J-13 Transition-In v2.docx

Attachment J-13 Transition-In

1.0. CONTRACT TRANSITION-IN

1.1. Transition-In Requirements. The incoming contractor will have many time critical tasks to perform during the 12-month transition-in period that must be accomplished before the contractor can begin providing required dental services. Some of these tasks can be accomplished concurrently with others. However, certain tasks must be accomplished and certified as complete before the contractor can proceed. These critical sequential tasks include:

· Safeguarding Unclassified Sensitive DoD Information Certification The incoming contractor shall obtain acceptance of their attestation of compliance to their system infrastructure and covered contractor information system(s) via completion of the National Institute of Standards and Technology (NIST) Self-Certification Process (see Section C.5.1.). The contractor shall attest all system access requirements are met prior to accessing Department of Defense (DoD) data or interconnectivity with the Government systems and/or initiation of integration testing.

· Business to Business (B2B) Gateway After the contractor has obtained acceptance to their NIST Self-Certification for the system infrastructure and covered contractor information system(s), the contractor will work with the Government to establish an authorized secure connection via the DHA B2B Gateway or an authorized Government access point required to interface with the Military Health System (MHS) Data Repository (MDR) (see Section C.5.8), and Defense Manpower Data Center (DMDC) (see paragraph 1.6). The B2B Gateway or authorized Government access point must be established and tested before the contractor can begin testing the MDR and DMDC interfaces.

· Government Information Technology (IT) Systems Interface Once the authorized connection is operational the contractor can begin interface testing with Government IT systems required to verify ADSM eligibility, submit provider and enrollee utilization data reports, etc.

1.2. Post-Award Conference. Within 10 days following contract award, the incoming contractor shall attend a post-award conference (1-2 days) with the Contracting Officer and other Defense Health Agency (DHA) representatives at a location determined by DHA. The Contracting Officer or designee will notify all parties of the conference date. The purpose of this meeting is to provide an overview of the awarded contract, discuss the incoming contractor’s assumption of responsibilities, and the transition schedule. DHA and the contractor will also agree on the format for all transition reports.

1.3. Transition-In Integrated Master Plan (IMP) and Integrated Master Schedule (IMS). The incoming contractor shall submit its Transition-In IMP and IMS (in Excel format) no later than 15 days following contract award to allow Government oversight of the transition-in progress (see Section J, Exhibit B, Contract Data Requirements List (CDRL) R030, Transition-In IMP and IMS Plan). The contractor may view the DoD Integrated Master Plan (IMP) and Integrated Master Schedule (IMS) Preparation and User Guide, Version 9, October 21, 2005, at http://www.acq.osd.mil/se/docs/IMP_IMS_Guide_v9.pdf for guidance in developing their Transition-In IMP/IMS.

1.3.1. The contractor’s Transition-in IMP shall demonstrate that the contract transition is structured to provide a balanced technical approach, to minimize and control risk, to accomplish up-front summary planning and commitment, and to provide a basis for subsequent detailed planning. The Transition-in IMP shall include milestones and measurable indicators that can be used to evaluate the contractor’s progress toward being fully capable of providing services at the start of dental care delivery.

1.3.2. The Transition-in IMP/IMS shall address the transitions for the Active Duty Dental Program (ADDP), and the TRICARE Overseas Program (TOP) dental services, (see Section J, Attachments J-3a-b, Program Operations). The Transition-in IMP/IMS shall address all events and milestones that need to occur for each functional area described in this contract to enable the start of dental care delivery under this contract. Events include, but are not limited to, staff training; file conversion and testing; interface with DMDC, and the MDR; development of education and public relations, support services, provider networks, enrollment and claims processing systems. The Transition-in IMP/IMS shall address all processes and interdependencies associated with the provision of services to TRICARE beneficiaries. Interdependencies may include data such as exchanges, interfaces, and documents from the outgoing contractor and other entities.

1.3.3. The contractor shall identify an individual responsible for transition management who will serve as the single point of contact for the Government for all transition activities. This individual will be the overall coordination point for the management of the Transition-in IMP/IMS and coordinate and integrate interdependencies with the outgoing contractor and other entities associated with the transition of the contract.

1.3.4. The Transition-in IMP shall include the contractor’s in-process verification approaches. The Transition-in IMP shall provide the Government the ability to validate progress in order to make informed decisions. If multiple tasks are combined and identified in the Transition-in IMP as a single event, sufficient detail shall be provided to clearly identify all subtasks related to the single action.

1.3.5. The contractor’s Transition-in IMP/IMS shall address the contractor’s plan to mitigate identified risks. The Transition-in IMP shall be supported by a Risk Management Plan (RMP) that identifies risks to the successful execution of the contractor’s Transition-in IMP, to include risks resulting from interdependencies on activities by other parties associated with the transition. The Transition-in IMP shall include a Risk Management Strategy that clearly demonstrates how the contractor plans to mitigate risks identified in the RMP.

1.3.6. The Transition-in IMP/IMS shall include a subsection specific to Information Systems (IS). The IS subsection shall identify the management process and schedule to be used to develop and implement all IS, technical interfaces and security protocols. At a minimum, the subsection shall include contractor developed systems/applications, contractor and Government security, connectivity with all Government interfaces and applications and testing. The IS subsection shall be maintained and updated as appropriate to reflect changes to development and implementation of IS.

1.3.7. The contractor shall coordinate data conversion and testing activities with the Government and submit required documents within the timeframes established during integration/testing meetings, i.e. Test Plan, and Test Scenarios as indicated in the IMP/IMS, but no later than 30 days following the Systems Integration Interface Meeting (see paragraph 2.9, Data Conversion and Testing Activities).

1.3.8. The Transition-in IMP/IMS shall include a subsection that provides a staffing plan that delineates the hiring and training schedule of employees relevant to the stand-up of the contractor’s responsibilities. The Plan and Schedule shall be incorporated into the contractor’s Transition-in IMP/IMS. The training schedule shall be developed in order to ensure staff is trained with the requisite knowledge to perform the responsibilities of their position.

1.4. Records Manager. The contractor shall identify its Records Manager to the Contracting Officer within 10 days after the date of award. The contractor shall schedule its Records Manager to attend the next available DHA records management class in accordance with TRICARE Operations Manual (TOM), Chapter 9.

1.5. Transition Specifications Meeting. The incoming contractor shall attend a 2-4 day meeting with DHA and the outgoing contractor within 20 days of the transition start date. There will be a specific transition specifications meeting for each program, ADDP and the TRICARE Overseas Program (TOP) remote dental services, transition-in. Contractor representatives attending this meeting shall have the experience, expertise, and authority to provide approvals and establish project commitments on behalf of their organization. The purpose of this meeting is to finalize the schedule of events associated with the incoming contractor’s assumption of responsibilities and receipt of files from the Government and outgoing contractor, and also the outgoing contractor's transition-out of activities and workload. In addition, the incoming contractor will receive an overview from DMDC and specific DHA offices such as Program Integrity, Personnel Security Branch, and Communications. The Contracting Officer Representative (COR) will notify all parties of the meeting dates. The incoming contractor shall incorporate all specifications of the final transition schedule into its Transition-in IMP/IMS and submit the revised Transition-in IMP/IMS within 10 days or as agreed to by DHA (see Section J, Exhibit B, CDRL R030, Transition-In IMP and IMS Plan). The transition revisions will be incorporated into Transition-In IMP/IMS at no cost. The outgoing contractor will incorporate the applicable specifications of the final transition schedule into its Transition-Out/Residual Services Phase-Out Plan.

1.6. DMDC Systems Integration Interface Meeting (SIIM). The incoming contractor shall attend a 3-4 day meeting with representatives of DMDC, and DHA within 45 days after the transition start date. There will be a specific DMDC SIIM meeting for each program, ADDP and TOP remote dental services, transition-in. The ADDP and TOP meetings may be combined at the discretion of DHA. The COR will notify all parties of the meeting dates and location determined by DHA. The purpose of this meeting is to discuss the implementation and testing of the DMDC interface applications. The incoming contractor and the Government shall identify functions, technical details, areas of the interface application, and telecommunications needs that require clarification. This meeting will also be used to determine a schedule of activities for a timely and successful implementation of the interfaces. The contractor shall ensure that they will have representatives attend the DMDC SIIM who will also be attending the continued integration meetings as stated in the TRICARE Systems Manual (TSM). The DMDC SIIM will give these individuals a foundation for how the integration and interface was initiated. Prior to the meeting, the incoming contractor and the Government may participate in technical interchange discussions as needed. The incoming contractor shall submit an agenda and list of questions to be addressed to DHA no later than 5 business days prior to the meeting. Within 3 business days following the meeting, the incoming contractor shall submit minutes of the meeting to DHA for approval in accordance with Section J, Exhibit B, CDRL W010, Transition-In Status Report. The incoming contractor shall incorporate all events and milestones established for the DMDC interfaces into its Transition-in IMP/IMS.

1.7. DHA Finance Interface Meeting. Within 10 days following the Data Manpower Data Center (DMDC) Systems Integration Interface Meeting (SIIM), the incoming contractor shall submit suggested dates for the Finance Interface Meeting. For this meeting the incoming contractor shall attend a meeting with representatives of DHA in a method determined by DHA. The meeting times and frequency will be mutually agreed upon by all parties. DHA will notify all parties of the meeting times. The contractor may participate at these meetings via telephone conference call. The purpose of these meetings is to discuss the method in which the contractor shall interface with DHA for submission of the contractor’s invoices. The incoming contractor and the Government shall identify functions, technical details, other areas of the interface application and telecommunications needs that require clarification. The incoming contractor shall submit an agenda and list of questions to be addressed to DHA no later than 5 business days prior to the initial meeting. Within 3 business days following each meeting, the incoming contractor shall submit minutes of the meeting to DHA for approval in accordance with Section J, Exhibit B, CDRL W010, Transition-In Status Report. The incoming contractor shall incorporate all events and milestones established for the finance interfaces into its Transition-In IMP/IMS.

1.8. Follow-on Meetings. Additional meetings between the incoming and outgoing contractors, and other parties will occur as needed. The COR will notify all parties of the meeting dates and provide an agenda to all parties prior to the meeting. Within 3 business days following a meeting, the incoming contractor shall submit minutes of the meeting to DHA for approval in accordance with Section J, Exhibit B, CDRL W010, Transition-In Status Report.

1.9. Travel Costs. All transition related contractor travel costs shall be at the expense of the contractor.

2.0. START-UP REQUIREMENTS

2.1. Contractor Weekly Status Reporting. Beginning the first month following the transition start date and continuing through the third month following the start of dental care delivery under this contract, the incoming contractor shall submit weekly status reports of transition-in and operational activities to DHA (see Section J, Exhibit B, CDRL W010, Transition-In Status Report). The Contracting Officer may revise this reporting schedule based on the status of the transition and other operational factors.

2.2. Performance Assessment Tool Reporting. The incoming contractor shall attend initial training on the submission of deliverables within 30 days of the transition start date. Additional training for new users will be provided throughout the contract upon request (see TOM, Chapter 14). DHA and the contractor will agree on the format and any necessary revisions for all recurring reports and plans. Report templates will be finalized no later than 60 days prior to start of dental care delivery.

2.3. Military Health System (MHS) Data Repository (MDR). The incoming contractor shall coordinate with the DHA Dental Program Section within 90 days of the transition start date to revise and finalize the MDR data file layout (Section J, Attachment J-12, MDR Data Elements Layout). The incoming contractor shall submit a test file in accordance with the interface control document, no later than 60 days prior to the start of dental care delivery (see Section C.5.8)

2.4. Memorandum Of Understanding (MOU) with DHA Communications. The contractor shall meet with DHA Communications within 60 days of the transition start date to develop a MOU, including deliverables and schedules. The MOU will establish the review and approval process for annual education plans, and identify the DHA process for obtaining education materials. The MOU shall also address the ordering and bulk shipment of materials (see Section J, Exhibit B, CDRL R120, MOU with DHA Communications).

2.5. MOU with TOP. The contractor shall meet with the TOP contractor within 120 days of the transition start date to develop an MOU. The MOU will identify the process for medically necessary evacuations and/or transfers of ADSM ADDP dental patients when no dentist is available for ADSM dental emergencies. The MOU will also address the process of referring an ADSM to a medical provider for pain management pending travel to an area with a qualified dentist (see Section J, Exhibit B, CDRL R010, MOU with TOP Contractor).

2.6. MOU with Federal Employee Dental & Vision Insurance Program (FEDVIP). The contractor shall meet with FEDVIP representatives within 180 days of the transition start date to develop an MOU. The MOU will identify the process for coordination of claim payments when care was erroneously paid or denied for Reserve Component members that are enrolled in FEDVIP (see Section J, Attachment J-3b, Program Operations, and Exhibit B, CDRL R200, MOU with FEDVIP).

2.7. User Access Requirements. The incoming contractor’s Facility Security Officer (FSO) shall meet with DHA Personnel Security Branch (PSB) as scheduled at the Transition Specification meeting. The purpose of this meeting is to review personnel security requirements and the procedures for requesting background checks and Common Access Cards (CACs) in accordance with the TRICARE Systems Manual (TSM), Chapter 1, Section 1.1. The FSO shall undergo the required background check and obtain the necessary trustworthiness certification (Automated Data Processing/Information Technology (ADP/IT)) prior to approving requests for the remaining staff in the incoming contractor’s organization.

2.7.1. The incoming contractor shall ensure personnel complete appropriate background and security checks in accordance with the TSM, Chapter 1, Section 1.1.

2.8. Connectivity Requirements. The incoming contractor shall collaborate with the Government to establish the required interfaces with Government systems and applications. The contractor shall complete the submission of required forms (e.g., Business to Business Questionnaire, DD Form 2875, etc.) in accordance with the TSM, Chapter 1, Section 1.1. DHA will coordinate Business to Business (B2B) Gateway connectivity or authorized Government access point for the contractor. The B2B Gateway shall be completed and be effective no later than 120 days following the completion of the Systems Integration Interface Meeting (SIIM) specified in paragraph 1.6.

2.9. Data Conversion and Testing Activities. The contractor shall coordinate data conversion and testing activities with the Government and submit required documents within the timeframes established during integration/testing meetings, i.e. Test Plan, and Test Scenarios as indicated in the Transition-in IMP/IMS.

2.9.1. The incoming contractor shall provide documentation of compliance with the NIST-based IA program identified in Section C.5.1 to fulfill all system access requirements prior to connecting with the MHS and/or the initiation of integration testing. DHA Test Managers will work with the contractor to plan, execute and evaluate the Integration Testing efforts. The contractor shall identify a primary and a back-up Testing Coordinator to work with the DHA Test Managers. The Testing Coordinator is responsible for contractor testing preparations, coordination of tests, identification of issues and their resolution, and verification of test results. A web application will be available for use by Contractor Test Coordinators to report and track issues and problems identified during integration testing.

2.10. Receipt of Files. The incoming contractor will receive the files and information as indicated in the table below, Transition-In/Information Files Transfers. The incoming contractor shall complete any necessary conversion and testing as necessary to meet the schedule requirements established in the Transition Specifications, DMDC SIIM, and Finance Interface meetings, and the incoming contractor’s Transition IMP/IMS as approved by DHA. The listings in the tables are not all-inclusive or absolute. The lists are provided as a guideline and may be revised by mutual agreement of the involved parties at the Transition Specifications Meeting. The details of the information and data to be transferred to the incoming contractor will be determined at that meeting. To the extent possible, these files will be transmitted via electronic file transfer methods.

File/ Information Type

Receipt Date General Description

Public Relations/ Installation Listings

2.11. Transfer of Automated Data Processing (ADP) Files. The outgoing contractor will prepare all specified ADP files in non-proprietary electronic format and transfer to the incoming contractor in accordance with the schedule set at the Transition Specification Meeting unless otherwise negotiated by the incoming and outgoing contractors, and DHA. The contractor shall include non-proprietary file specifications and documentation as may be necessary for interpretation of these files. The outgoing contractor will continue to participate in preparation and testing of these files until they are fully readable by the incoming contractor or DHA.

2.11.1. The incoming contractor shall perform initial conversion and testing of all ADP files no later than 30 days following receipt of the files from the outgoing contractor. ADP file conversions testing shall be fully tested, loaded and operational prior to the start of dental care delivery. Integration testing will be conducted to validate the contractor’s internal interfaces. This testing will verify the contractor’s system integration, functionality, and implementation process. The incoming contractor shall be responsible for the preparation and completion of integration testing 45 days prior to the start of dental care delivery.

2.12. Systems Development. Approximately 60 days prior to the start of dental care delivery, the non-claims processing systems and the telecommunications interconnections between these systems shall be reviewed by DHA or its designees, to include a demonstration by the contractor of the system(s) capabilities, to determine whether the systems satisfy the contract requirements. This includes the telecommunications links with DHA, the Defense Enrollment Eligibility Reporting System (DEERS) and the MDR. The contractor shall make any modifications required by DHA prior to the initiation of services.

2.12.1. If the contractor utilizes their own link-analysis program, rather than commercial anti-fraud software, then the contractor shall submit their link-analysis program to the DHA Office of Program Integrity 90 days prior to the start of dental care delivery (see TRICARE Operations Manual, Chapter 13, Section 1).

2.13. Execution of Agreements with Network Providers

2.13.1. All network provider agreements shall be negotiated, executed, and loaded to the contractor’s system, 90 days prior to the start of dental care delivery date, or at such other time as is mutually agreed between the contractor and DHA.

2.13.2. The contractor shall begin reporting on network adequacy on a monthly basis 120 days after transition start date (see Section J, Exhibit B, CDRL M050, Provider Network Access Report).

2.14. Execution of Agreements with TRICARE OCONUS Preferred Dentists (TOPDs).

2.14.1. The DHA Dental Program Section will provide the current listing of TOPDs to the contractor. The contractor shall begin recruiting and reporting the number of TOPD agreements completed on a weekly basis no sooner than 90 days prior to start of OCONUS dental care delivery (see Section J, Exhibit B, CDRL W010, Transition-In Status Report). The contractor shall identify new TOPDs by provider’s name, specialty, implant training, gender, work address, and work telephone number to the COR, via email, within 15 days of completing a TOPD agreement (see Section J, Attachment J-3b, Program Operations for OCONUS).

2.14.2. The contractor shall begin reporting the number of TOPD agreements completed on a weekly basis 90 days prior to start of OCONUS dental care delivery (see Section J, Exhibit B, CDRL W010, Transition-In Status Report). The contractor shall identify new TOPDs by provider’s name, specialty, implant training, gender, work address, and work telephone number to the COR, via email, within 15 days of completing a TOPD agreement (see Section J, Attachment J-3b, Program Operations for OCONUS).

2.14.3. The contractor shall coordinate with the COR and the OCONUS Dental Service Points of Contact (DSPOCs) to determine if additional TOPDs are required in an area.

2.15. CONUS and OCONUS Remote Active Duty Service Member (ADSM) Enrollment.

2.15.1. No later than 45 days prior to the start of dental care delivery, DMDC will notify all ADSMs via email of the new contract. The email notification will direct the ADSM to the TRICARE website to obtain additional information. DHA will provide the content of the notification.

2.15.2. Remote ADSM dental enrollments that are in place at the start of the ADDP contract will continue as long as all remote eligibility requirements continue to be met. The incoming contractor will not have to re-evaluate remote enrollments.

2.15.3. The outgoing contractor is responsible for entering remote ADSM enrollments into DEERS up to the start of dental care delivery on the new contract. The incoming contractor shall start entering remote enrollments into DEERS as of the start of dental care delivery.

2.16. Transaction Testing. In the absence of the inclusion of testing requirements in updated Health Insurance Portability and Accountability Act (HIPAA) legislation, contractors shall comply with testing requirements in accordance with the Contracting Officer’s direction. At a minimum, testing shall include the following:

2.16.1. Contractors shall test their capability to create, send, and receive compliant transactions. Contractors shall provide written evidence (e.g., certification from a transaction testing service) of successful testing of their capabilities to create, send, and receive compliant transactions to the COR no later than 60 days prior to the start of dental care delivery (see Section J, Exhibit B CDRL W010, Transition-In Status Report).

2.16.2. Where failures occur during testing, the contractor shall make necessary corrections and re- test until a successful outcome is achieved.

2.16.3. Contractors shall test their capability to process standard transactions. This testing shall be “cradle-to-grave” testing from receipt of the transactions, through processing, and completion of all associated functions including creating and transmitting associated response transactions. Testing involving the receipt and processing of claims transactions shall also include the creation of contract compliant electronic Dental Explanation Of Benefits (DEOBs). It is expected that the contractors shall complete “cradle-to-grave” testing no later than 30 days prior to the start of services.

2.17. Ongoing Transfer of Orthodontic Claims History Updates. The outgoing contractor will transfer to the incoming contractor, in a mutually agreed format, all processed orthodontic claims history in accordance with the specifications in the final transition schedule. The transfer will occur at least weekly, or in accordance with the specifications in the final transition schedule, until such time that all orthodontic claim-related processing is completed by the outgoing contractor.

2.18. Claims Processing Dual Operations. During the period in which both the incoming contractor and the outgoing contractor are processing claims (365 days after the start of dental care delivery under this contract which is referred to the Residual Services Phase-Out period for the outgoing contractor), the outgoing contractor will transfer to the incoming contractor the processed orthodontic claims files following each processing cycle or according to a schedule determined during the Transition Specifications Meeting. The incoming contractor shall utilize the processed orthodontic claim history files received from the outgoing contractor for orthodontic claim adjudication beginning with the first claims processing cycle.

2.19. Residual Processing. The filing deadline for residual claims is one year from the date of service. The outgoing contractor will process all residual claims with dates of service prior to the start of dental care delivery of the succeeding contract and received up to 365 days after the date of service. The outgoing contractor will also complete the processing of written and telephonic inquiries, appeals and grievances (that are timely filed), and adjustments related to timely filed claims for dental care provided prior to the start of dental care delivery of the succeeding contract, until they are fully completed even if it is past the 365 days after the start of dental care delivery. For example: A claim is filed 364 days after care and denied 5 days later. The ADSM appeals within the contractual time limits and the claim is adjusted 30 days later.

2.20. Transitional Cases. In notifying beneficiaries of the transition to another contractor, the incoming and outgoing contractors shall include instructions on how the ADSM may obtain assistance with transitional care. If the outgoing contractor succeeds itself, costs related to each contract will be kept separate for purposes of contract accountability.

2.21. Authorizations and Referrals. The incoming contractor shall honor authorizations and referrals from the outgoing contractor.

2.22. Program Integrity. The incoming contractor shall receive case files and documentation regarding all open program integrity cases from the outgoing contractor no later than 30 days from the start of dental care delivery. The incoming contractor shall work with the DHA Program Integrity Office (PI) to ensure seamless continuity of oversight of these cases.

2.23. Health Insurance Portability and Accountability Act of 1996 (HIPAA). The incoming contractor, as a covered entity under HIPAA, may honor an authorization or other express legal document obtained from an individual permitting the use and disclosure of protected health information prior to the start of dental care delivery date (HHS Privacy Regulation, §164.532).

2.24. Web-Based Services And Applications. No later than 60 days prior to the start of dental care delivery, the incoming contractor shall demonstrate to DHA successful implementation of all web-based capabilities as described in the contract.

2.25. Processing Guidelines and Instructions. The contractor shall develop processing guidelines, desk instructions/user’s manuals and reference materials for internal use, at least 10 days prior to the start of dental care delivery. Desk instructions shall be available to each employee in the immediate work area. Reference materials such as procedure codes, diagnostic codes, and special processing guidelines, shall be available to each work station with a need for frequent referral. Other reference materials shall be provided in each unit with a reasonable need and in such quantity as to ensure the ease of availability needed to facilitate work flow. Electronic versions may be used. An electronic copy shall be provided to the COR for dissemination and use within the DHA Dental Program Office in accordance with Section J, Exhibit B, CDRL R100, Standard Operating Procedures (Desk Procedures), with updates provided as changes occur.