QA_Set_3_final.docx

TRICARE Dental Program

HT9402-15-R-0001

Question Set #3

1. Previously unanswered in Q&A Set 2 - #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: A claim that is marked with a status code 4 could be either a new claim or an adjusted claim. Status code 4 claims that were not captured in status code 1 or elsewhere represent an additional universe of claims.

The Government will be providing supplemental data for status code 4 claims that represent a claim payment not otherwise accounted for. The data will contain the following four fields: Persistent Key; Claim Number; Claim Line Item Number; and Procedure code. The offerors can merge this supplement data with the previously provided data to determine which of the status code 4 claims had payments not otherwise accounted for. The percentage of these paid status code 4 claims is a very small percentage of the status code 4 claims not otherwise accounted for. The remaining status code 4 claims (those not identified in this supplemental data set) that were not counted elsewhere can be considered as not having a benefit paid on them.

An Amendment will be posted extending the submittal date for Volumes 1, 2 and 4 to May 12, 2015. The submission date for Volume 3 Past Performance will remain due on April 28, 2015.

The combined electronic PDF will be submitted with Volumes 1, 2 and 4.

HT9402-15-R-0001 Page 1 of 1 Questions and Responses #3