Q A_Set_2.docx

TRICARE Dental Program

HT9402-15-R-0001

Question Set #2

1. Correction to previous response in Q&A Set 1 -#6. Claims data files. Request that the Government provide claims paid in foreign currency in each of the last 5 years. This information will be needed by offerors to understand the magnitude of this requirement.

RESPONSE: The Government previously responded to a question stating that the TDP contractor does not pay claims in foreign currency. This statement is not correct. Per Attachment J-6a paragraph 10.1, “If the claim is submitted by a TOPD and there is no assignment, the TOPD will be paid. If a provider submits the claim and requests that the payment be made to the enrollee, then the contractor shall forward the payment to the enrollee. Provider claims filed by the enrollee shall be paid to the enrollee in U.S. Dollars, unless the enrollee assigns payment to the provider in which case the payment shall be made in local currency.”

Claims billed in foreign dollars are converted to U.S. dollars for reporting purposes to the Government. The Government does not specifically track which currency was used to pay the claim. The claims data, that was previously provided, indicates the OCONUS claims by the Special Processing Code (CONUS or OCONUS) and also the Billing Provider ZIP Code.

2. Previously unanswered in Q&A Set 1 - #34. RFP Attachment J-15#2 Enrollee File. It appears the ZIP codes for 1,551 enrollees are reflected as non-U.S. but are really U.S. ZIP codes. Can the Government please clarify if offerors should ignore the country listed and replace with the corresponding state?

RESPONSE: Offerors should use the listed country code. It appears that the ZIP codes were not updated when the country code was updated in DEERS.

3. RFP Attachment J-15 #7 Claims Data. Please clarify the Government response for Question #4 in Questions and Responses Set #1 regarding the “Status Code 4” definition. For a claim that is marked with a status code of 4, should that claim be considered as a “Paid” claim, or is it an adjusted claim and the original claim has already been counted elsewhere?

a. In examining the data in field #21 in more detail, the definition and breakout of claims in this category is critical to determining an accurate and adequate premium level. Based on the response for Question #4, it is not clear whether claims with a status code of 4 are duplicative of claims already captured in status code 1, or whether claims with a status code of 4 represent an additional universe of payments not captured in status code 1. Please state whether claims labeled as Cancelled/Batch Paid represent an additional category of payments not included in status code 1 that are additive to the total identified as status code 1.

RESPONSE: DHA will provide a response in the near future. This response will extend the submittal date for Volumes 1, 2 and 4. However, Volume 3 Past Performance will remain due on April 28, 2015. Specifics of the extended submittal date will be clarified in a future Amendment.

HT9402-15-R-0001 Page 1 of 1 Questions and Responses #2