Consolidated Teaming List and Info 040722.pdf

Defense Health Agency – TRICARE Claims Review Service (TCRS)

Solicitation HT940221R0002

List of Parties Interested in Subcontracting/Teaming

The following companies have expressed interest in possibly performing in a subcontracting/teaming capacity for the upcoming TCRS requirement:

1. ARC Healthcare

2. Claim Technologies, Inc

3. Defense Contract, Inc Solutions (DCI Solutions)

4. Deloitte Financial Advisory Service LLP

5. Gordon, LLC

6. Mindleaf Technologies Inc

7. Hyperscience

8. Neil Hoosier & Associates

The following pages include information that each company has requested be shared.

This is a living document, and any updates will be posted to SAM.gov.

*Disclaimer: Information included within this document has been provided at the request of the listed parties, and without any endorsement or assurances from the United States

Government or Defense Health Agency

ARC Healthcare:

Claim Technologies:

ABOUT CLAIM TECHNOLOGIES INCORPORATED

Veteran-Owned Small Business

Claim Technologies Incorporated (CTI) is a veteran-owned small business and Chapter S Iowa

Corporation founded in 1990. We conduct business from our Des Moines, Iowa office.

Our Mission

For over 30 years it has been CTI’s mission to help self-funded health plan sponsors reduce claim expense and improve service through independent audit and control of their third-party claim administration. While others may claim leadership in healthcare claims auditing, CTI pioneered the use of continuous quality improvement (CQI) techniques to better understand and improve administrator performance. Because we are an independent auditor, focused solely on claim administration, we are often hired by benefit consultants, public accounting, and actuarial firms to conduct healthcare claim audits for their clients. Our time-tested approach and years of industry experience allow us to contribute additional context to existing and future challenges facing our clients and the claim administrators who serve them.

What Sets Us Apart

Proprietary Audit Systems

CTI’s proprietary audit system is unmatched. Most competitors today use some technological tools in their health claim audits. But CTI’s computer-driven audit system is completely automated and fully integrated. We use a consistent, systematic approach to deliver thorough and accurate results. In the 30 years since we pioneered this computer-driven approach to health plan auditing, we’ve continued to enhance our audit system to adapt to industry trends, technological advances, and client-specific needs. Over the years we have invested thousands of hours to the ongoing development of these systems. We’ve got this down to a science, allowing us to audit more efficiently and deliver a greater return on audit investment.

Audit Methodology

CTI’s audit methodology is rooted in statistical process control and enhanced by a philosophy of

CQI. This methodology allows us to ensure a high degree of consistency in our approach to healthcare claim auditing. Efficient planning and maximized use of our proprietary systems and technology produces a streamlined audit product requiring fewer hours to complete than that of our competitors. When combined with the knowledge and experience of our long-tenured audit professionals, we significantly reduce the amount of time it takes to conduct an audit.

Auditor Experience

Healthcare claim auditing is all we do – allowing us to be completely independent and objective for our clients. CTI auditors have an average of 30 years’ experience, and all have insurance or third-party administrator experience.We are confident in our knowledge of administrator systems, processes, and procedures. In fact, our auditors have reviewed claims adjudicated by more than 200 third-party administrators in the last five years – including industry giants like

Aetna, UnitedHealthcare, Blue Cross Blue Shield, and Cigna.

Repeat Business

Our longest standing client relationship has spanned 16 years. During that time, we have conducted over 85 audits of their administrators. We pride ourselves on going above and beyond for our clients and we credit 80% of our revenue each year to repeat business.

Who We Serve

CTI values our long-term relationships with self-funded plan sponsors. We have served 20 state government health plans and worked with numerous counties, municipalities, school districts, and universities, the Federal Reserve System, the United States Postal Service, and Amtrak. In addition to serving public entities, we also work for leading private sector companies such as

Corteva/DuPont, BAE Systems, Anheuser-Busch, Ingersoll Rand, and Tyson Foods. In the past five years, we have conducted nearly 700 independent healthcare audits.

Data Security

CTI maintains the American Institute of CPAs (AICPA)'s Service Organization Control reporting platform SOC 2 compliance for data security.

CONTACT INFORMATION

Proposal Contact

Randall J. Brandt

Vice President

Telephone: (515) 244-7322 rbrandt@claimtechnologies.com < Caution-mailto:rbrandt@claimtechnologies.com >

Corporate Headquarters

Claim Technologies Incorporated 100 Court Avenue – Suite 306 Des Moines, IA 50309 Telephone: (515) 244-7322 http://www.claimtechnologies.com mailto:rbrandt@claimtechnologies.com

DCI:

POC: Christina Hercek Email: chercek@dci-solutions.com Phone: 443-220-6441

Deloitte:

Deloitte Financial Advisory Service LLP POC: Barton Bishop, bbishop@deloitte.com;

703.423.9407

Gordon:

GORDON is proficient in Compliance Auditing & Consulting Medical Review Coding & Billing Reimbursement & Improper Payment Provider Screening Project Management governmentrelations@gordon-llc.com

(301) 363-9186

Mindleaf:

Name of the Company: MindLeaf Technologies Inc Address: Connector Park, 59 Lowes Way, Ste 104, Lowell, MA 01851 (781)275-1845 (781)275-1847 www.mindleaf.com Cage Code: 1FWR3 Business Standard: Small Disadvantaged Business Point of Contact: Paresh K Shah Email: pshah@mindleaf.com and/or 781-275-1845 x 6202 Experience with DHA: Prime Contractor – Medical Support Services, CONUS + OCONUS operations.

Hyperscience:

POC: Chris Harr email: christopher.harr@hyperscience.com phone: (571) 241-2024 mailto:bbishop@deloitte.com mailto:governmentrelations@gordon-llc.com

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Easily build customizable and configurable Flows to route required documents or data outputs to specific teams or downstream processes. And, if any aspect of your process needs to change in the future, Flows are easy to edit.

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Easily create a Flow, a series of fully-customizable code Blocks that perform specific tasks such as classification, extraction, or validation within your business process. A Flow can automatically send requests to a BPM tool, for example, to start a new case after data has been extracted using Hyperscience, increasing straight-through processing.

CONFIRM

data outputs with external systems (so you can see if a submitted claim is from an active customer).

MODIFY

extracted data so it’s compatible with downstream systems.

ENRICH

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Discover the Hyperscience Platform Today:

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Modernize operations with the support of our subject matter experts, proven methodology, and global partner ecosystem - from planning and implementation to steady-state support and expansion.

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Lower Error Rates67%

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BACKGROUND

A large cabinet level federal civilian agency that provides near-comprehensive healthcare services and non-healthcare benefits.

Today, millions of claims are filed with the agency. These claims come in a variety of formats including mail, fax, and electronic submission. Almost all of the claims received contain a degree of handwritten text. Faced with a growing backlog of hundreds of thousands of claims and about 3 months processing time, the agency embarked on a 5-year contract.

The contract was for a variety of

SPEEDING UP CLAIMS PROCESSING AT A

LARGE CABINET LEVEL FEDERAL CIVILIAN

AGENCY

upgrades, including the automatic processing of incoming mail claims.

It’s the first step in a larger digitization effort for the agency, with the vision of providing greater visibility and transparency about where claims are in the process.

CHOOSING HYPERSCIENCE

The agency wanted to speed up processing times without sacrificing accuracy. It knew the variability and diversity of documents received required an intelligent, flexible solution.

To complicate matters further, these are large file submissions - often downloaded from the agency’s website, filled out by hand and mailed in - nearly all contain handwritten text and other difficult conditions that Optical Character Recognition [OCR] and other legacy products cannot reliably handle.

The Hyperscience Platform is built to tackle challenging conditions which cause legacy tech to fail, including scan/fax distortions, handwritten and printed text, and patterned or textured backgrounds. The Platform also uses a single extraction model for handwritten and machine printed text, as opposed to other products that require an operator to manually select which model to use.

Hyperscience’s proprietary Machine Learning models read outside the box and are smart enough to drop out details of the template to only return the relevant data. This enables Hyperscience to deliver the highest accuracy and automation rates available today, and it continues to learn on an organization’s data -behind their firewall - to drive lower error rates and higher automation.

With a tight timeframe for implementation and the help of IBM and their federal systems integration partner, Aptive, the agency was up & running with Hyperscience roughly two months after the contract was signed.

Hyperscience’s infrastructure-agnostic solution, robust API, and interoperability made standing up a production environment smooth and seamless, enabling the agency to handle high-volume processing.

Using Hyperscience today, the agency can quickly and efficiently classify documents while reliably extracting handwritten information. In the first three months, more than 1 million pages, or 115,000 claims, were processed automatically.

RESULTS DELIVERED

The agency measures success based on the rate of forms that can be accurately processed end-to-end.

Whereas with their old solution they were achieving roughly 77% accuracy rates, today with Hyperscience, they’re targeting - and exceeding

- over 96% accuracy and 99% automation.

In addition to decreasing claims processing intake times and reengineering their workflows to be more efficient and effective, they’re also freeing up valuable employee time to focus on more strategic, innovative initiatives that better serve constituents and their families now and into the future.

AT-A-GLANCE

Industry Federal Government

Goal Reduce claims backlog to respond to constituent claims faster.

Solution Leverage Hyperscience to automate incoming mail processing for constituents benefit claims.

Results

- More timely and reliable claims processing

- Over 115,000 claims processed automatically within the first 3 months

>96% Accuracy

>99% Automation

March 2022

Capabilities & Qualifications Related to Work on TRICARE Claims Review Services

Background

Neil Hoosier & Associates (NHA) is a small, SBA 8(a)-certified, minority-owned business established to focus its expertise toward providing innovative services and solutions for the healthcare industry. Appraised at Capability Maturity Model Integration (CMMI) for Services Level 3 Maturity, NHA has a reputation for accepting accountability and clearly defining roles and responsibilities, and is recognized for our work ethic, integrity, and reliability. As our past performance clearly indicates, we have demonstrated our ability to develop strong working relationships and communicate effectively with all levels of customers and stakeholders. We are particularly adept at working within associated groups of contractors as an independent entity performing functions on behalf of our customer and do so as part of several contracts.

Furthermore, our past performance ratings prove we can be trusted to follow through and deliver high quality services on schedule.

NHA personnel have extensive experience in health benefits, including private insurance enrollment;

marketing and sales regulations; claims processing and appeals regulations; coordination of benefits and recovery (COB&R); federal regulation, policy, and guideline development; medical record review (MRR); and contractor evaluations. Our staff includes project managers, business analysts, nurse and physician reviewers, and quality assurance analysts with certifications in coding and document improvement.

Requirements Alignment – Medical Record Reviews and Compliance Reviews

For 14 years, NHA has been reviewing first- and second-level Medicare appeals decisions under the Centers for Medicare and Medicaid Services (CMS) Evaluation and Oversight Contract. Our staff examine Medicare Part A, Part B, Part C, Part D, and durable medical equipment claims to determine the accuracy, timeliness, and quality of decisions as well as overall performance of Qualified Independent Contractors (QICs) and Medicare Administrative Contractors (MACs). Using proven processes and protocols, NHA develops evaluation protocols, performs onsite and remote audits to evaluate medical necessity and correct coding determinations, and reviews sample cases in accordance with Medicare’s national coverage guidelines, rules, and regulations. Our clinicians also conduct MRRs for adherence to compliance reviews for accurate billing for acute inpatient and outpatient level of care, as well as review files for proper billing ICD 9/10 codes and Diagnostic Related Group (DRG) validation to support reimbursement. Additionally, NHA provides CMS assurance that QICs are performing critical functions in their Statement of Work (SOW) in accordance with task order requirements. Our tools and processes could be quickly and easily adapted to support the TCRS contract.

NHA reports detailed findings for each evaluation as well as develops comprehensive composite reports.

From these reports we help to shape the overall appeals process with recommendations resulting in revisions to manuals, protocols, and SOWs.