.