TOP_21_Section_B_CLIN_Descriptions.doc

Section B

SUPPLIES OR SERVICES AND PRICES/COSTS

ContinuatioN

CONTRACT LINE ITEM NUMBER (CLIN) Descriptions.

0001 Transition-in. CLIN 0001 establishes a firm, fixed price in whole dollars with no cents, unit of issue “Lot,” for transition-in tasks as defined in Section C, Description/ Specifications/Work Statement, paragraph C.26 and Draft TOM Chapter 24, Section 1. This amount shall include all costs and profit anticipated in the performance of transition-in tasks to accomplish the requirements in the contract and shall not include any costs associated with any other CLIN.

0002 Deliverables, DD Form 1423-1, Contract Data Requirements List (CDRLs) for Transition-In CDRLs. CLIN 0002 is a not separately priced CLIN for transition-in contract deliverables, which include, but are not limited to, data submissions, plans, reporting, and other documents, which are prepared and delivered in accordance with Section C, Description/Specifications/Work Statement; Section F, Deliveries or Performance, paragraph F.5; and Section J, Exhibit A, Contract Data Requirements List.

0003 Performance Readiness Validation (PRV)/Performance Readiness Assessment and Verification (PRAV). CLIN 0003 establishes a firm, fixed price in whole dollars with no cents, unit of issue “Lot,” for transition-in tasks to accomplish the requirements for PRV and PRAV activities in accordance with Section C, Description/Specifications/Work Statement, paragraphs C.26.3 and C.26.4.

X001 Healthcare Support—Prime Enrolled Members. CLIN X001 establishes fixed unit price per each member per month for TOP Prime Enrolled beneficiaries. The contractor shall furnish all necessary labor and materials to perform the administrative and support services associated with providing managed care services to TOP Prime Enrolled beneficiaries and any other TRICARE beneficiaries who are not included in CLINs X002 and X003, as stated in Section C, Description/Specifications/Work Statement, paragraph C.1.2.

X002 Healthcare Support—Prime Remote Enrolled Members. CLIN X002 establishes a fixed unit price per each member per month for TOP Remote Prime Enrolled beneficiaries. The contractor shall furnish all necessary labor and materials to perform the administrative and support services associated with providing managed care services to TOP Remote Prime Enrolled as stated in Section C, Description/Specifications/Work Statement, paragraph C.1.2.

X003 Transient Care Management. CLIN X003 establishes fixed unit price per case for administrative and health care support services, including cashless, claimless access to routine, urgent and emergency health care, to eligible transient beneficiaries when they receive care outside the 50 United States and the District of Columbia, as stated in Section C, Description/Specifications/Work Statement, paragraph C.21.

X004 Transient Ambulance/Aeromedical Evacuation Services. CLIN X004 establishes a fixed unit price per case for providing transient ambulance/aeromedical evacuation services as stated in Section C, Description/Specifications/Work Statement, paragraph C.14.

X005 Written Translation Services—Routine. CLIN X005 establishes a fixed unit price per each page for providing routine translation services as stated in Section C, Description/Specifications/Work Statement, paragraph C.19.

X006 Written Translation Services—Urgent. CLIN X006 establishes a fixed unit price per each page for providing urgent translation services as stated in Section C, Description/Specifications/Work Statement, paragraph C.19.

X007 Claims Processing Fee—TRICARE Eligible (Defense Healthcare Program). CLIN X007 establishes a fixed unit price per each claim for processing and adjudicating claims for TRICARE beneficiaries who are non-Medicare eligible, as stated in Section C, Description/Specifications/Work Statement, paragraph C.16.

X008 Claims Processing Fee—Medicare Eligible (Medicare Eligible Retiree Health Care Fund). CLIN X008 establishes a fixed unit price per each claim for processing and adjudicating TRICARE claims for TRICARE beneficiaries who are dual-eligible beneficiaries (TRICARE and Medicare Eligible), as stated in Section C, Description/Specifications/Work Statement, paragraph C.16.

X009 Access to Care in Kinshasa—Democratic Republic of the Congo. CLIN X009 establishes a fixed unit price per each member per month for obtaining access to services at Centre Medical de Kinshasa/Centre Privé d’Urgence (CMK/CPU) for Active Duty Service Members stationed in that location, as stated in Section C, Description/Specifications/Work Statement, paragraph C.42.2.

X010 Medical Capability Reports. CLINs X010 establishes fixed unit price per each report for Medical Capability Reports, as stated in Section C, Description/Specifications/Work Statement, paragraph C.22, and Section J, Attachment J-10, Medical Capability Reporting.

X011 Block Overflight Permits. CLINs X011 establishes firm, fixed price in whole dollars with no cents, unit of issue “Lot,” for the purchase and use of Block Overflight Permits for TRICARE beneficiaries, as stated in Section C, Description/Specifications/Work Statement, paragraph C.14.10, and Section J, Attachment J-11, Block Overflight Permit Locations.

X012 Performance Incentive Pool. CLINs X012 establishes the firm fixed-price incentive with a unit of issue “Lot.” See Section H, Special Contract Requirements, paragraph H.6., for the criteria for earning the incentive.

X013 Deliverables DD Form 1423-1—Contract Data Requirements List (CDRLs). Not separately priced (NSP). CLINs X013 are not separately priced CLINs for data submissions, plans, reporting, and other documents, which are prepared and delivered in accordance with Section C, Description/Specifications/Work Statement; Section F, Deliveries or Performance, paragraph F.5; and Section J, Exhibit A, Contract Data Requirements List.

X014 Transition-Out. CLIN X014 establishes a firm, fixed price in whole dollars with no cents, unit of issue “Lot,” for transition-out services as defined in Section C, Description/Specifications/Work Statement, paragraph C.26, and Draft TOM Chapter 24, Section 1. Although priced for each option period, transition-out shall occur only once during the life of the contract. The transition-out period will run concurrently with the last exercised option period of the contract.

HT940219R0001

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