Industry QA -- TCRS RFP Final Consolidated List.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.

No, 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 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?

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

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.

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.

RFP/Manual Location Subsection/Citation Subject Question Government Response

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 (to be added) FAR 52.219-14

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

RFP/Manual Location Subsection/Citation Subject Question Government Response

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

Section B - Supplies or Services and Price/Cost

Section 1.2 Maximum Contract Value Can DHA please provide specifics on the contract ceiling increase of $13M?

Ceiling increased due to potential for PIAA

Section C - Description/ Specifications/ Work Statement

Section 1.8 and Section 1.14.4 Contractor Travel Please confirm that all travel costs associated are at contractor expense.

Yes.

Section C - Description/ Specifications/ Work Statement

Section 1.11.1 CAC Requirements Section 1.11.1 requires all personnel be issued a CAC. Please verify the claims auditing software should perform CAC authentication.

All Government systems require CAC authentication..

Access to Contractor network, applications, and the DMS do not require CAC authentication.

Section C - Description/ Specifications/ Work Statement

Section 3.5 DEERS Interface The RFP references the DEERS Interface Environment. Does this interface offer API access capable of supporting the eligibility check?

No

Section C - Description/ Specifications/ Work Statement

Section 5.1.7.3 Software/ Applications Would the government consider providing an API or other connection that could provide access to data from systems that are critical to the audit?

No

Section C - Description/ Specifications/ Work Statement

5.1.8 Document Management System Please provide the average electronic file size for each review type?

File size is dependent on the characteristics of the random sample.

RFP/Manual Location Subsection/Citation Subject Question Government Response

Section C - Description/ Specifications/ Work Statement

5.1.8 Document Management System

How long is the contractor required to store both electronic and paper records for review?

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

Section C - Description/ Specifications/ Work Statement

5.1.8 Document Management System

Please provide the volume of paper claims the contractor should expect to process per year compared to electronic.

The Government anticipates that all claim reviews will be processed electronically. Electronic submissions to the DMS will be in accordance with the MOU's with the private sector care contractors.

Section C - Description/ Specifications/ Work Statement

Section 5.1.12 Continuity of Operations Plan

Please provide metrics for the Continuity of Operations Plan (COOP) site such as capacity, testing, requirements, maximum permitted downtime, etc. Please also provide the functions considered mission essential.

Plan is to be submitted to Government for approval.

Section C - Description/ Specifications/ Work Statement

Section 5.4.1.4 Claim Volume Fluctuation Can DHA provide provide a best or worst case scenario of claim volume fluctuation or assign a percentage so the contractor can budget accordingly?

Claim volume fluctuations will be agreed upon through contract modification if exceeding the estimates contained in Section J, Attachment J-6, TCRS Compliance Review Schedule.

Section C - Description/ Specifications/ Work Statement

5.4 and 5.5 Compliance Reviews, Medical Record Reviews, and Focus Studies

How many pages on average are received per review for each review type?

Page count is dependent on the characteristics of the random sample.

Section C - Description/ Specifications/ Work Statement

5.5 Focus Studies

Please confirm that the Annual Health Care Cost compliance reviews are the same as Annual PIIA Compliance Reviews

These are two different types of reviews.

Section C - Description/ Specifications/ Work Statement

5.5.1.2.2 Focus Studies

This section provides workload volumes. However, the timeframe for completion has not been provided. Please provide the timeframe allowed to complete focused studies.

Timeframes are established in the Performance Work Statement for each focused study, and evaluated during the proposal process.

Section C - Description/ Specifications/ Work Statement

5.5.2.2.1 Medical Record Reviews

This section provides workload volumes. However, the timeframe for completion has not been provided. Please provide the timeframe allowed to complete medical record reviews.

Timeframes are established in the Performance Work Statement for each focused study, and evaluated during the proposal process.

Section C - Description/ Specifications/ Work Statement

Section 6.6 Risk Management Framework (RMF) for DoD IT

Please describe what the Govt means by "reserved" for Section 6.6.

"Risk Management Framework (RMF) for DoD IT: Reserved"

"Reserved" means "not applicable"

Section C - Description/ Specifications/ Work Statement

6.11.2 DHA IT Security

This section states, "6.11.2 The contractor shall submit the completed DD Form 2875 to the DHA IT Security for verification of Tier I or Tier II Designation. The DHA Personnel Security will verify that the contractor employee has the appropriate background investigation completed or a request for background investigation has been submitted to the Office of Personal Management (OPM).

Acknowledgment from OPM that the request for a background investigation has been received and that an investigation has been scheduled will be verified by the DHA Personnel Security prior to access being approved."

Please provide a copy of the DD Form 2875.

The form is available at https://www.esd.whs.mil/Portals/54/Documents/D D/forms/dd/dd2875.pdf

Section C - Description/ Specifications/ Work Statement

7.1.1 and 7.1.2 Documents Please provide the documents that are currently imbedded in 7.1.1 and 7.1.2, as they are unable to be opened from the RFP.

The documents have been provided as attachments in the final RFP PDF.

Section L - Instructions, Conditions, Notices to Offerors

L.2.2 Organizational Conflict of Interest Please confirm that the offeror may submit a single statement that no organizational conflicts of interest exist.

Please refer to L.2.2.4

Section L - Instructions, Conditions, Notices to Offerors

L.2.2 Organizational Conflict of Interest If a single OCI statement is not acceptable, can the government provide a template for offerors' use?

Please refer to L.2.2.4

RFP/Manual Location Subsection/Citation Subject Question Government Response

Section L - Instructions, Conditions, Notices to Offerors

Section L.4.1 Proposal Preparations

Section L.4.1 states, "The font for submissions shall be Times New Roman, not smaller than 12 point font; however, smaller fonts are permitted on illustrations, organization charts, supporting data exhibits, report listings or labels on process flows." Please confirm Calibri or Arial font is acceptable for graphics, charts, tables, and narrative headings.

Please continue using times new roman across all graphics, charts, tables, and narrative headings.

Section L - Instructions, Conditions, Notices to Offerors

Section L.4.2 Proposal Submission What size files are accepted by the Government, are there any restrictions on Governement incoming email?

File size limit coming from outside organizations to Government e-mails is 20 megabytes

Section L - Instructions, Conditions, Notices to Offerors

Section L.6.1.3 and CDRL

AP020

Program Management Plan

The PMP that meets the requirements of CDRL AP020 is close to the management approach that is required in L.6.1.4. Are we expected to submit with the proposal a PMP that meets the requirements of the CDRL as an attachment AS WELL AS include in Vol II information that answers L.6.1.4?

Please include CDRL in Volume II and it does not count towards the page limit, L.6.1.3.

Section L - Instructions, Conditions, Notices to Offerors

Section L.7.3.2.1 Past Performance Contract Descriptions

We plan to submit multiple task orders for an ordering type contract vehicle. As ordering type contracts with multiple orders do not typically have concurrent periods of performance or periods of performance limited to 12 consecutive months, would the government consider allowing multiple orders not to exceed 24 consecutive months as only 1 past performance reference?

No

Section L - Instructions, Conditions, Notices to Offerors

Sections L.7.7. and M.6.2 Past Performance Questionnaires Please confirm that PPQs are not expected for contracts that already have informaiton in Past Performance Information Retrieval System

(PPIRS).

It is incumbent upon the contractor to provide PPQs for past performance submitted.

Section L - Instructions, Conditions, Notices to Offerors

L.9.2 Financial Data

Section L.9.2 states, "The offeror shall submit the following documents:

- The offeror's most recent Dun and Bradstreet (D&B) Comprehensive Report, or if not available, another rating company report that is essentially equivalent to D&B (e.g., A.M. Best Company)

- Annual Reports for the offeror's three(3) most recent fiscal years (including audit opinions)

- Balance Sheets, Income Statements, Statement of Retained Earnnings, and Statements of Cash Flows

- Statement of projected quarterly cash flows for a one (1) year period beginning with the start of the contract (i.e., Transition-In period) -Form 10-K Annual Report"

Please confirm offerors are only required to submit the financial documents that are applicable. For example, Form 10-K Annual Report would only be applicable to public companies.

Please see revised Section L language.

103 CDRLs CDRLs OT020 - OT060 Memorandums of Understanding - Patient Claims History

We have found a best practice for Memorandums of Understanding to be reviewed and revised as needed for every ordering period (similar to A020-A070). Please advise, as this is listed as a one-time

CDRL.

Historically, a one-time CDRL for OT020-OT060 has been sufficient.

104 Section J Attachments Attachment J-6 Compliance Reviews Workload Please confirm the 4,000 estimated claim volume shown for each compliance review cycle for the East Region and West Region row is a combined workload of 4,000 for both East and West Regions.

Yes, this is the combined workload.

RFP/Manual Location Subsection/Citation Subject Question Government Response

105 Section J Attachments Attachment J-6 Annual PIIA Compliance Reviews

Workload provided in Ordering Period 2 for Annual PIIA Compliance Reviews of 16,000 appears to be received and due during Ordering Period 1. Please advise which Ordering Period this should be priced.

Ordering Period 2 starts March of 2024, and the estimated date claims information from PCC is due to TCRS Contractor in March of 2024.

106 Section J Attachments Attachment J-10 Compliance Review Guidelines

Document states, “Prior to beginning an audit, the auditor will review the Deficiency File for the individual contract he/she is to audit to become familiar with error findings from previous audits”.

Can the DHA provide an example of the Deficiency Guide?

The Deficiency File is a part of the Analysis of Purchased-Care Contractor Payment and Occurrence Audit Error Report. It is prepared by the TCRS contractor in accordance with attachment J-10, Chapter 1, Section D.

107 Section L L.6.2.2, Page L14 of L22 Table 2 Proposal Page Limits, Page L9 of L22

Section L.6.2.2 indicates the draft transition-in plan is to be submitted in the format and description required by CDRL R010. The last sentence states, “The plan shall not count against the 50 page limit and is limited to 10 pages.” CDRL R010 indicates the first submission of this draft plan is 7 days after contract award and it is to be in a Microsoft Project format.

Is this draft plan due with the submission of the proposal or 7 days after contract award?

The draft plan is due with proposal submission and the final plan is due 7 days after contract award.

108 Section L L.6.2.2, Page L14 of L22 Table 2 Proposal Page Limits, Page L8-9 of L23

Section L.4.3 indicates the technical proposal shall not exceed 50 pages and Table 2 indicates the Technical Proposal is limited to 40 pages with the “Transition-in- Overview (included in the Technical Proposal” limited to 10 pages. However, Section L.6.2.2 indicates the draft transition in plan “shall not count against the 50 page limit as is limited to 50 pages.”

Can the page limit for the Technical Proposal listed in Table 2, Proposal Page Limits, be changed to 50 pages and an annotation added to the Transition-in Overview in Table 2 that its 10 page limit is not counted in the 50 page limit if the Technical Proposal?

Please see revised Section L language.

109 Section L L.6.1.3, Page L12 of L22

Subsection L.6.1.3 states that offeror’s proposal shall include its Program Management Plan (PMP) in the format and description required by CDRL AP020 and that the CDRL document shall not count against the 50 page limit.

CDRL AP020 states it is due 5 calendar days after contract award.

Is this draft plan due with the submission of the proposal or 5 days after contract award?

The draft plan is due with proposal submission and the final plan is due 5 days after contract award.

110 Section L Exhibit L-4, Solicitation Cross Reference Table in the list of Exhibits is titled Exhibit L-5 in its header when printed.

Can this document be re-titled? The Government will update accordingly.

111 Section L Exhibit L-5, Price Proposal Template in the list of Exhibits on the second and third tab, it is titled Exhibit L-7 in its header when printed.

Can this document be re-titled? The Government will update accordingly.

RFP/Manual Location Subsection/Citation Subject Question Government Response

112 Section L Exhibit L-7, TCRS Historical Rebuttal Report (2017 – 2021) in the list of Exhibits is titled Exhibit L-8 in its header when printed.

Can this document be re-titled? The Government will update accordingly.

113 Section L Exhibit L-8, Historical TRICARE Overseas Program Data in the list of Exhibits is titled Exhibit L-9 in its header when printed

Can this document be re-titled? The Government will update accordingly.

114 Section L Exhibit L-9, Draft Quality Assurance Surveillance Plan

(QASP)

in the list of Exhibits is titled Exhibit L-10 in its header when printed

Can this document be re-titled? The Government will update accordingly.

115 Section C paragraph 5.4.2.1.4 and 5.4.2.1.5 indicate that the TCRS contractor evaluates for payment errors and for occurrence errors

Can the Government provide data or information as to how many or what percentage of previously assessed historical errors have been in each of those two categories.

Error ratios are variable. Historically, the random sample for occurrence claims audits has been lower in volume than the random sample for payment claims audits.

116 NA NA Extension (Potential Offeror) would like to request an extension to the closing date of the solicitation.

No, the Government will not be granting an extension due to the fact that a draft RFP closed in February and this posting was synopsized 14 days prior to the final posting.

Whether companies from Outside USA can apply for this?

(like,from India or Canada)

No

118 Whether we need to come over there for meetings?

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

Can we perform the tasks (related to RFP) outside USA? (like,from India or Canada)

No

120 Can we submit the proposals via email? Please refer to sam.gov posting

Can an a fillable pdf be provided for SF 33 and Section B.

documents?

No, text can be added to the PDF through Adobe Acrobat.

Will the Government provide Wage Determination(s) and provide a mapping of RFP labor categories to the WD Occupation Code(s)?

No, the Government will not provide mapping of labor categories as there is no stated required labor categories.

Section B - Supplies or Services and Price/Cost

Sections 1.6.1, 1.6.1.2, 5.3.2, CDRL W020

Transition-Out Please confirm the number of months for the Transition-Out period.

The transition-out timeframe is dependent on workload.

Please refer to Section C.5.3.2. The Contractor shall complete all work assigned during the ordering period to include all associated reports.

Section C - Description/ Specifications/ Work Statement

Section 5.1.14 Attachment

Section 5.1.14 states, "All contractor personnel must meet Government requirements for access to Government computers and/or systems. This includes providing fingerprints (CDRL M010, Employee Access to DoD IS/Networks Report)."

Attachment J-9 is the Example of Active Duty Dental Audit Detail Report. Please provide the Questionnaire for Public Trust Positions referenced in 5.1.14.

The reference to J-9 has been removed.

RFP/Manual Location Subsection/Citation Subject Question Government Response

Section L - Instructions, Conditions, Notices to Offerors

Section L.6.1.3/CDRL AP020 and Section L.6.2.2/CDRL R010

Program Management Plan and Transition-In Plan

Section L.6.1.3 indicates that the Program Management Plan be in accordance with CDRL AP020, which indicates the plan be submitted in Word. However, an element of the plan is a project plan with a detailed schedule that must be submitted in a "format agreed to by the COR."

Section L.6.2.2 states, "Additionally, the offeror shall submit its draft transition-in plan in the format and descriptions required by CDRL R010." CDRL R010 states this plan should be submitted in Microsoft Project.

Please confirm the project plans can be submitted in Adobe PDF for the proposal in accordance with L.4.1 requiring electronic formats of Volumes I-III and V are Adobe PDF and Microsoft Word."

Historically, the project plan schedule has been submitted in MS Excel.

Government will update CDRL R010 to change MS Project to MS Office format.

Yes, acceptable electronic file formats for Volumes I-III and V are Adobe PDF and/or Microsoft Word.

Section L - Instructions, Conditions, Notices to Offerors

Section L.8.4 CDRL Pricing

This section states, "….reports shall not be separately priced in Section B, Form 33." However, it contines, "The Offeror shall provide a price for each CDRL in each ordering period. The Price Proposal Template (Exhibit L-5, TAB entitled "CDRL Cost Estimate") provides a worksheet for the Offeror to enter its price."

Exhibit L-5's CDRL Cost Estimate worksheet only provides for a total price for CDRLs, not an individual price for each CDRL.

Please advise where offerors should submit individual pricing for CDRLs.

Include the total CDRL price in the L-5 pricing spreadsheet and individual CDRL price using the DD1423 in block 18. Section L langauge updated to clarify

Section L - Instructions, Conditions, Notices to Offerors

Section L.8.4 CDRL Pricing Please confirm offerors are not required to submit a price for CDRLs for the Option to Extend period since it is not included in Exhibit L-5.

Yes

128 CDRLs CDRL W030 Audit Status Report

CDRL W030's beginning date is contract award, due "First business day after end of reporting period following receipt of the first set of compliance review documentation." However, workload will not begin until Ordering Period 1. Please confirm CDRL W030 is not due during Base Period.

CDRL W030 will be changed for clarity.

Will you please clarify the size standard for this solicitation? The NAICS listed is 5416911 with the size of $16.5M; however, the following sections seem to add to the size standard or make an exception to it. We are currently listed in SAM as other than small for 541611 but with the new threshold as of May 2, 2022 we are small under the NAICS (we understand that SBA is not changing the size standards in SAM until Oct, 2022). We are also certified HUBZone and verified SDVOSB. Are we eligible to bid as a prime?

The size standard will be updated based on May 2nd update.

130 C14 of C50 C.3.5 Government Furnished Materials Will the DHA allow the use of an application programming interface (API) to directly connect to DEERS and PCDIS?

No

131 C14 of C50 C.3.5 Government Furnished Materials Will the DHA please confirm if there are batch data extraction capabilities within DEERS and PCDIS?

No, there are not batch data extraction capabilities.

132 C25 of C50 C.5.3.1 Transition In If there is any work in progress from the incumbent contractor, can the DHA please specify outstanding deliverables?

No, the Government cannot comment on current incumbent or outstanding deliverables

133 C25 of C50 C.5.3.1 Transition In If it is acceptable to facilitate a document transfer from the incumbent contractor or the DHA, how do we obtain access to the incumbent's documentation?

The Government does not anticipate a need for file transfers.

134 C25 of C50 C.5.3.1 Transition In If it is acceptable to facilitate a document transfer from the incumbent contractor or the DHA, can the DHA specify the volume/size of the incumbent's documentation?

The Government does not anticipate a need for file transfers.

RFP/Manual Location Subsection/Citation Subject Question Government Response

135 C25 of C50 C.5.3.1 Transition In If it is acceptable to facilitate a document transfer from the incumbent contractor or the DHA, will the DHA enable a mass migration of the incumbent's documentation?

The Government does not anticipate a need for file transfers.

136 C26 of C50 M.5.2 Transition Out The TCRS evaluation criteria (Section M.5.2) only references Transition-In. Does the DHA intend to score the Transition-Out referenced in section C.5.3.2?

See Amendment 0001 Q&A

137 C26 of C50 M.5.2 Transition Out Is the Transition Out Period for 6 months following the Ordering Period included in the total contract value?

See Amendment 0001 Q&A

138 C31 of C50 C.5.5.1.2.2 Focus Studies Are the PIIA random samples stratified by cost?

PIIA Sampling methodology is currently being developed. Cost may be included as a factor.

139 C38 of C50 C.6.9.2

MHS Demilitarized Zone (DMZ) Medical Community of Interest (MedCOI) Business-to-Business (B2B) Gateway

If our technical architecture leverages CAC authentication through a proprietary VPN solution, do we still require another VPN appliance to access the B2B gateway for additional network connections?

The Government does not anticipate a need for the Contractor to access the B2B gateway.

If VPN solution meets the requirements, it is sufficient.

140 Price Proposal Template Tab 1007, 2007, 3007, 4007, 5007, 6007, 7007

Focus Studies

Will the DHA please confirm that we should not estimate costs for the Focus Study CLINs in our proposal since a separate task order will be released after award (and we can ignore the Statement of Work estimates when calculating our price)?

Yes

141 Summary by CLIN, OP All CLIN Numbering

Will the DHA please clarfiy the pricing Template? Specifically the "Summary By CLIN, OP" tabs feature a different series of CLIN numbers compared to the cover page. For example on the "Price Proposal Template" CLIN 1009 is Medical Record Reviews, and on the "Summary By CLIN, OP" tab "X009" references the Transition out. Similarly the "CDRL Cost Estimate" tab features Deliverables as X010 and the "Price Proposal Template" features them as 1011.

Summary Tab will be updated to mirror Price Proposal Template

142 Page 5 of 7 N/A Focus Studies and Medical Record Reviews

The DHA gave historical information for these reviews. Will the Statement of Work estimates be updated to capture the estimates provided in the last round (Question 38)?

The estimated volume provided in Section C.5.5.1.2.2 includes up to date information.

Historical focused study volume will not be added to Section L.

143 Section C C.5.5.1.2.2. Compliance Audits

The RFP estimates that 16,000 focused study PIIA compliance audits may be ordered each Ordering Period. Does DHA anticipate all 16,000 claims would be audited in one audit cycle, or would they be divided into smaller, more manageable audit segments such as 4,000 claims every quarter in an Ordering Period year? The answer to this question will affect bidders' plans for staffing.

The Government anticipates that the PIIA audit will be one sample, per Ordering Period.

144 Section L 5.1 SF-33 Per SAM, the solicitation documents posted on 5/2/2022 are a synopsis. Please confirm an SF-33 for 5/2/2022 is not required to be submitted in Volume I.

Please use SF-33 from 5/16 posting

145 Section L 5.1 SF-33 The SF-33 has no Issue date.