Responses_to_Questions.pdf

TRICARE Claims Review Services HT9402-17-R-0002 Response to Request for Proposal (RFP) Questions

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 1 | P a g e

Question No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

1. This is a LPTA solicitation. It asks for past performance information.

The usual method of evaluation past performance information is that if the offeror has no past performance, it is evaluated as neutral. On a pass/fail, acceptable or not acceptable criteria, that is usually considered pass, or acceptable.

That being the case, there is no benefit to submitting superb past performance. It is rated as acceptable, just as is no past performance. So, offerors are well advised to not submit past performance information.

At best it does not help. At worst it hurts.

So, you can save yourself work by removing the requirement that you evaluate past performance information. Simply avoid asking for it. With none submitted, each offeror is acceptable on that criteria (if it remains in your evaluation).

Will you remove the call for past performance information and save yourself some work?

The Government will not remove the Solicitation’s past performance evaluation criteria. The Government will evaluate past performance pursuant to the Solicitation, M.5.0. It is inaccurate to assume offerors can ensure an Acceptable past performance rating by refusing to disclose recent and relevant past performance information. The Solicitation, L.2.1.5 and M.2.2, state the CO may determine an offeror non-responsive and ineligible for contract award for failing to submit information required by the Solicitation. The Government advises offerors to carefully review the instructions of L.7.0, related to past performance information. In addition, M.5.1 states “(t)he Government will evaluate past performance information submitted by the offeror and any other past performance information that the Government has independently obtained.”

No. To be responsive an offeror shall comply with Solicitation Section L, especially paragraphs 2.1.7 and 7. DHA will evaluate proposals in accordance with Section M, paragraph 2.2.

2. Section L5.5, Small Business Participation, Subcontracting Plan

Attachment J-18, Subcontracting Plan

DHA has provided subcontracting goals in subsection 5.5.2,

1. Please confirm that the percentage goals stated in this subsection apply to the total subcontracted dollars.

2. The Subcontracting Plan provided as Attachment J-18 appears to be associated with a company.

Will DHA provide a subcontracting plan

1. See response below.

2. Attachment J-18 will be removed in a future amendment.

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 2 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

Subsection L 5.5, page L11 template?

Alternatively, will DHA permit offerors use their own subcontracting plan template in lieu of a government-provided template?

3. The title for Section L5.5 references a small business participation plan. Since the acquisition is a Lowest Price Technically Acceptable award, we assume that DHA does not require a small business participation plan.

Please confirm.

3. Subcontracting plan is required. The subcontracting plan will not be evaluated, but, will be incorporated into the contract.

3. Section L, Section C, Subsection 6.3, Section 6.4 Page L15, Subsection 6.3, page C12

Based on the proposed contract structure where claims review does not occur until Option Period 1, we assume that incumbent contractor will process all claim reviews during the transition period.

Please confirm.

Yes. The incumbent TCRS contractor is responsible for finalizing all compliance review work as part of the final option period CLIN. See Section C, paragraph 6.3.2 Transition-Out, for additional information regarding contract closeout and claim responsibility. This requirement is unchanged from the current TCRS contract.

4. Section B, Supplies or Services and Prices/Cost

Section B, Page 1

Given the six month transition period and the significant level of effort required for the transition activities, can offerors propose a payment schedule for the transition period in lieu of a one time payment at completion?

Allowing fixed price payments during the transition will provide a more equal playing field among small and large offerors.

No, the offerors cannot propose a payment schedule for the transition period in lieu of a one time payment at completion.

5. Attachment L, Exhibit L-8, Claims that have Rebuttals have a different cost than claims without rebuttals. Will the government allow for a separate CLIN and pricing structure for claims with 1 Rebuttal and another CLIN and pricing structure for claims with 2 rebuttals?

The proposed unit price per claim should include all work effort from the initial claim reviews through potential second rebuttal reviews. Reference Section L, paragraph 8.3.

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 3 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

6. Section C. Section 7.

Additional Requirements

7.1 Page C23

The PWS states “Generally, a 14 day notice will be provided for all meetings hosted by DHA, at one of its Government locations. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor”

In order to price this effort appropriately, please provide specific guidance to offerors on the number of trips each year, number of staff for each trip and to which DHA locations.

Historically the TCRS contractor has been required to attend meetings at the DHA Aurora, CO, government location no more than one to two times per option year. Historically about 3 people have attended meetings at the Government facility, however that may vary based on both the government and contractor discretion. Based on a fixed-price contract, DHA expects the offeror to propose to perform the TCRS tasks in a cost-effective manner.

7. Section C., Section 7.

Additional Requirements

7.1 Page C

The PWS states “Generally, a 14 day notice will be provided for all meetings hosted by DHA, at one of its Government locations. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor”

Would the government consider travel to be a cost reimbursable ODC?

No. Travel should be included in an offerors overall pricing proposal.

8. Section L, Section 2.2, Organizational Conflicts of Interest

Subsection 2.2.3.1 Page L5

The RFP lists companies that have actual or potential organizational conflicts of interest.

Are these companies prohibited from bidding on this contractor can they bid with an acceptable OCI mitigation plan? Please clarify.

See Section L, paragraph 2.2, Organizational Conflicts of Interest (OCI). which complies with FAR 9.504 and FAR 9.505-1 through 9.505-4 and DFARS 209.5, and Section H, paragraph 8. DHA strongly encourages offerors to read these references.

In Section L, paragraph 2.2, DHA identified those entities it determined have potential or actual OCI based on the work each entity performs for DHA.

The list is to “assist prospective offerors in developing their own business strategies regarding DHA requirements; and in doing so avoid, mitigate, and neutralize ANY actual and potential OCIs.” (Emphasis added.) The list is NOT all inclusive.

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/09.htm#P642_111956 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/09.htm#P663_116659

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 4 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

DHA will not respond to a potential offeror’s questions about another potential offeror’s OCI per FAR 3.104-3(a).

Each offeror is responsible for assessing whether it has a potential or actual conflict of interest and if the circumstances require mitigation. The mitigation plan shall address how the offeror will avoid, mitigate or neutralize any “actual” or “potential” OCIs. DHA strongly encourages offerors to familiarize themselves with FAR 3, Improper Business Practices and Personal Conflicts of Interest; and FAR 9.5, Organizational and Consultant Conflicts of Interest, and DFARS ). A potential offeror may submit questions about its own potential or actual OCI, and the contracting officer will determine what information, if any, may be provided to the offeror.

9. Section L, Table 1, Page L8 The RFP calls for Offerors to Submit an Organizational Change Roadmap describing changes to the offerors organization. Some companies have a history going back 50 or more years.

Will the government limit the organizational change roadmap to the past 5 years, which will provide sufficient information for the government to determine relevancy?

The “roadmap” required by the Solicitation, Section L, paragraph 7.8, is intended to “facilitate the Government’s relevancy determination.” Pursuant to Section L, paragraph 7.1.2, and Section, paragraph 5.2, the Government will only make relevancy determinations for recent efforts. For an effort to be recent, it must be ongoing or concluded within the last three years from the solicitation closing date. The offeror’s road map shall comply with Section L, paragraph 7.8. The Government cannot advise how far back the roadmap must go historically, as this may be different depending on offerors’ individual circumstances.

10. Section L, Section 4.12.1, Page L10 We assume that the organization chart is in addition to the page limit for each volume. Per section 4.12.1 DHA has asked that the organization chart be

The organizational chart will not count against the page count for each volume as outlined section L, paragraph 4.4.1, “The table of contents, index, and

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 5 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response placed in front of each volume.

Will the DHA clarify the requirement for page count for each volume?

tabs separating sections of the volume will not be counted as long as they do not contain proposal content.” The government will amend Section L, paragraph 4.4.1 in future amendment to include the organizational chart to the page exemption list.

11. Section L, Volume V, Financial Data

Page L22

It is very unusual to require a guarantee from either the parent company or company owners regarding performance and financing commitments.

Can DHA provide the context for this requirement?

Will DHA remove this requirement and instead rely on financial reports and D&B reports?

Reference FAR-9.104-3.

No.

12. Section H.

Subsection 4, Improper Business Practices and Personal Conflicts of Interest, page H9

Subsection 4 states that the contractor will evaluate the services of other contractors and therefore, will be precluding from bidding on future supply or services contracts which relate to those evaluated services. The PWS states that the contractor will conduct claims processing reviews of private sector contractors in accordance with the TRICARE purchased care contracts and other TRICARE manuals.

1. Please provide clarification on exactly what services the contractor will not be able to pursue in the future as a result of performing the Tricare Claims Review Services?

2. Specifically, does the limitation apply to future recovery audit services to identify and recover improper payments under the TRICARE program?

3. Does the limitation apply to provision of services under Managed Care Support

1. DHA will not respond to hypothetical scenarios.

2. DHA will not respond to hypothetical scenarios.

3. DHA will not respond to hypothetical scenarios.

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 6 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

Contracts for TRICARE and DHA only?

13. Section L, Subsection 7.7, Past Performance Questionnaires, page L19

In lieu of a past performance questionnaire for government contracts can Offerors provide a copy of the most recent project evaluation in the Past Performance Information Retrieval System (PPIRS) as part of their submission?

Will DHA allow contractor evaluations from PPIRS in lieu of submitting past performance questionnaires?

No, per Section L, paragraph 7.7.1. of the RFP, “The Government will not accept or evaluate any PPQs sent directly to the Government from a proposing offeror or its subcontractors.” The Government urges offeror to follow the requirements to be responsive.

14. Attachment J-5 DHA Sampling Methodology

Depending on the TRICARE contract type, the universe for a paid sample may contain between several hundred thousand to 30 million claims. All claims with a government payment amount above a high-dollar threshold (i.e., $200,000) are reviewed, and claims below this threshold are randomly sampled based on stratification of the government payment amount. The high-dollar threshold may fluctuate from one audit to the next, depending on the composition of the claims payment universe.

Low-dollar thresholds (i.e. claims with government payment amounts < $100.00) have been established in some contracts for sample exclusion due to historically low error rates for these claims and to ensure efficient utilization of audit resources.

We understand the sampling methodology in Attachment J-5 is to be conducted as a stratified random sample based on paid amounts and stratified sampling on billed amounts for the denied claims. This stratification process as currently defined limits TRICARE’s ability to measure each purchase care contractor’s performance against claims processing performance standards. We

No, the Government is not considering that type of change at this time.

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 7 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response believe there is an opportunity for the sampling methodology to be applied after the use of the comprehensive code auditing software on the entire volume of claims. Sampling (for both paid and denied) can then be performed post processing of the code auditing software to feed into the more detailed compliance reviews.

Will the Government consider modifying the requirement of the sampling methodology so that the code auditing software and process is applied to the entire volume of all claims instead of the sample claims selected for review?

This change to the sampling methodology is likely to yield more claims with a materially inaccurate claim payment, inconsistent policy instruction, incorrect reimbursement determination or other area of concern.

Further, this sequenced sampling methodology will be more effective at ensuring the accuracy of billing and coding for all TRICARE beneficiaries; not just those claims selected for review.

Finally, we believe the change is within scope of the RFP as it was previously disclosed that DHA continually evaluates the design of the sampling methodologies and implements revisions as warranted

15. Section B, Supplies or Services and Prices/Costs, Item #1006

Section B, Supplies or Services and Prices/Costs, Item #1006, states a volume of 7,500 for Option Period 1 Managed Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C paragraph 6.4.2.1), however in Section J, Yes. Section B, CLIN 1006 will be updated in a further amend to correctly reflect the estimated claim volume of 15,000 for MCS Annual Health Care Cost Audits, matching Section J, Attachment J-6, Compliance Review Schedule for Option

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 8 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

Attachment J-6, page 1 of 5 of the TCRS Compliance Review Schedule it states a volume of 5,000 under the MCS AHCC for North, South, West. Will the Government clarify the discrepancy?

Period 1.

16. Section C, 6.1.5 Section C, 6.1.5 of the solicitation references "CDRL R310, Compliance Review Procedural Guidelines, Desk Instructions, and Reference Materials" however, Exhibit A does not list CDRL R310. Will the government provide CDRL R310 in Exhibit A?

Yes. Exhibit A will be updated in a future amendment to include CDRL R310 – Compliance Review Procedural Guidelines, Desk Instructions, and Reference Materials.

17. PWS 6.5.1 Based on the fact that there is no reference to medical necessity or appropriateness of care, may we assume that nurses are not required for these focus study reviews?

This is a Performance Based contract. It is up to the offeror to determine how it will conduct focus studies and what labor categories and skill sets it will use to meet the solicitation requirements consistent with healthcare standards and best practices.

18. PWS 6.5.2.1 Based on the fact that this section states that these reviews are not intended to determine medical necessity or appropriateness of care/services rendered, may we assume that nurses are not required for these focus study reviews?

See response to question 17.

19. PWS 6.5.2.7 Please provide historical information regarding how many claims or records were escalated to a nurse practitioner or physician annually on the current contract.

Medical record reviews are a new requirement under this solicitation; therefore historical data/information in unavailable.

20. PWS—throughout and TCRS Section L Exhibit L-7 Price Proposal Template 4- 4-16.xlsx

Please provide the breakdown of the types of claims (in-patient, out-patient, SNF, HH, hospice, DME) that are included in the overall quantity by CLIN.

DHA does not have this information available since claim selection is based on a statistically valid sampling approach that selects claims based on a claims paid or billed amount and not by type or place of service.

21. PWS 6.5.2.2.4 PWS states “Purchased-care contractors will obtain the appropriate documentation from the provider of services within a designated time-frame and will submit the medical records directly to the contractor via the contractor’s DMS. The COR will provide

No. Reference Section C-6.5.2.2.4 which states “Once the government has selected a review topic the COR will work with DHA Program Offices and/or entities to direct purchased-care contractor to obtain copies of medical records

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 9 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response copies of notification letters to the contractor for information purposes.”

Will the contractor be responsible for requesting documentation from purchased-care contractors or providers of services?

required for review” (emphasis added).

22. Section K, FAR 52.204-8

(a) (1)

What is the NAICS code for this acquisition? The NAICS code for this acquisition is 541611.

Section K FAR 52.204-8 will be updated in a future amendment.

23. Section L, 4.3 The instructions state that “offerors may use 8-point Times New Roman for illustrations, organization charts, supporting data exhibits, report listings, or levels on process flows.” We assume that tables are considered supporting data exhibits and8-point font may be used in tables as well.

Is our assumption correct?

Yes.

24. Section L, 5.5.2 Small Business Participation/Subcontracting Plan

We assume that the goals stated in 5.5.2 are a percentage of total planned subcontracted dollars.

Is our assumption correct?

Yes.

25. Section F, Deliveries or Performance

Section F of the RFP and the Standard Form (SF) 33 appears to have different periods of performance.

Please clarify which period of performance is applicable for this effort.

The period of performance referenced in Solicitation Section F should be used. SF 33 and Attachment J-6 will be updated accordingly in a future amendment.

26. Section I, FAR 52.222-49 Service Contract Labor Standards-Place of Performance Unknown

(MAY 20214)

Section I, FAR52.222-49 states “the place of performance was unknown when the solicitation was issued.”

Will the government provide the place of performance?

Will work be performed on the government site or the contractor site?

No. Reference C.5.0, more specifically that the contractor shall provide all necessary facilities.

Contractor site. Reference Section C-6.4.2.1.1, last sentence which stipulates purchased care

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 10 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response contractors are required to submit claims document directly to the contractor.

27. Attachment J-10 Section 4. This section indicates that if a medical necessity decision is required during the compliance review, a nurse consultant will be utilized.

Would this be considered outside of the FFP pricing submitted?

If to be included, please provide information on which tasks the use of the nurse clinician is used and estimated level of effort historically needed for each task.

No. This is a fixed price, performance-based service contract, not a fixed-price level-of-effort contract as defined in FAR 16.207.

DHA will not prescribe how a potential offeror meets the TCRS requirements except where noted.

28. (1) Is there a current vendor that is providing these services?

(2) If there is a current vendor providing these services, are you able to provide the contract number and name of the vendor?

Yes.

The current TCRS contractor is Concept Plus LLC.

The contract number is H94002-09-D-0001.

29. 1_TCRS__SF_33_10-11-16:

p. 3, Item 1006;

2_TCRS_Section_B_CLIN_ Descriptions_6-7-2016: p. 1, Item 1006

For Option Period 1, is the estimated MCSC Annual Health Care Cost Audit claims volume for the entire period 7,500 or 15,000?

Reference response to question 15.

30. 1_TCRS__SF_33_10-11-16:

p. 2, Item 0002, p. 2;

16_TCRS_Section_J_Attach ment_J- 6_TCRS_Compliance_Revi ew_Schedule_6.7.16: p. 1;

6_TCRS_SECTION_F_10-

Is Option Period 1 anticipated to commence on March 1, 2017 or August 1, 2017?

August 1, 2017. Reference response provided for question 25.

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 11 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

6-16: p. 1, Section 2.0 Period of Performance

31. 16_TCRS_Section_J_Attach ment_J- 6_TCRS_Compliance_Revi ew_Schedule_6.7.16: All pages

Please clarify the overall claims assumptions offerors should use. The individual task volumes for OP1 & OP2 align with 2_TCRS_Section_B_CLIN_Descriptions_6-7-2016, but the Total Estimated Claim Volume do not. The Total Estimated Claim Volume for OP3-5 equal the individual task volumes show in J-6, but the individual task volumes do not correspond with OP3-5 in Section B.

The estimated claim volumes listed in Standard Form (SF) 33, CLIN 1006, Option Period 1 Managed Care Support Contracts Annual Health Care Cost Audits shall be updated to correctly reflected the estimated claim volume of 15,000 as is reported in Section B, and Section J, Attachment J- 6.

The estimated claims volumes for all option years and CLINS identified in Section B, match (other than the CLIN referenced above) both SF 33 and attachment J-6.

32. 20_TCRS_Section_J_Attach ment_ J- 10_DGA_Compliance_Revi ew_ Guidelines: p. 5

Chapter 1, Paragraph E of the Compliance Review Guidelines states that purchased-care contractors have 45 days to submit rebuttal comments. Does this timeline apply equally for initial rebuttals and second rebuttals? If not, what is the timeline for purchased-care contractors to submit second rebuttal comments?

Typically purchased-care contractors have 45-days to submit initial claims documentation to the TCRS contractor, and 30-days to submit rebuttal and second rebuttal comments. Time-lines may vary by purchased-care contract; however the government will always provide copies of DHA’s purchased-care contractor transmittal letters to the TCRS contractor. Reference Section C, paragraph

6.4.2.1.1 for further information regarding DHA transmittal letters.

33. 26_TCRS_Section_J_Attach ment_J- 18_SB_Subcontract_Plan:

all pages

Could DHA provide an editable Subcontract Plan template for offerors to complete (e.g., in Word)?

See response provided to question 2.

34. 29_TCRS_Section_L__10_ 6_16: p. L8 and L11

In Table I, Proposal Volumes, Volume I contents include OCI Representation and Mitigation Plan.

The detailed instructions for Volume I do not include OCI. Does DHA have a preferred form or format for documenting OCI information?

No, DHA does not have a preferred format for documenting OCI information. Reference response provided to question 8.

35. 35_TCRS_Section_L_Exhib it_L- Up to the release of the TCRS RFP, have any Focus Studies been conducted? If so, how many claims

No. This is a new contract requirement and therefor no historical data is available.

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 12 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

6_TCRS_Historical_Worklo ad_Report were included in the studies?

36. 35_TCRS_Section_L_Exhib it_L- 6_TCRS_Historical_Worklo ad_Report

Up to the release of the TCRS RFP, have any Medical Record Reviews been conducted? If so, how many claims have been reviewed to date?

See response provided to question 19.

37. (ALPS) is a Service Disabled Veteran Owned Small Business (SDVOSB). We have over 15 years’ experience in medical claims review and have been a subcontractor on the VHA External Peer Review Program since November 2005. On this project our nurses and coders review Veterans’ medical record to verify quality of care. ALPS is interested in participating in the TCRS solicitation as a subcontractor.

My question is – Is there a set-aside amount for SDVOSB participation? If not, will the government consider a set-aside for SDVOSB? Your consideration is appreciated.

No, there isn’t a set-aside set amount.

No the offer will propose a percentage of small business goals in accordance with L.5.5.

38. H and L

H: 8.1 Organizational Conflicts Of Interest (OCI);

L: 2.2 Organizational Conflicts of Interest (OCI)

Is working on both the TCRS contract and T2017 a conflict? We are a teaming partner with one of the named T2017 awardees and provide a very small deliverable related to the discovery and verification of Other Health Insurance. We are very interested in this opportunity and want to be sure we do not take other actions that could cause a conflict.

Reference response to question 8.

39. Is it expected that the contractor will work from paper or from scanned images? If scanned images are they standard templates or formats?

See Solicitation Section C, paragraphs 6.1.8, 6.1.7.

The contracting officer strongly encourages offerors to read all solicitation documents.

40. What are the supported channels to exchange data between the Contractor and the Government?

Reference Solicitation Section F, paragraph 6.

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No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response

41. What are the supported channels to exchange data between the Contractor and Providers?

There is no requirement for the TCRS contractor to exchange data or information to TRICARE providers.

42. Please list all GFE systems, their purpose, and the Government organization point of contact of ownership, associated with this solicitation.

Specifically for the applications listed under Section

4.2 – 4.2.2.2

The government listed all Government Furnished Information (GFI) in Solicitation Section C, paragraphs 4.2 through 4.2.2.2. As stipulated in the referenced paragraphs, offerors should reference Section J, Attachments J-16 and 17 for additional information regarding GFI systems/application(s).

43. How would the awardee access the Government GFE systems?

Reference Solicitation Section C, paragraph 4.2.2, Section J, Attachment J-1, and TRICARE Systems Manual Chapter 1, Section 1.1. The link to DHA’s TRICARE Manuals is provided at Section C, paragraph 2.1.

44. How would the awardee maintain GFE systems owned by the Government?

Awardees are not required to maintain Government owned systems /applications.

45. What are the security controls for access of the Government GFE systems?

See response provided for question 43.

46. Are automated rules created by the incumbent considered GFE?

No.

47. Does the Government maintain a Help Desk for GFE systems? What is the contact / engagement process?

See response provided for questions 43.

48. Will the Government provide connectivity to their applications? ( Both primary and DR)

See response provided for question 43.

49. Please detail the minimum baseline system requirements for computers accessing Government systems?

See response provided for question 43.

50. Is the Government "TA" system the system of record for reporting?

Yes.

51. How long and in what format is the contractor to retain documents, both paper and digital?

Reference Solicitation Section H, paragraph 1.4 and TRICARE Operations Manual (TOM), Chapter 9.

52. What are the SLA/ SLO on Government provided systems?

The government does not have service-level agreements (SLA) or service level objectives (SLO)

FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 14 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response for government provided systems. Contractors are however required to consult with the DHA Privacy Office to determine if the contractor must obtain a Data Sharing Agreement (DSA) or Data Use Agreement (DUA). Reference Section H, paragraph 1.8 and TRICARE Systems Manual (TSM), Chapter 1, Section 1.1.

53. What are the expected SLA/ SLO for Contractor systems?

See response provided for question 52.

54. Are background checks a contractor expense? Yes. Reference TOM, Chapter 2 and TSM, Chapter 1, Section 1.1.

55. General Please clarify the Period of Performance. The PoP dates in RFP/CLIN do not match Section F.2.0.

Reference response provided for question 30.

56. L, Subfactor 1 Does the Program Management Plan (PMP) go against the Technical Volume page count?

No. Reference Solicitation Section L, paragraph 6.2.5, last sentence.

57. L, Subfactor 2

Does the Internal Quality Management Program (IQMP) go against the Technical Volume page count?

Requirement in Section L, 6.3.1 asks offerorsto describe their IQMP which is included in the Technical Volume page count.

58. L, Subfactor 2 How many CDRLs are to be provided with the proposal response?

CDRLs AP020 and R010 are to be provided with the proposal response.

59. L, Subfactor 2 Do CDRLs go against technical volume page count?

Reference Solicitation Section L, paragraphs 6.2.5 and 6.4.2.

60. Section C, 6.4.2.1.1 “…[purchased-care providers] submit legible copies of processed claims information . . .”

Question: Are documents submitted by purchased-care providers submitted to the contractor in paper or electronically?

Reference Solicitation Section C, paragraphs 6.1.7 through 6.1.7.1, 6.1.8 and Section J, Exhibit A, CDRLs, CDRL number A020-A080.

61. Will the contractor be required to invoke National Correct Coding Initiative (NCCI) edits for non-institutional providers and OPPS services?

No. Reference Solicitation Section C, paragraph

6.1.6.2 which requires the contractor to maintain the TRICARE OPPS software. This software encompasses coding rules and guidelines from Centers for Medicare and Medicaid Services (CMS), the American Hospital Association (AHA), FOR OFFICAL USE ONLY SOURCE SELECTION INFORMATION FAR 3.104 & 2.101 15 | P a g e

No

Potential Offeror

DRAFT Solicitation Citation & Paragraph

Question/Comment DHA Response the Department of Health and Human Services (HHS), the American Health Information Management Association (AHIMA), etc. The CMS Outpatient Code Editor (OCE), Medicare Code Editor (MCE) and the NCCI are used to review correct coding.

62. C4, C.6.1.1.2 The contractor shall provide position descriptions for all staff/labor categories including required education, training, certifications, experience, and the number of full time equivalents (FTE) assigned to each labor category. At the minimum, each position description shall include the following information:

Labor Category Supervisory or non-supervisory position Minimum education Minimum professional experience Minimum professional certifications, licensure, and/or registrations Description of tasks performed and solicitation task reference

Question: How does providing positions descriptions for ALL staff/labor categories/FTE’s map to a FFP CLIN?

The information is to be provided for the Service Labor Standards Clause 52.222-41.

63. C5, C.6.1.2.1 NIST Certification of Compliance and Disaster Recovery.

Please provide the NIST reference Numbers required.

Reference Section J, Exhibit A, CDRL A010 and TSM, Chapter 1, Section 1.1.

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NIST Certification of Compliance and Disaster Recovery.

What systems are we certifying?

How often do we need to perform a DR "test"?

64. C9, C.6.1.10 What % of claims need to be translated?

How many different languages need to be translated?

The number of claims requiring translation is unknown. However, reference Section L, Exhibit L-9, which provides the historical claims processing workload and the TCRS contract audit workload for the TRICARE Overseas Program (TOP).

65. L9, L.4.4 L.4.4 states that if a required document is not listed in Table 2, then it does not have a page limit. Can required plans not included in the 50 page limit for Volume II be provided as an Appendix? For example the Program Management Plan (PMP), Internal Quality Management Program (IQMP), Transition-In Plan, etc.

For the PMP see response 56.

For the IQMP see response 57.

For the Transition-In Plan reference Section L, paragraph 6.4.

66. L9, L.4.4.1 Table 2, Proposal Page Limits

Will the Government explain the 3 page limit for organization chart?

Does that mean a graphical representation along with its supporting narrative cannot exceed 3 pages?

The contracting officer determined that a 3 page limitation was sufficient.

Yes.

67. L10, L.4.4.1 Will the Government consider increasing the page allowance for Volume II - Technical Proposal [NTE 50 pages] to enable the Offeror to adequately address the comprehensive nature of the requirements?

No.

68. L9, L.4.3 States that Narratives are to be double-spaced, Times New Roman, no smaller than 12-point but then it states that the font for both electronic and paper submissions shall be Times New Roman, and at least 12-point with normal spacing and kerning.

Please confirm the spacing requirement double-spaced or normal spacing?

Double spaced refers to line spacing within a document or a full space between lines, while normal spacing is referring to the space between characters. This will be addressed in a future amendment.

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69. L10, L.4.12 The offeror shall submit its proposed organizational structure in an organizational chart and shall include the prime offeror, the parent entity, affiliates, subsidiaries, teaming partners, and first-tier subcontractors. A first-tier subcontractor has direct responsibility for providing claims review services or performs functions related to claim or medical record reviews.

Question: Will the Government allow offeror to submit Org Chart on 11 x 17? If so, how many pages does is count?

70. L10, L.4.12.1 The offeror shall include company names, addresses and telephone numbers in the organizational chart.

The offeror shall disclose a clear description of the organizational relationships in the case of a joint venture or other business structure (e.g., subsidiary relying upon its parent corporation and/or relying on other corporate subsidiaries of its parent). The offeror shall place a copy of the organization chart in the front of each volume.

Question: Will the Government allow offeror to submit Org Chart on 11 x 17? If so, how many pages does it count?

No.

71. L10, L.4.12.1 Does the Government require only the graphic representation of organization chart at the front of each volume?

The government not only requires graphic representation of the organization chart as required in the Section L, paragraph 4.12.1, it also requires the company name, address, etc. as indicated in the first sentence.

72. L16, L.7.2.2 Please clarify the past performance requirements.

Shall the offeror provide a maximum of 3 total or 3 per team member?

As stipulated in Section L, paragraph 7.2.2, “The offeror shall provide a maximum of three recent and relevant contracts for itself and for each (emphasis added) of its first-tier subcontractors.”

73. Section C, The RFP states: “Upon receiving DHA notification

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Description/Specification/ Work Statement;

6.1.4 TRICARE Manual

Changes of a draft TRICARE Manual change, the contractor shall review and, if appropriate, provide timely comment on the proposed change to the government. Once manual changes are published, the contractor shall notify its staff of the specific TRICARE Manual change and ensure its staff uses the appropriate version of the TRICARE Manuals when evaluating healthcare claims based on the claim’s “processed to completion” date.”

Will DHA confirm the protocol used to convey the level of effort or cost impact associated these changes? While we expect that many changes will not impact the total cost, what is the mechanism for assessment and management of changes in scope that impact pricing?

DHA will not answer hypothetical questions. The government expects contractors to utilize their internal business experience and knowledge of industry practices to independently determine potential cost for manual changes.

74. Section C, Description/Specification/ Work Statement; 6.1.6

The RFP states: “6.1.6 The contractor shall ensure the following software/applications are readily available for use by its staff. The contractor shall maintain the current versions as well as predecessor versions of the following software.”

Is a predecessor version required for the first version to be installed upon implementation or going forward?

It’s possible the predecessor versions of software are needed especially if upon award the dates of services for a claim selected for review is prior to the TCRS contract start work date.

75. Section C, Description/Specification/ Work Statement;

6.1.7 Document

Management System (DMS)

The RFP states: “6.1.7.6 The contractor shall grant the Government access to its DMS. The COR will determine what government personnel require access to the DMS and provide a list to the contractor by the start of Option Period 1.”

Please provide an estimate of how many government personnel will be required to access to the contractor’s document management system.

At this time approximately 5.

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76. Section C, Description/Specification/ Work Statement;

6.1.10 Translation Services

The RFP states: “The contractor shall ensure that translation services are available to review claims submitted by host nation providers in any format, including narrative format and processed by the TOP purchased-care contractor to the appropriate medical and diagnostic codes.”

“Any format” is open to interpretation. Can the DHA please provide examples of formats that have been received in the past?

No. Please reference TOM, April 1, 2015, Chapter 24 which in general stipulates that the TRICARE Overseas Program contractor may accept any claim form or alternative documentation from foreign country healthcare providers or TRICARE beneficiaries who reside overseas, as long as the documentation provided contains sufficient data/ information to facilitate claims processing.

77. Section C, Description/Specification/ Work Statement;

6.2.3 Government (External)

QA Reviews

The RFP states: “The Government will conduct ongoing evaluations of finalized contractor reviewed claims.”

Will these reviews be performed once a year, or on a rolling basis?

No. The Government will determine the frequency and timing of government quality assurance reviews as deemed necessary and appropriate.

78. Section C, Description/Specification/ Work Statement;

6.5.1.2 Government Process

The RFP states: “6.5.1.2.1 Once a study topic has been identified the COR will work with DHA Program Offices and/or entities directing purchased-care contractors to have claims information transmitted directly to the contractor within a designated time-frame.”

Can offerors specify a file format for use by the purchased-care contractors when extracting/submitting data for focused studies? This will ensure consistency; improve quality, and speed-up the required analysis work.

Yes. Reference Solicitation Section C, paragraph

6.1.8 and Section J, Exhibit A, CDRLs A020 – A080.

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79. Section C, Description/Specification/ Work Statement;

6.5.1.2 Government Process

What should the contractor do with the data for the focused study once the study is complete? Will this data be retained for some specified period (e.g., 90 days) – or should it be immediately deleted?

Reference Solicitation Section H, paragraph 1.4 – Records Management and TOM, Chapter 9.

80. Section C, Description/Specification/ Work Statement;

7.1 Government and

Contractor Visits/ Meetings

The RFP states: “All contractor travel costs associated with any of these meetings [all meetings hosted by DHA] shall be the responsibility of the contractor.”

Can the DHA provide a history of these types of meetings, or if possible, a proposed schedule of future meetings?

Reference response to question 6.

81. Section L, Instructions, Conditions, and Notices to Offerors; 2.2.4

Due to short timeframe for response development, it is possible that COI issues may be identified shortly before the submission of the response. In the event this happens, will DHA consider COI mitigation plans submitted along with proposal response as responsive, rather than 15 calendar days prior to the proposal due date?

No. The proposal due date will be extended to 11/30/2016.

82. Section L, Instructions, Offerors; 4.3

The instructions state proposal narratives are to be double spaced. Would the DHA consider removing this requirement for all volumes for easier readability and to ensure responses that are page constrained can be kept to the page limits set?

Reference response to question 68.

83. Section L, Instructions, Offerors; 6.2.5

The RFP states: “The offeror shall submit its Program Management Plan (PMP) in the format and description required by CDRL AP020. The offeror shall describe it process for integrating the proposed PMP to ensure accuracy and timeliness of services and products delivered, describe its approach for risk management and how risks will be mitigated, and describe its approach for developing a training program and process to ensure the solicitation requirements are met. The

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CDRL document shall not count against the 50 page limit.”

Because of the short proposal period and because many items are finalized during the contract start-up period, is it acceptable to submit a prototype/sample PMP with the submission, with the final due after contract award once more details are determined?

The offerors shall comply with Section L instructions.

With respect to the PMP, Section L, paragraph 6.2.5 instructs the offerors to submit a plan in the format and description required by CDRL AP020. While CDRL AP020 requires the awardee to submit a final PMP within five days of contract award, the Government will evaluate the offerors’ PMPs submitted pursuant to Section L instructions under the applicable Section M evaluation criteria.

84. Section L, Instructions, Offerors; 6.4 Subfactor 3, Transition-in

In order to assist offerors with the transition-in planning activities, will the DHA provide a copy of the incumbent contractor’s transition out plan?

No. Such information is proprietary to the incumbent contractor.

85. Section L, Instructions, Offerors; 7.4

The RFP states: “If the offeror or any of its first-tier subcontractors and teaming partners has had any contract terminated for default or cause within the last 3 years preceding submission of the proposal, the offeror shall provide documentation detailing the reason for the termination.”

Does this requirement relate to only contracts that are “relevant to this solicitation” as defined in Section M, Evaluation Factors for Award?

The offeror should disclose any terminations for default or cause within the last 3 years and the Government can decide whether they are relevant to the solicitation and how to use the information.

86. Section L, Instructions, Conditions, and Notices to Offerors;

9.0 Volume V, Financial

Data

Section 9.2 states offerors shall submit the DCMA Form 1620 04-04, Guaranty Agreement for Corporate Guarantor (Exhibit L-4).

Is an offeror that is a corporate subsidiary but that believes it can independently “demonstrate adequate financial resources to perform the prospective contract” still required to obtain an

If the offeror is a Corporate Subsidiary they are still required to submit a competed Guaranty Agreement For Corporate (Form Exhibit L-4, DCMA Form 1620 04-04).

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Question/Comment DHA Response express corporate guarantee of performance and submit a completed Guaranty Agreement For Corporate Guarantor Form (Exhibit L-4, DCMA Form 1620 04-04)?

87. Section L, Instructions, Conditions, and Notices to Offerors;

9.0 Volume V, Financial

Data

If offerors are permitted to proceed without submitting the Guaranty Agreement for Corporate Guarantor (Exhibit L-4, DCMA Form 1620 04-04), are offerors still required to submit the financial data requested in RFP Section L, Section 9.1-9.2 for their parent corporation(s)?

Yes.

88. Section L, Instructions, Conditions, and Notices to Offerors;

9.0 Volume V, Financial

Data

Can the Government clarify that, if required, the terms of the Guaranty Agreement For Corporate Guarantor Form (Exhibit L-4, DCMA Form 1620 04-04) are applicable only to this contract and no other government contracts?

Only to this contract.

89. Exhibit L-9 TRICARE Overseas Program Data (2010 - present)

This exhibit states “2010 – “present”. What date was constitutes “present”? Could a date be provided to show when the data was gathered?

Yes. Section L, Exhibit L-9 will be amended to reflect the date that constitutes present.

90. Does this proposal require the contractor to be affirmative action compliant?

Yes. Affirmative action compliance is applicable to this solicitation. The solicitation will be amended to include FAR 52.25 - Affirmative Action Compliance.

91. Based on previous audit experience, do you have an expectation as to total projected hours for the planned 63,400 claims? We are anticipating 12-15k hours but want to ensure we have a plan for adequate staffing levels

DHA does not have this information. The TCRS is a performance-based contract. It is the offeror’s responsibility to develop its technical approach to meet the requirements of the TCRS Solicitation.

See Solicitation Section L, paragraph 6.0, Section C, paragraphs 6.0 8.2 which provides the performance requirements under this contract.

92. The estimated 63,400 claims for Op Year 1 does not include medical claim reviews. Are there no medical record reviews currently anticipated?

Please advise as to the plan for medical review audits

Reference Section C, paragraph 6.5.2.2.5 and Section G, paragraph 3.1.2.

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93. Would a contractor be allowed to automate certain testing processes vs having an auditor test every attribute?

The TCRS is a performance-based contract. It is the offeror’s responsibility to develop its technical approach to meet the requirements of the TCRS Solicitation. See Solicitation Section L, paragraph

6.0. DHA will evaluate proposals in accordance

with Section M. See Solicitation Section M, paragraph 2.2.

94. What is the expectation as it relates to onsite testing at the insurance companies compared to offsite review?

The contract does not require the contractor to conduct on-site testing at insurance companies.

Reference Section C, paragraph 6.4.2.1. The contracting officer strongly encourages offerors to read all solicitation documents, contract requirements and the Federal Business Operations (FBO) notices carefully and to comply with all instructions to prevent the offeror’s proposal from being NONRESPONSIVE.

95. What testing attributes are expected for the focused studies (i.e. the risk area or testing the entirety of the claim like a compliance review)?

Reference Section C, paragraph 6.5.

96. What is the anticipated timeframe for the onsite contractor Readiness Test?

The anticipated length of the onsite Readiness Test is 5 business days. However the timeline may be adjusted (i.e. increase/decreased) to accommodate testing requirements.

97. Can you provide a high level synopsis of any previous claims testing performed?

Any pervasive issues encountered?

Average sample size?

An…