Revised_15_Jan_2015_responses.pdf

The following responses that were provided on 15 January 2015 are revised as indicated by track changes.

6. (3). Sections C.3.1, C.4.10.1 - The incumbent contractor has an advantage in modeling the enrollments and utilization based on their experience performing the current contract. To ensure adequate competition, please provide the historical data on enrollments as a percentage of the total number of TDP-eligible beneficiaries that were enrolled during each year of the current TDP contract.

Government Response: As stated in Section J, Attachment J-156, we intend to provide a listing of eligibles and enrollees. We will also provide the following enrollment data pertaining to the current TDP contract. Offerors will be able to determine the percentages.

CONUS Enrollment Data.

• By month per option period

• By Government premium (contribution/paid) plans

• By Subscriber paid plans (non-Government contribution)

• By single/family plan type

• By active duty/guard/reserve

• By Ccurrent enrollments, additions, retro-active additions, current cancels and retro-cancelsand disenrollments

• By Ttotal covered livescontracts

• Data collected May 2012 through Dec 2014

OCONUS Enrollment Data.

• By month per option period

• By Government premium (contribution/paid) plans

• By Subscriber paid plans (non-Government contribution)

• By single/family plan type

• By active duty/guard/reserve

• By Ccurrent enrollments, additions, retro-active additions, current cancels and retro-cancelsand disenrollments

• By Ttotal covered livescontracts

• Data collected May 2012 through Dec 2014

35. (30). Attachment J-16 Claims Data Page 3 of 10. Claims Data (provided from Government's system): Provides detailed claims data for Option Periods 1 through 3 (Aug 1, 2009 - July 31, 2012). The following information is provided for downloading purposes: This data is in a pipe-delimited text file format., The record length is ???, The line count is ????, The byte count is ???.

The data does not include any pending claims and claims that have not been processed, or the amount paid. Question/Comments.

a) Does claims data include submitted, allowed, and paid claims and procedures by service month/date/contract period and by ADA procedure code? If not, can that be supplied?

Government Response: Please refer to Section J, Attachment J-10 for a list of the data that will be provided. A data dictionary will be supplied with each data file, as applicable. Enrollee information will be encryptedde-identified. The data will not include provider identifiers other than a ZIP Code, pending claims, unprocessed claims, or any dollar amounts. No dollar amounts will be provided. The data does include the service date and procedure code, but the data does not specify by contract period. The final life cycle status resolution of the claim line item will be indicated. In addition, the Government will provide totals of enrollees meeting the Accidental Maximum and/or the Annual Maximum.

b) Is claims data available by the same splits of data used for eligible/enrolled data (as shown below)? If not, can that be supplied?

• State/Country

• 5-digit zip code

• Age Group o 0-1, 2-4, 5-18, 19 and up

• Sponsor Rank by o E1-E4 o Other for all remaining ranks

• Status by:

o Active Duty family member o Reserve Component (RC) member o RC family member o Survivor member

Spouses Children

Government Response: Offerors will be able to derive this information from the raw claims data provided except for Rank and Survivor Status. See previous response to a) above.

d) Since member coinsurance varies by pay grade (per Attachment 4- Cost Shares), does this means that claims/eligibility/enrollment data will need to be split by these categories. Can that data be supplied?

Government Response: DHA does not collect the claims data by rank. In Section J, Attachment J-15 the TDP Eligible Report and the TDP Enrollee Report include E1-E4 and higher ranks are indicated by “other.” The CONUS and OCONUS Enrollment Data reports will be revised to include rank.

g) Is any information available regarding in-network utilization versus out-of-network utilization? Is any information available regarding current network discounts?

Government Response: Offerors will be able to derive network utilization from the raw claims data provided. See previous response to a) above.The claims data will not include network utilization as it would give insight into the incumbent’s network, which is considered proprietary. Dollar amounts such as amount allowed or paid will not be released.