Exhibit L-5_Price_Proposal_Template v1.xlsx

XLSX spreadsheet 26 KB Posted Jun 7, 2022

Attached to: TRICARE CLAIMS REVIEW SERVICE (TCRS) -- CANCELLED
Solicitation number: HT940221R0002
Issued by: Defense Health Agency

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File	Type	Posted
HT940221R0002_Amendment 0007.pdf	PDF	Nov 8, 2023
Exhibit L-5_Price_Proposal_Template_v3.xlsx	XLSX spreadsheet	Jun 16, 2022
HT940221R0002_Amendment 0004.pdf	PDF	Jun 16, 2022
HT940221R0002_conformed 0003.pdf	PDF	Jun 10, 2022
Exhibit L-5_Price_Proposal_Template_v2.xlsx	XLSX spreadsheet	Jun 10, 2022
HT940221R0002_Amendment 0003.pdf	PDF	Jun 10, 2022
Exhibit L-8_Historical TRICARE Overseas Program Data v1.xlsx	XLSX spreadsheet	Jun 7, 2022
Exhibit L-4_Solicitation Cross-Reference Table (Sections L M and C) v1.pdf	PDF	Jun 7, 2022
Exhibit L-9_Draft Quality Assurance Surveillance Plan (QASP) v1.docx	DOCX document	Jun 7, 2022
HT940221R0002_conformed 0002.pdf	PDF	Jun 7, 2022
Exhibit L-7_TCRS Historical Rebuttal Report (2017-2021) v1.xlsx	XLSX spreadsheet	Jun 7, 2022
Industry QA -- TCRS RFP Final Consolidated List.pdf	PDF	Jun 7, 2022
HT940221R0002_Amendment 0002.pdf	PDF	Jun 7, 2022
Section C_7.1.2 Contractor Employee Mandatory Training (FY22).pdf	PDF	May 26, 2022
Section C_7.1.1 DHA CAC Request Process.pdf	PDF	May 26, 2022
HT940221R0002_Amendment 0001.pdf	PDF	May 26, 2022
Section C_7.1.1 DMDC TASS Application.xlsx	XLSX spreadsheet	May 26, 2022
W030 Audit Status Report v1.pdf	PDF	May 26, 2022
Industry QA -- TCRS RFP Amendment 0001.pdf	PDF	May 26, 2022
R010 Transition In Plan v1.pdf	PDF	May 26, 2022
HT940221R0002_conformed 0001.pdf	PDF	May 26, 2022
Industry QA -- TCRS RFP 5.17.22.pdf	PDF	May 17, 2022
HT940221R0002.pdf	PDF	May 16, 2022
TCRS CDRLs.zip	ZIP file	May 16, 2022
Section L Exhibits.zip	ZIP file	May 16, 2022
Section J Attachments.zip	ZIP file	May 16, 2022

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Price Proposal Template

TCRS HT940221R0002
Section L Exhibit L-5 Price Proposal Template
OFFEROR:
		Price Proposal by CLIN
Period	CLIN/ SLIN	CLIN Description	Unit of Issue	Quantity	Price Each	Price Total
Transition-In	0001	Transition-in (Section C Paragraph 5.3.1 Transition-in). Fixed price	LO	1		$0.00
	0002	Deliverables (DD Forms 1423-1, Contract Data Requirements List (CDRLS)) Not separately priced (NSP)	NSP
Base total		Total				$0.00
Ordering Period 1	1001	Ordering Period 1 Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	16,000		$0.00
	1002	Ordering Period 1 TRICARE Medicare Eligible Program (TMEP) (currently TDEFIC) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	7,200		$0.00
	1003	Ordering Period 1 TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	4,800		$0.00
	1004	Ordering Period 1 TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	8,400		$0.00
	1005	Ordering Period 1 Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	2,500		$0.00
	1006	Ordering Period 1 Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C Paragraph 5.4.2.1) Fixed price per claim.	EA	11,000		$0.00
	1007	Ordering Period 1 Focus Studies (Section C Paragraph 5.5.1)	NSP
	1008	Ordering Period 1 Focus Studies -- PIIA Compliance Reviews (Section C Paragraph 5.5.1) Fixed price per claim. (Not applicable to OP1)	NSP
	1009	Ordering Period 1 Medical Record Reviews (Section C Paragraph 5.5.2) Fixed price per record.	EA	4,000		$0.00
	1010	Ordering Period 1 Transition-Out (Section C Paragraph 5.3.2) FFP	LO	1		$0.00
	1011	Ordering Period 1 Deliverables (DD Forms 1423-1, CDRLS) Not separately priced (NSP).	NSP
Ordering Period 1 Total						$0.00
Ordering Period 2	2001	Ordering Period 2 Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	16,000		$0.00
	2002	Ordering Period 2 TRICARE Medicare Eligible Program (currently TDEFIC) Quarterly Compliance Reviews (Section C Paragraph 5.4). Fixed price per claim.	EA	7,200		$0.00
	2003	Ordering Period 2 TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (Section C Paragraph 5.4). Fixed price per claim.	EA	4,800		$0.00
	2004	Ordering Period 2 TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	8,400		$0.00
	2005	Ordering Period 2 Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	2,500		$0.00
	2006	Ordering Period 2 Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C Paragraph 5.4.2.1) Fixed price per claim.	EA	11,000		$0.00
	2007	Ordering Period 2 Focus Studies (Section C Paragraph 5.5.1 )	NSP
	2008	Ordering Period 2 Focus Studies -- PIIA Compliance Reviews (Section C Paragraph 5.5.1) Fixed price per claim.	EA	16,100		$0.00
	2009	Ordering Period 2 Medical Record Reviews (Section C Paragraph 5.5.2) Fixed price per record.	EA	4,000		$0.00
	2010	Ordering Period 2 Transition-Out (Section C Paragraph 5.3.2) FFP	LO	1		$0.00
	2011	Ordering Period 2 Deliverables (DD Forms 1423-1, CDRLS) Not separately priced (NSP).	NSP
Ordering Period 2 Total						$0.00
Ordering Period 3	3001	Ordering Period 3 Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	16,000		$0.00
	3002	Ordering Period 3 TRICARE Medicare Eligible Program (currently TDEFIC) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	7,200		$0.00
	3003	Ordering Period 3 TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	4,800		$0.00
	3004	Ordering Period 3 TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	8,400		$0.00
	3005	Ordering Period 3 Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	2,500		$0.00
	3006	Ordering Period 3 Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C Paragraph 5.4.2.1) Fixed price per claim.	EA	11,000		$0.00
	3007	Ordering Period 3 Focus Studies (Section C Paragraph 5.5.1)	NSP
	3008	Ordering Period 3 Focus Studies -- PIIA Compliance Reviews (Section C Paragraph 5.5.1) Fixed price per claim.	EA	16,100		$0.00
	3009	Ordering Period 3 Medical Record Reviews (Section C Paragraph 5.5.2) Fixed price per record.	EA	4,000		$0.00
	3010	Ordering Period 3 Transition-Out (Section C Paragraph 5.3.2) FFP	LO	1		$0.00
	3011	Ordering Period 3 Deliverables (DD Forms 1423-1, CDRLS) Not separately priced (NSP).	NSP
Ordering Period 3 Total						$0.00
Ordering Period 4	4001	Ordering Period 4 Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	16,000		$0.00
	4002	Ordering Period 4 TRICARE Medicare Eligible Program (currently TDEFIC) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	7,200		$0.00
	4003	Ordering Period 4 TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (Section C Paragraph 5.4). Fixed price per claim.	EA	4,800		$0.00
	4004	Ordering Period 4 TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	8,400		$0.00
	4005	Ordering Period 4 Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	2,500		$0.00
	4006	Ordering Period 4 Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C Paragraph 5.4.2.1) Fixed price per claim.	EA	11,000		$0.00
	4007	Ordering Period 4 Focus Studies (Section C Paragraph 5.5.1 )	NSP
	4008	Ordering Period 4 Focus Studies -- PIIA Compliance Reviews (Section C Paragraph 5.5.1) Fixed price per claim.	EA	16,100		$0.00
	4009	Ordering Period 4 Medical Record Reviews (Section C Paragraph 5.5.2) Fixed price per record.	EA	4,000		$0.00
	4010	Ordering Period 4 Transition-Out (Section C Paragraph 5.3.2) FFP	LO	1		$0.00
	4011	Ordering Period 4 Deliverables (DD Forms 1423-1, CDRLS) Not separately priced (NSP).	NSP
Ordering Period 4 Total						$0.00
Ordering Period 5	5001	Ordering Period 5 Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	16,000		$0.00
	5002	Ordering Period 5 TRICARE Medicare Eligible Program (currently TDEFIC) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	7,200		$0.00
	5003	Ordering Period 5 TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	4,800		$0.00
	5004	Ordering Period 5 TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	8,400		$0.00
	5005	Ordering Period 5 Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	2,500		$0.00
	5006	Ordering Period 5 Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C Paragraph 5.4.2.1) Fixed price per claim.	EA	11,000		$0.00
	5007	Ordering Period 5 Focus Studies (Section C Paragraph 5.5.1)	NSP
	5008	Ordering Period 5 Focus Studies -- PIIA Compliance Reviews (Section C Paragraph 5.5.1) Fixed price per claim.	EA	16,100		$0.00
	5009	Ordering Period 5 Medical Record Reviews (Section C Paragraph 5.5.2) Fixed price per record.	EA	4,000		$0.00
	5010	Ordering Period 5 Transition-Out (Section C Paragraph 5.3.2) FFP	LO	1		$0.00
	5011	Ordering Period 5 Deliverables (DD Forms 1423-1, CDRLS) Not separately priced (NSP).	NSP
Ordering Period 5 Total						$0.00
Ordering Period 6	6001	Ordering Period 6 Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	16,000		$0.00
	6002	Ordering Period 6 TRICARE Medicare Eligible Program (currently TDEFIC) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	7,200		$0.00
	6003	Ordering Period 6 TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	4,800		$0.00
	6004	Ordering Period 6 TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	8,400		$0.00
	6005	Ordering Period 6 Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	2,500		$0.00
	6006	Ordering Period 6 Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C Paragraph 5.4.2.1) Fixed price per claim.	EA	11,000		$0.00
	6007	Ordering Period 6 Focus Studies (Section C Paragraph 5.5.1)	NSP
	6008	Ordering Period 6 Focus Studies -- PIIA Compliance Reviews (Section C Paragraph 5.5.1) Fixed price per claim.	EA	16,100		$0.00
	6009	Ordering Period 6 Medical Record Reviews (Section C Paragraph 5.5.2) Fixed price per record.	EA	4,000		$0.00
	6010	Ordering Period 6 Transition-Out (Section C Paragraph 5.3.2) FFP	LO	1		$0.00
	6011	Ordering Period 6 Deliverables (DD Forms 1423-1, CDRLS) Not separately priced (NSP).	NSP
Ordering Period 6 Total						$0.00
52.217-8, Option to Extend (6 months)	7001	Ordering Period 7 Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	8,000		$0.00
	7002	Ordering Period 7 TRICARE Medicare Eligible Program (currently TDEFIC) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	3,600		$0.00
	7003	Ordering Period 7 TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	2,400		$0.00
	7004	Ordering Period 7 TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	4,200		$0.00
	7005	Ordering Period 7 Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (Section C Paragraph 5.4) Fixed price per claim.	EA	1,250		$0.00
	7006	Ordering Period 7 Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (Section C Paragraph 5.4.2.1) Fixed price per claim.	EA	11,000		$0.00
	7007	Ordering Period 7 Focus Studies (Section C Paragraph 5.5.1)	NSP
	7008	Ordering Period 7 Focus Studies -- PIIA Compliance Reviews (Section C Paragraph 5.5.1) Fixed price per claim.	EA	16,100		$0.00
	7009	Ordering Period 7 Medical Record Reviews (Section C Paragraph 5.5.2) Fixed price per record.	EA	2,000		$0.00
	7010	Ordering Period 7 Transition-Out (Section C Paragraph 5.3.2) FFP	LO	1		$0.00
	7011	Ordering Period 7 Deliverables (DD Forms 1423-1, CDRLS) Not separately priced (NSP).	NSP
52.217-8 Total						$0.00
Total all Ordering Periods						$0.00
		Total Evaluated Price				$0.00

Section L, Exhibit L-7

TCRS HT9402-15-R-0003, Section L Exhibit L-7 Page &P of &N

Summary by CLIN, OP

TCRS HT940221R0002
Section L Exhibit L-5 Price Proposal Template
OFFEROR:
			Totals by Ordering Period							Total by
	Price Proposal by CLIN by Ordering Period	Base	OY 1	OY 2	OY 3	OY 4	OY 5	OY 6	52.217-8	CLIN
0001	Transition-in (Section C paragraph 6.3.1 Transition-in). Fixed price									$0.00
0002	Deliverables (DD Forms 1423-1, Contract Data Requirements List (CDRLS)) Not separately priced (NSP)
X001	Mangaged Care Support Contracts (MCSCs) Quarterly Compliance Reviews (PWS Paragraph 5.4)		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X002	TRICARE Medicare Eligible Program (currently TDEFIC) Quarterly Compliance Reviews (PWS Paragraph 5.4)		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X003	TRICARE Overseas Program (TOP) Quarterly Compliance Reviews (PWS Paragraph 5.4)		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X004	TRICARE Pharmacy Program (Tpharm) Quarterly Compliance Reviews (PWS Paragraph 5.4)		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X005	Active Duty Dental Program (ADDP) Semiannual Compliance Reviews (PWS Paragraph 5.4)		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X006	Mangaged Care Support Contracts (MCSCs) Annual Health Care Cost Audits (PWS Paragraph 5.4.2.1)		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X007	Focus Studies (PWS Paragraph 5.5.1 )		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X008	Focus Studies PIAA (PWS Paragraph 5.5.1 )
X009	Medical Record Reviews (PWS Paragraph 5.5.2)		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X010	Transition-Out (PWS Paragraph 5.3.2 )		$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
X011	Deliverables (DD Forms 1423-1, Contract Data Requirements List (CDRLS)) Not separately priced (NSP) Enter Estimated Cost on the "CDRL Cost Estimate" Worksheet
	Total per period	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
	Total all CLINs/Periods									$0.00
	6-month extension of services									$0.00
	Total Evaluated Price									$0.00

CDRL Cost Estimate

TCRS HT940221R0002
Section L Exhibit L-5 Price Proposal Template
OFFEROR:
	Estimated Cost for CDRLs	Base	OP 1	OP 2	OP 3	OP 4	OP 5	OP 6
0002	Deliverables (DD Forms 1423-1, Contract Data Requirements List (CDRLS)) Not separately priced (NSP)
X010	Deliverables (DD Forms 1423-1, Contract Data Requirements List (CDRLS)) Not separately priced (NSP)
	Total Estimated Cost for CDRLs	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
	Not included in the total evaluated price

File details come from the government source that posted it. Updated Jun 7, 2022.