R020_Appeals_Processing_Guidelines,_Desk_Instructions_and_Reference_Materials.pdf
PDF 137 KB Posted
- Attached to
- TRICARE Overseas Program (TOP) 2021 Solicitation - HT940219R0001 Federal contract opportunity
- Solicitation number
- HT9402-19-R-0001
- Issued by
- Defense Health Agency
About this file
This document contains a Contract Data Requirements List (CDRL) and related federal contract opportunity. The CDRL outlines data item requirements for the TRICARE Overseas Program (TOP) 2021 contract, including delivery of appeals processing guidelines, desk instructions, and reference materials. The federal contract opportunity is a solicitation for the TOP 2021 acquisition, seeking a contractor to provide a wide range of administrative health care support services for overseas beneficiaries. Key requirements include developing provider networks, referral management, eligibility verification, medical evacuations, record translation, claims processing, and beneficiary education. Proposals are due by October 31, 2019. The potential period of performance is one base year plus seven one-year options, for a total of eight years. The Defense Health Agency seeks to integrate military health system readiness, health, care, and cost through this contract.
R020 Appeals Processing Guidelines, Desk Instructions and Reference Materials
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Text version
DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
| 1_DATA_ITEM_NO: R020 |
| 2_TITLE_OF_DATA_ITEM: Appeals Processing Guidelines, Desk Instructions and Reference Materials |
| 3_SUBTITLE: INITIAL |
| 4_AUTHORITY_Data_Acquisit: |
| 5_CONTRACT_REFERENCE: TOM, Ch. 2, Sec. 10 & 32 CFR 199.10 |
| 6_REQUIRING_OFFICE: OGC |
| 7_DID_250_REQ: |
| 8_APP_CODE: |
| DIST_STATEMENT: B |
| 10_FREQUENCY: See Block 16 |
| 11_AS_OF_DATE: See Block 16 |
| 12_DATE_OF_FIRST_SUBMISSI: See Block 16 |
| 13_DATE_OF_SUBSEQUENT_SUB: See Block 16 |
| addressee1: Submit through the |
| draft1: |
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| 16_REMARKS: FIRST SUBMISSION: |
Frequency: One Time Reporting Period Start Date: Start of service delivery Due Date: 60 calendar days before start of reporting period
SUBSEQUENT SUBMISSION:
Frequency: As Required Reporting Period Start Date: Same as first submission Due Date: Within 15 days of update
PHI/PII: No FILE FORMAT: No specific file format required
CONTENT DETAILS:
The contractor shall deliver one complete set of its processing guidelines, desk instructions, and reference materials covering all tasks required in TOM, Chapter 2, Section 10 and provide updates as changes occur.
| 17_PRICE_GROUP: |
| ESTIMATED_TOTAL_PRICE: |
| G_PREPARED_BY: Chris Jung |
| H_DATE: 09/01/2018 |
| 1_APPROVED_BY: Chris Jung |
| J_DATE: 09/01/2018 |
| reg38t: 0 |
| A_CONTRACT_LINE_ITEM_NO: |
| B_EXHIBIT: |
| DSYSTEMITEM: |
| E_CONTRACTPR_NO: HT9402-19-R-0001 |
| FCONTRACTOR: |
| of_pages: 1 |
| Reset: |
| TDP: |
| OTHER: |
| TM: |
| Page number of this page: 1 |
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