Industry QA -- TCRS RFP 5.17.22.pdf

Question Number

RFP/Manual Location Subsection/Citation Subject Question Government Response

1 General Is there a current contractor or sub-contractor qualified to compete for this contract?

Companies that are considered small businesses under NAICS 541611 are qualified to compete.

2 General Is the DHA satisfied with the work performed by the current contractor?

The contract is being recompeted as the period of performance has ended.

3 General Is there an interest in the addition of technology applications for improving management and program integrity?

The TCRS contractor manually re-adjudicates claims in accordance with TRICARE regulations and reimbursement requirements to detect errors in automated claims payments and or payment record coding.

4 General On average, how many medical review cases are completed per month? Per reviewer? By type?

The number of reviews is TBD. The optional CLIN for this focus study was exercised twice.

Each time, approximately 800 claims were sampled.

5 C C4 of C50 Is it expected that the current contractor will be transitioning out?

The current contract has a CLIN for transition out services.

6 C C18 of C50 Would the DHA consider oftware otehr than TRICARE CORE 3M Grouping Software?

No, the TRICARE 3M CORE Grouper is populated with TRICARE specific data. The Government must be able to validate Contractor findings.

7 C 5.1 C17 of C50 Please provide a projected level of effort estimate by performance elements

For Objective 1, Quarterly Compliance Review estimated volume, please refer to Attachment J- 6_TCRS_Compliance_Review_Schedule.

For Objective 2, Focus Studies, including PIIA, estimated volume, please refer to Section C 5.5.1.2.2.

For Objective 3, Medical Record Reviews estimated volume, please refer to Section C 5.5.2.2.1.

8 What is the current level of effort ?

It is incumbent on contractor to staff appropriately based on the requirement.

What are the current labor categories assigned to this existing contract?

It is incumbent on contractor to staff appropriately based on the requirement.

Is the DHA expecting new labor categories? Please provide the additional labor categories for coming phase of work.

It is incumbent on contractor to staff appropriately based on the requirement.

11 C 5.1.8 C20 of C50 Does the DHA have a current document management system that it expects to be used for the coming phase of work?

No, it is incumbent on contractor to maintain a DMS based on the requirement in Section C.

12 C 5.1.13 C22 of C50 Does the DHA require a full time records manager or can this work be included in another position?

This is a required position. It is incumbent on contractor to staff appropriately based on the requirement.

Would the DHA consider a solution for maintaining records in the cloud?

Please refer to Section C.5.2.

14 5.1.14 C22 of C50 Does the DHA require a full time system security administrator or can this work be included in another position?

This is a required position. It is incumbent on contractor to staff appropriately based on the requirement.

RFP/Manual Location Subsection/Citation Subject Question Government Response

15 C 5.1.1.2 C17 of C50

The tasks requirement states that the contractor "shall ensure that staff assigned to conduct medical record reviews have the appropriate knowledge, skills, experience, and credentialing such as Certified Professional Coder (CPC), Certified Professional Coder - Outpatient Hospital (COC), Certified Coder-Payer (CPC-P), Evaluation and Management Certified Coding Specialists and Certified Professional Medical Record Auditor (CPMA) (this is not an all-inclusive list), necessary to form an opinion consistent with industry standards and best practices.

What other positions would DHA expect to be included?

In addition to the requirements for Medical Record Reviews, the contractor shall ensure that a sufficient number of qualified staff with the appropriate knowledge, skills, experience and credentialing are available to meet all aspects of the contract. It is incumbent on contractor to staff appropriately based on the requirement.

16 L Pg L18 of L22

L.7.7.3 States "Questionnaires shall not be completed by employees representing the interests of the Offeror or its first-tier subcontractor(s) whose performance is being reviewed on the PPQ, including its own employees and those of parents, affiliates, subsidiaries, subcontractors, and other team members. How does this apply to where the proposed prime was a sub to the proposed first-tier subcontractor? Would DHA accept a questionaire completed from the proposed first-tier subcontractor?

No, questionaires provided by a firm with a stake in the outcome of the competition will not be considered.

17 Section C C7

Does the Government expect to require Key Personnel (KP) to be dedicated by the awardee contractor? If so, can the Government provide the LCATs and experience/education requirements for each KP and an overview of functional requirements?

There is no requirement for key personnel

18 Section C C7 If Key Personnel will be required, will these positions be limited to direct employees of the awardee, or will the Government allow awardee subcontractors to designate KPs?

There is no requirement for key personnel

19 Section C C4

Is it the intention of the Government that travel costs related to required travel by DHA are not reimbursable under this contract?

Given travel constraints and the existing public health emergency, will the Government accommodate non-in-person attendance to required meetings?

Per Section C.1.8, all contractor travel costs associated with any of these meetings shall be the responsibility of the contractor.

Logistical requirements for meetings are still TBD by the Government, due to the on-going pandemic.

20 Section C C13 What are the Security Clearance requirements for staff having access to the system named on Pages C13 – C14?

Please refer to Section H and Section C.7.1

21 Section C C19

The Government requires the awardee contractor to maintain the TRICARE Outpatient Prospective Payment System (OPPS) and Diagnosis-Related Groups (DRGs) Software. Will the Government accept the purchase expense of these systems as ODCs?

No, please capture these costs in your total evaluated price.

22 Section C C17 Can the Government provide staffing by the incumbent for the LCATs required under this contract with examples listed in 5.1.1.2?

No, the government cannot provide staffing of the incumbent

23 Section C C19 What is the Commercially Available off the Shelf (COTS) comprehensive code auditing software as described in 5.1.7.2 utilized by the incumbent?

We can not provide what the incumbent is utilizing

24 Section C C20 Can the Government provide details on how access to the systems listed in section 5.1.7.3 will be obtained by the awardee contractor?

The Government will facilitate Contractor access to Government systems post contract award.

RFP/Manual Location Subsection/Citation Subject Question Government Response

25 Section C C20

Is the DMS as described in section 5.1.8 currently used by the incumbent a propriety system or is it a Government system? If it is a Government system, will the awardee contractor by provided access?

The DMS system is proprietary, no further information can be provided.

26 Section C C21 Can the Government provide a list of languages for Translation Services as required in Section 5.1 11?

Exhibit L-8_Historical TRICARE Overseas Program Data.

27 Section C C25

Can the Government provide more details on the time-critical tasks required during Transition-In since this period is only 5 months (9/01/2022 – 2/28/2023) from the start of Order 1 Period (3/01/2023)?

The Transition-In period is a full 6 months.

Contractor should take into consideration all required events and milestones when creating the Transition-In Plan. The milestones in 5.1.2 are the time-critical tasks.

28 Section C C30

Can the Government provide historical data on focus studies for purposes of more informed pricing? How many studies has the Government ordered involving the incumbent? How many claims were part of each study? What as the length of time for each study?

Can the Government provide an example of a focus study to include topic, claim number, duration of study?

Focus studies are not separately priced and a PWS will be sent on an as needed basis that details specific requirements of the focus studies.

Historically, on an annual basis, one Focus Study and One Medical Record review were completed.

The claim counts were approximately 800 per study.

29 Section M M8

If only one (1) performance confidence assessment rating will be assigned for each offeror (Sect M.6.1) and that score is “Neutral Confidence” due to an offer not having any prior past performance (PP)relevant to the TCRS, can the Government elaborate on the impact of such PP rating to the offeror’s overall evaluation rating?

For example, how are the three evaluation factors (Technical Approach, Past Performance, and Pricing weighed? Equally or different evaluation weights? If different, can the Government provide a breakdown of each evaluation factor weight to total the overall evaluation percentage? As a further example, if an offeror is rated Acceptable or higher in Factor 1 Technical Approach and Factor 3 Pricing meets the best value criteria but Factor 2 Past Performance rating is “Neutral Confidence” would such an offeror still be under consideration for award?

Please refer to M.3.2. for how evaluation factors are rated. "Neutral Confidence" means "The offer or may not be evaluated favorably or unfavorably on the factor of past performance" as stated in M.6.5.2.

Section C - Decription/ Specifications/ Statement of Work

C.1.2

C.1.2. We clearly read and understand that DHA expects the TCRS contractor to manually audit and review claims. Therefore, if a bidder proposes any automated approach to auditing claims, we assume DHA would reject the bidder’s proposal. Is this a correct assumption?

The TCRS contractor manually re-adjudicates claims in accordance with TRICARE regulations and reimbursement requirements to detect errors in automated claims payments and or payment record coding.

Section C - Decription/ Specifications/ Statement of Work

C.5.1.7.2 C.5.1.7.2. ClaimCheck is no longer an actively supported software product. We ask DHA to provide the code editing product(s) currently being used by the TCRS incumbent contractor.

We cannot provide information about the incumbent

Please refer to Section C 5.7.2.

RFP/Manual Location Subsection/Citation Subject Question Government Response

Section C - Decription/ Specifications/ Statement of Work

C.5.1.7.2

C.5.1.7.2. Since ClaimCheck is no longer an actively supported software product, to audit each contractor appropriately, we assume the TCRS contractor would need to use the same specific code editing software used by the purchased care contractor so that the calculated results of the audit would be the same. If the TCRS contractor utilizes a different code editing software from the purchased care contractor, there would be instances where errors are assessed inappropriately because two different software editors adjudicate different parameters for some procedure codes. We respectfully ask DHA to provide what code editing software each of the incumbent purchased care contractors use so that the potentially high cost of obtaining the many different software licenses can be accurately estimated and included in the TCRS proposal.

Please refer to Section C 5.7.2. That is the only required comprehensive code auditing software.

Section C - Decription/ Specifications/ Statement of Work

C.5.1.7.3

C.5.1.7.3. The web links to both the “CMS Home Health (HH) PPS” and to the “TRICARE Rates and Reimbursement Website” both noted on page C-20 transfer to “Page Not Found” web pages. Please provide correct web page content links.

Tricare Rates and Reimbursement:

https://www.health.mil/Military-Health- Topics/Access-Cost-Quality-and-Safety/TRICARE- Health-Plan/Rates-and-Reimbursement

CMS Home Health:

https://www.cms.gov/medicare/medicare-fee-for-service-payment/homehealthpps?redirect=/homehealthpps

Section C - Decription/ Specifications/ Statement of Work

C.5.1.9

C.5.1.9. We respectfully request that DHA provide the most current MOUs between the TCRS incumbent and each of the purchased care contractors as noted in CDRLs A20 through A70. This will help bidders understand and plan for how each contractor will supply the electronic documents to the TCRS contractor for reviews.

The Government cannot provide the requested MOUs.

Section C - Decription/ Specifications/ Statement of Work

C.5.1.10

C.5.1.10. The TCRS contractor is required to receive 15-18 months of TED claims history from each purchased care contractor. These are defined on page C-22. This could represent a significantly large amount of data to be stored by the TCRS contractor. Will the claims history be filtered to only include beneficiaries (and/or providers) that are included in each audit sample, or is it expected that the entire 15-18 months of processed claims history be sent by each purchased care contractor to the TCRS contractor? Is it expected that all claims history data will be formatted following the specific TED data format, or do some purchased care contractors send claims history in proprietary formats?

The family history files are limited to the claims being sampled for audit. The format of the data is defined by the MOU's in Section C.5.1.9.

Section C - Decription/ Specifications/ Statement of Work

C.5.1.10

C.5.1.10. We understand that the TCRS contractor could use the 15- 18 months of processed claims history to perform duplicate claims check. Beyond that, how does DHA expect the TCRS contractor to use the claims history? It seems to be a large amount of data that would be of little use. What analysis of that data should be performed by the TCRS contractor?

The family history files are limited to the claims being sampled for audit. The format of the data is defined by the MOU's in Section C.5.1.9.

The family history files are used to validate adjustments and identify potential duplicate payments.

RFP/Manual Location Subsection/Citation Subject Question Government Response

Section C - Decription/ Specifications/ Statement of Work Section L - Exhibits

C.5.1.11

C.5.1.11. and Section L. Exhibit L-8 contains TOP workload data. It appears that a lot of TOP claims audited were from within the United States (example, 285 institutional claims from CA [California] on Excel line 30). Why would there be TOP claims to audit from within the United States?

TRICARE serves a somewhat transient beneficiary population.

Additional information about TOP claims processing scenarios can be obtained from the TRICARE Manuals.

38 Section L - Exhibits

Section L. There are spreadsheets in Section L that list historic workload volume for the Objective 1 Compliance Reviews.

However, the historic workload volume associated with Objective 2- Focused Audits, Objective 3-Medical Record Reviews, and Object 4- Continuity of Review Services was not included. We respectfully request that DHA provide the historic workload volumes for those three Objectives.

Historically, on an annual basis, one Focus Study and One Medical Record review were completed.

The claim counts were approximately 800 per study.

39 N/A N/A TRICARE Pilots and Demonstration Projects

In accordance with the FY 2017 National Defense Authorization Act (NDAA) the DHA has released multiple value-based care pilot programs. Are there specific TCRS implications, requirements, or assumptions related to the level of effort for supporting pilot programs that prospective contractors should include?

No, not at this time.

40 N/A N/A Sam.gov Posting When will the final solicitation be released? Please monitor sam.gov

41 N/A N/A Sam.gov Posting Will the DHA host another round of questions and answers once the final solicitation has been released?

The Government will provide answers to questions to ensure understanding of the requirement. See Section L.3.2

L-8 Historical TRICARE Overseas Program Data

Summary Workload Data Same Information for Other Contracts

Will the DHA please share information regarding the type of claims reviewed by the current TCRS contractor for the two Managed Care Support Contracts (MCSCs) East and West Regions and the TRICARE Medicare Eligible Program (TMEP) (i.e. institutional vs.

noninstitutional or inpatient length of stays or specialty volumes i.e.

2,000 pediatric claims, 1,000 physical therapy claims, etc.?)

Historically, random samples produced approximately 42% institutional; however, it could be closer to an equal sample of institutional vs non-institutional.

L-9 Quality Assurance Surveillance Plan

Table 1, Performance Standards Summary Matrix

Government QA Reviews Will the DHA please describe the frequency of random monitoring of the IPEB internal Compliance Review Tracking log? Is it once every two weeks, once a month, quarterly, etc.?

The monitoring is performed using the weekly workload reports. Those should be prepared and submitted per CDRLs W030 and W040.

L-9 Quality Assurance Surveillance Plan

Table 1, Performance Standards Summary Matrix

Government QA Reviews How long does the DHA want us to retain the IPEB internal Compliance Review Tracking log?

Records should be maintained in accordance with DHA Records Management Guidelines.

45 C4 of C50 1.6.1.1.1 Period of Performance (PoP) Transition In Period

Will the DHA please attach the latest version of the embedded attachments "DHA CAC Request Process.pdf, DMDC TASS Application.xlsx., and Contractor Employee Mandatory Training.pdf"?

Attached in final RFP.

46 C6 of C50 Section C Key Personnel 1.12 Key Personnel Does the DHA intend to identify Key Personnel or have the Contractor identify Key Personnel?

There is no requirement for key personnel

47 C6 of C50 Section C Key Personnel 1.12 Key Personnel If we hire personnel from the incumbent, can we redact the names of the personnel to protect their identities in our submission?

There is no requirement for personnel disclosure

48 C20 of C50 5.1.8.3 Document Management System

(DMS)

How many Government personnel will require access to our Document Management System?

Minimum of 5, Maximum of 7

49 C20 of C50 5.1.8 Document Management System

(DMS)

What is the Government's expectation for a retention policy of our documentation (length of time available and access to) post-rebuttal stage for each ordering period?

Records should be maintained in accordance with DHA Records Management Guidelines.

50 C25 of C50 5.3.1.2.1 Contractor Readiness Test Can we receive access to all TCRS solicitation relevant interface control documents and data dictionaries?

Please refer to the TRICARE Systems Manual.

Other relevant information will be provided after contract award.

RFP/Manual Location Subsection/Citation Subject Question Government Response

51 C28 of C50 5.4.2.1 Compliance Reviews - Quarterly/Bi-Annual/Annual

Does DHA expect a process difference between the quarterly/semi-annual and annual compliance reviews aside from the frequency and relevant claims?

DHA anticipates the process will remain the same.

52 C28 of C50 5.4.2.1.2 Data Formatting

In what file type will TADR and ADDP ADDR documents be provided? Will the underlying data of the TADR and ADDP ADDR reports be available for download as data files (e.g., .csv, .json, .xml)?

Yes, the TADR and ADDR are downloadable as .txt files.

53 C28 of C50 5.4.2.1.2 Data Formatting Is the TADR information in a structured format in the TA database? The TADR data is downloadable as a .txt file.

54 C28 of C50 5.4.2.1.2 Data Formatting Can we use the TADR information in database format or are we restricted to use the TADR paper format to import into our claims auditing software?

The TADR data is downloadable as a .txt file.

55 C28 of C50 5.4.2.1.2 Data Formatting Can the TCRS contractor batch upload final claims dispositions in the TED Audit Application?

No.

56 C29 of C50 5.4.2.1.8 Compliance Review Rebuttal Procedures

Outside of the formal compliance review rebuttal procedures, is there an expectation that the TCRS contractor would engage with the purchased-care contractors to explain findings?

No, not without Government direction. All findings are reviewed by the Government.

57 C29 of C50 5.4.2.1.8 Compliance Review Rebuttal Procedures

Outside of the formal compliance review rebuttal procedures, is there an expectation that the TCRS contractor would engage with the purchased-care contractors to confirm root causes?

No, not without Government direction. All findings are reviewed by the Government.

58 C30 of C50 5.4.2.1.9 Government Review and Final Error Determination

Are there opportunities for disputes after the final error determination where the TCRS contractor would have to support their conclusions?

A third review phase is possible, but rare.

59 C31 of C50 5.5.1.2.2 Focus Studies, Government Process

Will the DHA please advise if medical records reviews are included in the scope of the Payment Integrity Information Act of 2019 (PIIA) reviews whether it is in the first ordering period and beyond or commencing in a subsequent ordering period and beyond?

Medical record reviews are not within the scope of the PIIA audit at this time.

60 C31 of C50 5.5.1.2.2 Focus Studies, Government Process

Does the DHA expect a process difference between the compliance reviews process and the PIIA reviews process?

DHA anticipates the process will remain the same.

61 C31 of C50 5.5.1.2.2 Focus Studies, Government Process

As the TCRS contractor, is it within scope to perform or support any internal control testing in accordance with OMB Circular A-123 for the PIIA reviews?

QASP and quality assurance reviews will be utilized to support internal control testing.

62 C31 of C50 5.5.1.2.2 Focus Studies, Government Process

Will the PIIA reviews be a mix of the purchased-care contract claims (i.e. East, West, TMEP, TPharm) or will it be by specialty?

PIIA will be a random sample of purchased care claims.

63 C38 of C50

6.9.3 MHS Demilitarized Zone

Medical Community of Interest Business to Business Gateway

Questionnaire Will the DHA please provide the DHA B2B Gateway questionnaire referenced in this section?

Relevant information will be provided after contract award.

64 C40 of C50 Part 7, 7.0 Attachments/Technical Exhibit Listing

7.1.1 Contractor CAC Request

Process & 7.1.2 DHA's Contractor Training Instructions

Will the DHA provide timeline assumptions for system access or approving clearances for new employees?

Please refer to Section C 5.3.

65 C40 of C50 Part 7, 7.0 Attachments/Technical Exhibit Listing

7.1.1 Contractor CAC Request

Process & 7.1.2 DHA's Contractor Training Instructions

Can only CAC card employees work with the Government's CUI data or can other properly trained employees access the data once it is in our secure environment?

CAC cards are required.

66 I5 of I12 Section I Contract Clauses FAR 52.219-6 Notice of Total Small Business Set Aside (Nov 2020)

Will the DHA please confirm that all proposed subcontractors must be small businesses in accordance with the total small business set aside regulations? (Referenced under Section I FAR 52.219-6 Notice of Total Small Business Set-Aside (Nov 2020)).

Please refer to clause FAR 52.219-14 in final RFP.

RFP/Manual Location Subsection/Citation Subject Question Government Response

67 L8 of L22 L4 Proposal Preparation, L.4.1 Font Size

Useful graphics, such as workflows, sometimes cannot display searchable text. Can bidders include appropriate text in the captions of these illustrations so searches will find the graphic item successfully?

Yes

68 L8 of L22 L4 Proposal Preparation, L.4.1 Font Size Please clarify if the smaller font size also applies to content presented in tables.

Yes

69 L8 of L22 & L9 of L22 L4 Proposal Preparation, L.4.3 Page Limit

Will the DHA please confirm the page limit by volume for the technical proposal? Section L.4.3 states the technical proposal shall not exceed 50 pages inclusive of the exhibits, illustrations, attachments, flow diagrams, data dictionaries, figures, charts, and any other non-narrative documents. However, Table 2, Proposal Page Limits states that the technical proposal shall not exceed 40 pages, and Section L.6.2.2 mentions the Transition-in plan shall not count against the 50 page limit.

It will be 50 pages, inclusive of the 10 page transition in plan

70 L9 of L22 L4 Proposal Preparation, L.4.3 Page Limit

In Table 2 there is reference to the "The Transition-in Overview (included in Technical Proposal)". Will the DHA confirm if the 10 page limit is included within the 40 (or 50) page technical proposal page limit?

It will be 50 pages, inclusive of the 10 page transition in plan

71 L9 of L22 Section L Organizational Structure 4.11

Resumes Would the DHA consider adding resumes or resume summaries to validate personnel qualifications of those identified within the organizational chart?

It is incumbent on contractor to staff appropriately based on the requirement.

72 L12 of L22 Volume II, Technical Proposal, L.6.1.3

Program Management Plan (PMP) Are we able to cross-reference the PMP (CDRL AP020) within the Volume II Technical Proposal assuming these documents are located within the same volume?

Yes.

73 L22 of L22 Volume V, Financial Data, L.9.5

Unaudited Financial Statements

Will the DHA clarify for unaudited financial statements, does the contractor need to provide 3 years of Balance Sheets, Income Statements, Statements of Retained Earnings, and Statements of Cash Flows as well as a Statement of Projected Quarterly Cash Flows?

Language updated in Section L

74 L22 of L22 Volume V, Financial Data, L.9.5

Unaudited Financial Statements Will the DHA please clarify how many years of projected Income Statements and Balance Sheets are required?

Language updated in Section L

75 L22 of L22 Volume V, Financial Data, L.9.6

Supporting Narrative Will the DHA please provide its definition of "anomalies" or examples of anomalous financial data?

Language updated in Section L

76 L20 of L22 Volume IV, Price Proposal, L.8.6

CLINs Would the DHA consider the use of a general CLIN to capture costs that are shared across multiple CLINs (purchasing TRICARE CORE 3M Group Software for example)?

No, please capture these cost in your total evaluated price.

77 L21 of L22 Volume IV, Price Proposal, L.8.10

Reasonableness For the purchase of referenced software (i.e., TRICARE CORE 3M Group or ClaimCheck) does the DHA need multiple price quotes to justify the price reasonableness?

No, it's incumbent upon the contractor to make the determination if the price is reasonable