TCRS Recompete Industry QA.pdf

Question Number

RFP/Manual Location Subsection/Citation Subject Question Additional Info/Rationale Government Response

1 The notice states that it is a total-small business set aside. Does DHA intend to release the RFP as a total small business set aside competition, or is that still being determined?

Total Small Business Set-Aside

2 Can other than small business respond to this draft RFP with comments?

While the government welcomes recommendations to strengthen the requirement documents, we did state in the posting that the Government encourages responses from interested parties who are capable of responding to the entire scope of the draft RFP.

3 Is the procurement planned to be a small business set aside or is that yet to be determined?

Total Small Business Set-Aside

4 Is it possible that the procurement might be a GSA Schedule 70 acquisition or is it already decided it will be full and open RFP?

Full and Open Small Business Set-Aside RFP

5 OTHER Information Submission Instructions from the website.

Subcontracting It appears the Government is interested in receiving a response from parties who are capable of responding to the entire scope of the Draft RFP at this time. If our company only provides one of the services within the scope, how do we make it known we are willing to be a subcontractor to other larger entities?

This would allow smaller organizations that would fall under the small business umbrella to participate in providing services for the Governement.

The Government will consider providing a list of potential contractors, which would publically posted to the contract opportunity on SAM.gov. If your company is interested in being placed on such a list then please contact us with a written statement of consent and the information that you request be included. Any posted list will include a disclaimer that it is provided at the request of the listed parties and without any endorsement or assurances from the United States Government or Defense Health Agency.

6 Subcontracting The draft RFP HT940221R0002 – TRICARE Claims Review Service does not contain any subcontract provisions for a service-disabled veteran-owned small business (SDVOSB). Will the agency include a SDVOSB subcontracting requirement in the RFP?

No. As this procurement is a small business set aside, small business subcontracting plans and provisions are not required.

7 Section L - Instructions, Conditions, Notices to Offerors

Page L8 Submission formation

Will the Government consider eliminating the requirement to submit multiple CD copies of our proposals in favor of a fully electronic submission?

Yes, submissions will be fully electronic. References to CD copies have been removed.

8 Section L - Instructions, Conditions, Notices to Offerors

Page L17 Past Performance

Many companies are structured with multiple divisions or multiple legal entities that individually perform Prime Contracts but fall under a broader corporate umbrella. Recognizing such corporate structures exist across the industry, the procurement rules and numerous Government Accountability Office (GAO) decisions have made clear that procuring agencies may evaluate and credit an offeror with the past performance and corporate experience of sister subsidiary companies where the offeror’s proposal demonstrates that the resources of the sister subsidiary (e.g., workforce, management, facilities, or other resources) will be meaningfully contributed to contract performance. See GM–Bulltrack, B-

414591.6 (Comp. Gen. Oct. 30, 2018) (holding that an agency may properly attribute the experience or past performance of an affiliated company), and Iyabak Construction, LLC, B-409196 (Comp. Gen. Feb.6, 2014) (holding that the agency failed to articulate a rational basis for solicitation’s refusal to consider experience and past performance of sister subsidiaries). Would the Government please clarify that the Offeror may cite the prime contract past performance and experience of a sister subsidiary so long as the Offeror demonstrates how the resources of the sister subsidiary will meaningfully contribute to the performance of the opportunity?

The Government will consider past performance attribution in accordance with current law and regulation. Any assessment of whether a proposal adequately demonstrates that attribution of any particular entity’s past performance is properly attributable to an offeror remains solely in the discretion of the Government.

9 Section L - Instructions, Conditions, Notices to Offerors

Page L4 of L122 Discrepancies and Ambiguities

"...the offeror shall immediately notify the CO in writing with supporting rationale as well as the remedies the offeror is asking the CO to consider related to the omission or error no later than 10 business days after the CO issues the solicitation."

Would the Government please update this language to read "no later than 10 business days after the CO issues the solicitation or by the date questions are due, whichever is later"?

Government will update RFP language as recommended.

10 Section L - Instructions, Conditions, Notices to Offerors

Page L5 of L122 L.2.1.7.1 The paragraph states that the "CO may that the number of most highly rated proposals that might otherwise be included in the competitive range exceeds the number at which an efficient competition can be conducted. In this event, the CO may limit the number of proposals in the competitive range to the greatest-number that will permit efficient competition among the most highly rated proposals."

Would the Government please clarify what criteria will be used to determine the "most highly rated proposals" from all the highly rated proposals?

The Government will evaluate all proposals against the stated evaluation criteria in Sections L & M.

11 Section L - Instructions, Conditions, Notices to Offerors

Page L6 of L122 L.2.2.5 "...the offeror shall submit a mitigation plan to the CO, no later than 15 calendar days prior to the proposal due date..."

Would the Government please change the submission language to "the offeror shall submit a mitigation plan to the CO with its proposal submission"?

Government will update RFP language as recommended.

12 Section L - Instructions, Conditions, Notices to Offerors

Page L7 of L122 L.2.3.2.1 "... the Offeror shall notify the CO prior to the involvement in the proposal preparation by a former DOD or DHA employee/member reasonably expected to have had access to such information."

Would the Government please clarify when offerors are expected to notify the CO of any involvement in the proposal preparation by a former DOD or DHA employee/member?

Would the Government please advise as to when, following an offeror's notification, will offerors expect to receive any additional guidance from the Government on this matter?

Offerors should notify the CO regarding any involvement in the proposal preparation by a former DoD or DHA employee/member as soon as possible.

The Government will provide a response within 5 business days.

13 Section L - Instructions, Conditions, Notices to Offerors

Page L7 of L122 L.4.13.3.1 Would the Government please advise as to whether the required markings are to be made on the CD-ROMs for each volume, or within the volume files?

CD-ROMs will not be required for submission, references have been removed.

14 Section L - Instructions, Conditions, Notices to Offerors

Page L16 of L122 L.7.3.1.2 Would the Government please increase the Narrative page limitations to six (6) pages, allowing for up to two pages of narrative per past performance submitted?

The purpose of the narrative is to summarize the past performance that the prime offeror and each proposed first-tier subcontractor has in performing relevant work. The Past Performance Contract Descriptions (L.7.3.2) allow for offerors to provide a clear explanation of the functions performed and what aspects are relevant, among other information. Each Past Performance Contract Description provides up to 4 pages per contract. Thus, the Government finds 5 pages of narrative appropriate.

15 Section L - Instructions, Conditions, Notices to Offerors

Page L16 of L122 L.7.3.2 Would the Government please clarify if the maximum past performances to be submitted is three for the prime, and three for each first-tier sub?

Yes. A maximum of three for the prime and three for each first tier subcontractor.

16 Section L - Instructions, Conditions, Notices to Offerors

Page L16 of L122 L.7.3.3 - a "The offeror shall include a completed Client Authorization Letter (See Exhibit L-1, Sample Client Authorization Letter) for each contract."

Since offeror’s will be providing a PPQ that will be completed by the customer/client, will the Government consider removing the requirement for a client authorization letter?

The Government will clarify that “Client Authorization Letters” are only required for clients on commercial, i.e., non-federal or non-U.S. Government contracts. These letters are required because the Government intends to reserve the right to reach out to any such client for additional information as needed.

17 Section M - Evaluation Factors for Award

Page M1 of M8 Factor 1, Technical Approach

Subfactor 2, Transition-In being an evaluation factor could give an un-fair advantage to the incumbent who doesn't have a need for transitioning in. Could this be removed from the evaluation factors?

All offerors will be required to propose a transition-in plan which will be evaluated in accordance with Section M.

18 Section M - Evaluation Factors for Award

Page M1 of M8 Factor 1, Technical Approach

Subfactor 2, Transition-In being an evaluation factor could give an un-fair advantage to the incumbent who doesn't have a need for transitioning in. Could this be removed from the evaluation factors?

All offerors will be required to propose a transition-in plan which will be evaluated in accordance with Section M.

19 Section C - Decription/ Specifications/ Work Statement

Page C17 of C51 C.5.1.1 Are there any specific qualifications or credentials for the "single POC?" Do you consider this a full time job or can this individual have other responsibilities?

Significant managerial experience in a government healthcare reimbursement. This will be a full time role in program oversight.

20 Section C - Decription/ Specifications/ Work Statement

Page C17 of C51 C.5.1.1 There is a requirement to provide "ongoing status updates" and report "any issues." Are the updates separate from other specified reporting requirements? If so, is there any additional guidance?

Outside of contractual requirements, COR may engage with contractor through Scheduled teleconferences, for the purpose of proactive and transparent communication of existing, or potential, issues, including but not limited to, challenges related to staffing, deadlines, workload and technical problems.

21 Section C - Decription/ Specifications/ Work Statement

Page C17 of C51 C.5.1.1.2 Can you please provide additional information with respect to a "sufficient number of qualified staff?" What is the current number?

We understand this contract is estimated to be 2 times the current one. Should we expect the number of FTEs to double, or nearly so?

The government cannot advise about specific staffing requirements.

It is the Contractor's responsibility to determine specific staffing requirements and capabilities.

22 Section C - Decription/ Specifications/ Work Statement

Page C18 of C51 C.5.1.4 We understand about changes in the TOM. What about the implications of contractor changes?

By TOM, do we mean TRICARE Manual? This question is also very vague; unclear what we mean by contractor changes (e.g., do we mean transition from one contractor to the next, contractor-initated changes to the TRICARE Manual?). Suggest rephrasing to "We understand that the Government will notify the contractor when manual changes are published. However, will the Government please clarify [contractor change language]?"

Not all contract changes are published in the TRICARE Manuals; however, all contract changes will be communicated timely to all relevant parties by the Government.

23 Section C - Decription/ Specifications/ Work Statement

Page C21 of C51 C.5.1.9 Is there an expectation that the Memorandum of Understanding (MOU) will be in place the POP begins? If not, is there a suspense?

What should the contractor do in the interim?

CDRLs A020-A070 indicate the MOU must be established 60 calendar days prior to the start of the reporting period.

Period of Performance cannot commence until after MOU's are agreed to and executed.

24 Section C - Decription/ Specifications/ Work Statement

Page C22 of C51 C.5.1.12 Are there any specific issues related to COVID? The Government is still looking into issues or required changes related to COVID. The final RFP will include any COVID related requirements or changes.

25 Section C - Decription/ Specifications/ Work Statement

Page C22 of C51 C.5.1.13 This paragraph and the next identify two specific personnel requirements (there is also the single POC requirement in C.5.1.1).

Are there any other key, essential, or specific personnel that must be provided?

Those are the only required key personnel.

26 Section C - Decription/ Specifications/ Work Statement

Page C22 of C51 C.5.1.14 Can you please be more specific about the "required information" that the system security administrator must provide?

Please refer to Section H.

27 Section C - Decription/ Specifications/ Work Statement

Page C24 of C51 C.5.2.3.1 Please define "periodic." At the Government's discretion.

28 Section C - Decription/ Specifications/ Work Statement

Page C25 of C51 C.5.3.1.2 Please confirm that the contractor will have sufficient time to prepare for the "Readiness Test."

The Government will ensure reasonable time will be provided to prepare for the "Readiness Test".

29 Section C - Decription/ Specifications/ Work Statement

Nonspecific Nonspecific Does the Government anticipate any specific actions, requirements, changes, etc as the Military Health System (MHS) transition and the Defense Health Agency (DHA) transformation continue?

The Govenrment anticipates no impact from this transition on this contract.

30 Section B - Supplies or Services and Price/ Cost

Page 13 B 1.2 Can the Government clarify if the award value be $49,500,000? The maximum contract value will be $49,500,000.

31 Section L - Instructions, Conditions, Notices to Offerors

L.4.1 CDROMS The government is requesting CDROMs be submitted. We recommend the Government consider email submission in an acceptable Word or PDF version.

Submission will be fully electronic. No CDROMs will be required and references will be removed prior to releasing the final RFP.

32 Section L - Instructions, Conditions, Notices to Offerors

L.4.3 Font Size Is there a font size requirement? Will the government consider a smaller text size for tables and graphics, perhaps 8pt arial font?

All proposal narrative materials shall be formatted at 8½ by 11 inch with one inch (1") margins on all sides.

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. The final RFP will be updated accordingly with this information.

33 Section L - Instructions, Conditions, Notices to Offerors

L.4.3 OCI plan Where should a contractor provide the OCI mitigation plan? In accordance with Table 1, Proposal Volumes in Section L, an OCI Mitigation Plan shall be included in Volume I.

34 Section C - Decription/ Specifications/ Work Statement

5.1.7 Software Are we allow to utilize our own proprieterary software for use in conjunction with the requirements in this section?

No. Per Section 5.1.7.2, the only software variance allowed is a Claim Check equivalent.

35 Section C - Decription/ Specifications/ Work Statement

7.2 Attachment 2 The link for "Attachment 2 - Deliverable Schedule" is inactive, can you provide "Attachment 2- Deliverable Schedule" in a separate document?

Yes. Attachment 2 will be provided in a separate document.

36 Section C - Decription/ Specifications/ Work Statement

5.4.1.3 Compliance

Reviews - Quarterly/Bi- Annual

5.4.1.3. States the Government will develop and maintain the

sampling methodology and process for selecting sample claims.

Please clarify if the Government will be selecting the sample claims using the methods and processes as defined in DHA sampling Methodology or will the Contractor be responsible for claims selection utilizing the Government methodology and process as outlined in Section J, Attachment J-5 DHA sampling methodology

The Government provides the sample list of claim selections.

37 Section C - Decription/ Specifications/ Work Statement

5.1.2 Program

Management

Could the Government please clarify when the Program Management Plan (PMP) would be due to the Government?

In accordance with CDRL AP020, the initial Program Management Plan is due 5 calendar days after contract award. Each subsequent plan is due 30 calendar days before the start of each option period.

38 Section C - Decription/ Specifications/ Work Statement

5.1.8.6 Document

Managemnet System (DMS)

Is the access to the DMS that is requested for the Government both read and write access?

Read Only.

39 Section C - Decription/ Specifications/ Work Statement

5.1.8.6 Document

Managemnet System (DMS)

If the Government is requiring both read and write access to the DMS, that would require licenses and a pricing CLIN for those licenses. The current CLIN structure does not provide for separate license costs. How does the Contractor include those in the pricing structure for this IDIQ and how does the Government plan to review and discuss the Terms and Conditions of a license agreement?

The Government requires read only access.

40 Section C - Decription/ Specifications/ Work Statement

5.3.1.1 Transition-in

Plan

Could the Government please clarify when the Transition-in Plan would be due to the Government?

In accordance with CDRL R010, the transition-in plan is due 7 calendar days after contract award.

41 Section C - Decription/ Specifications/ Work Statement

5.3.1.2.7 Contractor

Readiness Testing

The last sentence of this section reads: "Prior to the contract start work date…". Should this be written as "Prior to the start of Option Period 1…"?

Reporting period refers to Option Periods, will revise for consistency

42 Section C - Decription/

Statement

5.5.1.1.1 Focus Studies Could the Government please confirm that the topics on which a focus study would be conducted will be chosen by the Government?

Government will provide topic and guidance through a Performance Work Statement.

43 Section C - Decription/ Specifications/ Work Statement

5.5.2.2.2 Medical Record

Reviews

Could the Government please confirm that the topics on which a medical record review would be conducted will be chosen by the Government?

Government will provide topic and guidance through a Performance Work Statement.

44 Section C - Decription/ Specifications/ Work Statement

1.7.1 Place of

performance

Can this work be performed remotely if proper precautions to protect the patient’s PII?

COVID-19 Yes. As long as required security precautions are documented and followed.

45 Section C - Decription/ Specifications/ Work Statement

1.8 Which key personnel shall attend the two annual meetings? The POC who fulfills Section 5.1.1. Additional personnel may attend at the Government discretion.

46 Section C - Decription/ Specifications/ Work Statement

1.8 Contractor

travel

Are traveling expenses billed with firm fixed pricing under the other direct cost (ODC)?

All contractor travel costs associated with any of these meetings shall be the contractor's responsibility.

Travel costs should be built into firm fixed price unit costs as appropriate.

47 Section C - Decription/ Specifications/ Work Statement

1.9 Other Direct

Costs (ODC):

Reserved

Are traveling expenses billed with firm fixed pricing under the other direct cost (ODC)? How should the contractor bill for the two annual meetings?

Travel costs should be built into firm fixed price unit costs as appropriate.

48 Section C - Decription/ Specifications/ Work Statement

1.12 Key personnel Selection is reserved. DHA should provide a list of key personnel with qualifications.

Key personnel are listed throughout the document; however, it would be easier to reference one section for all key personnel.

POC's specified in 5.1.1; 5.1.13; 5.1.14.

Main POC, Records Manager, and Systems Administrator.

49 Section C - Decription/ Specifications/ Work Statement

1.12 Key personnel Could DHA provide an employee roster with incumbent details, employees, titles, phone numbers, and email addresses?

We would like to retain program knowledge by hiring existing employees with good performance.

Any offeror wishing to hire existing employees may work with the incumbent contractor to obtain this information.

50 Section C - Decription/ Specifications/ Work Statement

1 Reserved Some sections are reserved; when will this information be available?

This information will be important in preparing the proposal.

"Reserved" sections are not applicable.

51 Section C - Decription/ Specifications/ Work Statement

3.5 TRICARE

Purchased-Care Contracts

How will this information be provided—digital? Digital

52 Section C - Decription/ Specifications/ Work Statement

3.5 TRICARE

Purchased-Care Contracts

Has the incumbent exacted pertinent information relevant to completing the review in an easy-to-read reference document?

Information relevant to completing reviews is proprietary. User guides for Government Systems are provided.

53 Section C - Decription/ Specifications/ Work Statement

5.3.1.2 Contractor

Readiness Testing.

Is information obtained in common letters impacting claim processing procedures or reimbursement determination updated in the TRICARE manuals? When?

The letters will be provided if there is an impact to claims processing or reimbursement procedures.

Manuals will be updated if applicable when change is the implemented.

54 OTHER Questions NAICS Codes Recommend adding NAICS code 541219 (Other Accounting Services, including billing offices)

The Government will use the NAICS code most appropriate to the type of services being solicited.

55 Section C - Decription/ Specifications/ Work Statement

1.11.1 CAC requirements Common Access

Cards

Please clarify which contractor personnel will require CACs based on the requirement that all work is performed remotely and/or from contractor facilities, rather than Government facilities. For example, should it be assumed that all personnel who are performing compliance reviews will need access into DEERS, PEPR, etc., and require CACs to do so?

Reference: "For all contractors who will work in Government facilities, the Facilities Security Officer (FSO)/Company's Security point of contact (POC) will provide the Government all the required information per the DHA CAC request process..."

All personnel will require a CAC.

All personnel performing compliance reviews will utilize their CAC's to access all systems used to confirm the claim processed correctly (DEERS, PEPR, etc)

56 Section C - Decription/ Specifications/ Work Statement

5.3.1.2.2 Readiness Test Given the ongoing COVID-19 situation and the prevalence of remote workers in this industry, we recommend allowing for a virtual or hybrid in-person/virtual Contractor Readiness Test event.

Reference: "At the time of the scheduled Readiness Test, a DHA Readiness Team consisting of the contract COR and various Government/contract personnel will arrive at the contractor’s work site to conduct the test and evaluate the contractor’s review results on a claim by-claim basis."

Companies are still operating substantial work-from-home operations to help contain the spread of COVID-19 within our workforce and communities.

The Government is still looking into issues or required changes related to COVID. The final RFP will include any COVID related requirements or changes.

57 Section C - Decription/

Statement

5.3.1.1 Transition-in

Plan

In order to attract and promote competition from a variety of qualified vendors beyond the incumbent, we recommend allowing bidders to propose their own transition-in timelines as part of their proposals, with a period of performance not to exceed six months.

This approach would allow bidders to define their own schedule, cost, and performance capabilities, against which the government could evaluate proposals for benefits, risks, and feasibility/realism.

Thank you for the recommendation. The Government will consider this suggestion in the final RFP.

58 Section C - Decription/ Specifications/ Work Statement

5.4.2 Compliance

Reviews

We encourage the government to provide an estimated breakdown of claim types (inpatient vs outpatient, facility vs professional fee) either as a forecast amount or actual historical workload.

Inpatient and outpatient claims vary widely in complexity, and may require different skillsets.

Providing an expected breakdown of inpatient vs outpatient claims and facility vs professional fee will allow bidders to provide more competitive pricing that more accurately reflects the needs of the government.

Historically, medical claims have been sampled in equal proportions. Dental and Pharmacy audits are 100% outpatient.

59 OTHER Please confirm that Service Contract Act Wage Determination will be applied upon contract award based on the actual physical work location of each impacted contractor employee.

The medical billing and coding workforce is often remote and geographically dispersed. The government will obtain much more competitive pricing if SCA WDs are based on actual work locations; some prior DHA contracts have applied WDs based on client or contractor corporate headquarters locations, which can substantially increase costs and prices when the DC metro area is used but staff are living and working remotely elsewhere.

Thank you for the recommendation. The Government will consider this suggestion in the final RFP.

60 Section C - Decription/ Specifications/ Work Statement

5.1.7.2 ClaimCheckTM

or Equivalent Code Auditing Software

We encourage the government to allow the use of vendors' proprietary software and tools as a cost-effective replacement for (or supplement to) COTS products, as long as the tools can be used within a NIST 800-171-compliant environment and provide the functionality required in the RFP. In this event, please confirm whether the government would require access/licenses to such tools.

Reference: "The contractor shall use a healthcare-recognized Commercially Available off the Shelf (COTS) comprehensive code auditing software which enables the contractor to evaluate the accuracy of billing and coding of claims selected for review as well as identifying incidental procedure codes and the bundling or unbundling of procedural codes."

Per Section 5.1.7.2, the only software variance allowed is a Claim Check equivalent.

61 Section C - Decription/ Specifications/ Work Statement

C.5.4.2.1.1. EDI 837 format claim data from contractors

Section C, 5.4.2.1.1. states that copies of processed claims information (i.e., medical claim forms CMS 1500, UB04) will be provided to the TCRS contractor. Will the MCSC and TMEP contractors also be required to provide the TCRS contractor with the original EDI data in the standard 837 formats as submitted by providers before the contractors processed the claims?

We understand the current procedure is that the MCSC and TMEP contractors convert EDI 837 claim data onto a paper (PDF image) claim facsimile, and it is this facsimile from which the claim source data is audited by the TCRS contractor. The contractors are required to store the 837 original source claims data they receive.

That original 837 data should be sent to the TCRS contractor in addition to the paper claim facsimile. Without auditing the source data (the 837 EDI claim) submitted by the provider, the government cannot be sure the processing of the claim is accurate since creating a paper claim facssimile from the EDI data is prone to incorrect representation on the paper version.

Also, the paper claim format cannot contain all the claim data that is available from the actual 837 EDI data.

No, for all 6 private sector care contracts, the EDI data is submitted through Tricare Encouter Data (TED Data) System, which populates the TED Audit Data Reports (TADR). See Exhibit J, Attachment 8.

62 Section J - List of Attachments and Exhibits

Count of claims by claim type

For the quarterly and annual MCSC and TMEP reviews, what percent of the total audit claims are institutional versus non-institutional/professional?

The time required to audit institutional claims versus professional claims is different and knowing the approximate workload of each will help bidders prepare a more accurate staffing estimate.

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

63 Section J - List of Attachments and Exhibits

Format and layout details of images and metadata sent by contractors to

TCRS

contractor.

Please provide specifications detailing the image formats and metadata that the contractors will provide to the TCRS contractor when they send claims and other documentation that supports the processed claim selected for review.

Knowing the formats and metadata provided will help bidders plan for proper configuration of their document management systems.

File formats: PDF, PNG, JPG, and TXT files.

64 Section J - List of Attachments and Exhibits

Annual volume of individual PDF image pages sent to

TCRS

contractor.

Please provide the annual volume of individual PDF pages sent as images in the data sent by the contractors to the TCRS contractor.

Knowing the volume of PDF pages needing to be stored and retrieved will help bidders to properly estimate the scale of data file sizes needed for their document management system.

The sample of claims is a random sample based on paid amounts.

Page counts vary from claim to claim, and can not be estimated accurately.

65 Section J - List of Attachments and Exhibits

J-8 Example TED Audit Detail Report

TED Audit data in database format

We note the TED audit detail report in J-8 appears to be a printed-out version of the TED data.

Question: Will DHA also be able to provide the TED Detail Audit data in a database format (comma delimited or other) so that it can be analyzed using data analysis tools rather than requiring human review of paper reports?

Providing the TCRS contractor with access to structured electronic data, both the source of claim data as well as payment history from the TED and other data, will allow advanced analytics to be performed to help identify audit errors more accurately.

The nature of these reviews require human review of the TED Audit Detail Report.

66 Section L - Instructions, Conditions, Notices to Offerors

L.2.2.4. Organizational conflict of interest.

L.2.2.4. includes Concept Plus LLC as an organization with potential conflict of interest. They are the incumbent TCRS contractor.

Question: Are they now excluded from being able to bid on the new TCRS opportunity?

Inclusion of Concept Plus may be in error. Inclusion of Concept Plus was in error, contractor removed.

67 Section L - Instructions, Conditions, Notices to Offerors

L.2.2.4. Organizational conflict of interest.

The list of companies with potential conflicts of interest noted in L.2.2.4. does not include the MCSC, TMEP, or TOP contractors – Humana, Health Net, WPS, International SOS, nor does it include their major first tier subcontractors PGBA and WPS.

Question: Why are these companies not considered to have a potential conflict of interest since, if one of them were awarded the TCRS contract, they would be reviewing their own claims for accuracy?

The Government will review the list of potential OCI contractors and update accordingly. The Government notes that any list of potential conflicts may be not exclusive or exhaustive. Actual conflicts can also arise or potentially be mitigated based on changing facts and circumstances.

68 Section B - Supplies or Services and Price/ Cost

Advance notice of audit volume changes

This is a fixed price ID/IQ contract, DHA could increase the volume of claims to be reviewed as necessary and the CLIN structure adequately provides the contractor with a mechanism to be paid for the work.

Question: How much advance notice will the Government provide the TCRS contractor if the volume of claims to be reviewed is increased significantly from the volumes listed in Attachment J-6?

For example, if the volume to be audited goes from 2,640 to 4,000 claims, the TCRS contractor will need adequate advance notice in order to hire additional staff in time necessary to respond to the increased volume.

The government will work with the contractor to ensure both parties are in agreement in instance of increased claims volume.

69 Section C - Decription/

Statement

C.5.3.1.2. Transition-In period of time.

Section C 5.3.1.2 states a Readiness review will be conducted by DHA 60 days prior to start of Option Year 1. The Base Period for the transition is only 90 days. This means the new TCRS contractor will have only 30 days after contract award to prepare to be ready to conduct the readiness review. It would seem this timing provides an advantage to the incumbent since a new contractor would find this schedule nearly impossible to stand-up and be successful with the Readiness review. We suggest the Base Period be expanded to 180 days so any contractor could be prepared in time.

Thank you for the recommendation The Government will consider this suggestion in the final RFP.

70 Section L - Instructions, Conditions, Notices to Offerors

L.4, Page L8 of L22

L.4 PROPOSAL

PREPARATION

Propsal Submission

In today’s environment, most computers no longer have CD RW (Read Write) drives to create data CDs. Current technology and industry standard is to deliver data files on USB Flash Drives, or via email to the CO and/or CS.

Since subsection L.7.7.1 instructs offerors to have past performance POCs to email the completed PPQ to Kristin.M.Decker.civ@mail.mil and Nicholas.R.Ceciliani.civ@mail.mil, perhaps the govenment might want to consider the submission of the proposal documents to also be delivered via email. Proposal submission via email has become standard for most federal and state proposals in the last decade.

Electronic submission will be required. CDROM submission will not be required and was included in error.

71 Section J - List of Attachments and Exhibits

Exhibit L-2, Past Performance Questionnaire

Proposal Submission

Please include the due date of when Attachment L-2 should be submitted to the Government for evaluation with the proposal.

Exhibit L-2 Past Performance Questionnaire shall be submitted by the proposal due date.

72 Section L - Instructions, Conditions, Notices to Offerors

L.4.13.2 and L.4.13.3 Proposal Submission

Section L.4.13.2 states:

Offerors shall submit proposals to the CO at the address indicated below. The proposals shall be in electronic format (see paragraph 4.0) in the quantities indicated in Table

1. Electronic copies shall be submitted to:

Mr. Nick Ceciliani, Contracting Officer Reference: TCRS Solicitation HT9402-21-R-0002 Defense Health Agency/MC-CD 16401 East Centretech Parkway Aurora, CO 80011-9066

Section L.4.13.3 states:

Each disc volume shall be marked as follows:

OFFEROR’S COMPANY NAME, e.g., XYZ Corporation Solicitation Number HT9402- 21-R-0002

Question: Please confirm this is an electronic submission. If yes, please provie the email address for submission of proposals and remove the requirement to submit disc volumes to a physical address.

Submission will be fully electronic. Email addresses will be provided in final RFP.

73 Section L - Instructions, Conditions, Notices to Offerors

Instructions Key Personnel Factor 2 Key personel appears to suggest 3 key staff at 1820 hours / yr / FTE; Volume 2 Pricing talks about 1920/yr/ FTE. Does CMS have preference for FTE hours per year? The current effort appears to be in range of 5 FTE for sole source 8(a) contract. Understanding $5-10M LOE estimate range as published in the CMS opportunity forecast.

Question: Would CMS please provide LOE guidance desired for this requirement?

This question is not applicable to this procurement.

74 Section J - List of Attachments and Exhibits

SOW Page 11;

Specific Requirements;

Tasks 1 and 2

Page 11; Specific Requirements; Tasks 1 and 2: There is no mention of an agile development process.

Question: If the contractor is capable of independently integrating with the system developer(s) as part of the Integrated Product Team (IPT), would CMS be interested in applying agile DevOps automated testing practices to save time and money through sharable test cases, test scripts, test data, and test personas?

This question is not applicable to this procurement.

75 Section J - List of Attachments and Exhibits

SOW Page 11;

Specific Requirements;

Tasks 1 and 2

Page 11; Specific Requirements; Tasks 1 and 2: There is no mention of an agile development process.

Question: Related, as UAT is conducted if the contractor has the capability to capture and automate a manually executed user test for user interface components, would CMS be interested in time and cost saving automated UAT that could be used as regression and smoke/operational testing as the product moves from development to operations? Is sharing of independently developed test cases, test scripts, and test data desired by CMS to encourage greater sharing and automation across the product development team for greater cost and time savings, repeatable testing and deployment activities, higher quality testing, and greater test case coverage of system and user interface requirements?

This question is not applicable to this procurement.

76 Section J - List of Attachments and Exhibits

SOW Page 11;

Specific Requirements;

Tasks 1 and 2

Page 11; Specific Requirements; Tasks 1 and 2: There is no mention of an agile development process.

Question: If the contractor is capable of independently integrating with the system developer(s) as part of the Integrated Product Team (IPT), would CMS be interested in applying agile DevOps automated testing practices to save time and money through sharable test cases, test scripts, test data, and test personas?

Question: Related, as UAT is conducted if the contractor has the capability to capture and automate a manually executed user test for user interface components, would CMS be interested in time and cost saving automated UAT that could be used as regression and smoke/operational testing as the product moves from development to operations? Is sharing of independently developed test cases, test scripts, and test data desired by CMS to encourage greater sharing and automation across the product development team for greater cost and time savings, repeatable testing and deployment activities, higher quality testing, and greater test case coverage of system and user interface requirements?

This question is not applicable to this procurement.

77 Section C - Decription/ Specifications/ Work Statement

5.3.1 "The contractor will have time-critical tasks to perform during the transition-in period prior to the first day of Option Period 1."

Transition-in Would DHA provide clarification on required transition tasks and which tasks are considered time-critical and require approval during the transition-in period?

See Section J, Exhibit A, CDRL's for detailed tasks and timeline requirements.

78 Section C - Decription/

Statement

5.3.1.2.2 Readiness Test. At

the time of the scheduled Readiness Test, a DHA Readiness Team consisting of the contract COR and various Government/contract personnel will arrive at the contractor’s work site to conduct the test and evaluate the contractor’s review results on a claim-by-claim basis."

Readiness Test Does DHA anticipate on-site visits or will they allow accommodations/guidance for remote work due to the COVID-19 pandemic?

The Government is still looking into issues or required changes related to COVID. The final RFP will include any COVID related requirements or changes.

79 Section C - Decription/ Specifications/ Work Statement

C.5.5.2 Medical Record Reviews

Would the govt consider adding the requirement of Medical Necessity Review or Appropriateness of care/services rendered?

We believe adding Medical Necessity Review or Appropriatness of care/services rendered as a requirement for review would add an additional benefit to the TCRS contract and provide a better overview to the Govt and identify areas where there could be an opporutnity for education and/or revenue recovery if appropriate.

Medical Record Reviews within the scope of this contract are not intended to determine or evaluate Medical Necessity Review or Appropriateness of care/services rendered.

80 Section L - Instructions, Conditions, Notices to Offerors

L.2.2.4 OCI It is noted that the incumbent TCRS Contractor, Concept Plus LLC has a actual or potential OCI. Does this mean that Concept Plus is precluded from bidding on the upcoming recompete of this contract?

Concept Plus was included in error.

81 Section L - Instructions, Conditions, Notices to Offerors

L.6.2 Transition-in Since this program has been managed by the same contractor for many years there may be critical transition-in activities that are not clear from the provided PWS. Recommend the Government consider providing a list of the critical transition-in tasks/activities and including a short term key personnel requirement for a Transition Manager.

See Section J, Exhibit A, CDRL's for detailed tasks and timeline requirements.

82 Section M - Evaluation Factors for Award

M.5.1.1 and M.5.1.2 Staffing/PM/QC In order to effectively evaluate the offerors staffing plan and alignment with the labor category consistent with the solicitation it would be helpful if the Government provided a list of expected labor categories with descriptions at least at a minimum for key personnel.

The government cannot advise about specific staffing requirements.

It is the Contractor's responsibility to determine specific staffing requirements and capabilities.

83 Section M - Evaluation Factors for Award

M.6.3.2 Past Performance Relevancy

Since most bidders will not have reviewed claims and customer service in similar circumstances to TCRS this seems to give the incumbent an advantage. Is the Government willing to consider complexity to claims reviewed for other Government agencies or organizations?

In accordance with Section M, the Government will determine complexity based on the offeror’s experience in reviewing claims and customer service in similar circumstances. Complexity does not specifically state that it must be under the exact same circumstances as the existing requirement. The Government will consider complexity of claims reviewed for other Government agencies or organizations but notes that any assessment of relevancy will still also consider the scope, magnitude, and complexity of the past performance contract reference.