Industry QA_Amend 0001.pdf

Question Number RFP/Manual Location Subsection/Citation Subject Question Government Response

1 Section M - Evaluation Factors for Award

M.5.2.2. Relevancy

Section M.5.2.2. states that the criteria used to assess past performance relevancy includes a “total enrollment per year of 24.2M;” however, the total annual enrollment under the current TDP contract is less than 2 million members. Please advise if the 24.2M stated in the RFP is correct

Section M.5.2.2. updated with correct annual enrollment.

Section L - Instructions, Conditions, Notices to Offerors

L.4.1. Volume 1

Table L.1 lists Completed Section J, Exhibit B CDRL Blocks 18 (L.5.2) and L.5.2 refers to Section J, Exhibit A. Can the Government confirm that Offerors are to fill out the worksheet in J-20 for CDRL pricing in lieu of Block 18 of each CDRL?

Please complete the worksheet in J-20 in lieu of Block 18 of each CDRL.

Section L - Instructions, Conditions, Notices to Offerors

L.4.2. Electronic Copies

In an effort to reduce file sizes, please confirm that Volume 1 RFP PDF documents may be submitted PDF, e.g., Section B, SF 33 and SF30s, CDRLs, DCMA Form 1620 04-04, Wage Determinations, Financia Data.

Yes, Section L.4.2. has been updated.

Section L - Instructions, Conditions, Notices to Offerors

L.4.2. Electronic Copies

In an effort to reduce file sizes, please confirm that certain parts of Volume 3 may be submitted in PDF, e.g., Consent Letters, Client Authorization Letters, Past Performance Questionnaires, Small Business Compliance Record

Yes, Section L.4.2. has been updated.

Section L - Instructions, Conditions, Notices to Offerors

L.2.7./L.4.2. Email Submission

In recent proposal submissions on similar contracts, combined Volume sets were more than 50MB without compression. Can the Government confirm the email size capacity for an individual email for the DHA TDP6 General Inbox?

In previous aquistions, submissions to general inboxes have not caused an issue on file size. The government will confirm receipt of submission.

Section L - Instructions, Conditions, Notices to Offerors

L.5.7 Corporate Guarantee

Section L.5.7 requires offerors to submit the Corporate Guarantee using DCMA Form 1620 04-04 and references Attachment J-15; however, J-15 contains DCMA Form 1620 2017. Can the Government please confirm offerors should submit DCMA 1620 04-04?

Exhibit J-15 has been removed in Amendment 0001.

7 Section J - List of Attachments and Exhibits

J-18, #3 - CONUS Enrollment Data by Contracts (Plans) Data File

The file “DEERS Data 2 of 2 TDP_ENROLLEES_2022.xlsx” shows a total of 1.8 M covered lives. However, in the file “Admn Data 1 of 2 TDP CONUS_oconus data May 2017–August 2022_.xlsx,” Tab “CONUS Enrollment” shows 1.81M covered lives and the “OCONUS Enrollment” tab shows 204K covered lives for a combined total of 2.03 M covered lives. Can DHA confirm the correct covered lives total and the applicable break out by CONUS and OCONUS for each plan type?

See the revised file Admn Data 1 of 2. At tab "Total Enrollment" the Total Enrollment quantity for each period includes the total OCONUS enrollment quantity. Note to derive the CONUS enrollment population, subtract the OCONUS Total from the Total Enrollment quantity.

8 Section J - List of Attachments and Exhibits

J-18, #4 - OCONUS Enrollment Data by Contracts (Plans) Data File

The file “Admn Data 1 of 2 TDP CONUS_oconus data May 2017–August 2022_.xlsx” shows that there are 277K plans (“OCONUS Plans” tab) but only 203K covered lives (“OCONUS Enrollment” tab) enrolled under those plans.

Please clarify.

See the revised data file Admn Data 1 of 2. The revised "OCONUS Enrollment" tab for Aug. 22 displays 286,938 Covered Lives and the Aug. 22 data at tab "OCONUS Plans" displays a quantity of 277,357 plans.

9 Section J - List of Attachments and Exhibits

J-20 Price Evaluation Template; Section B Unit Costs

The price evaluation template (J-20) provides CLINS that appear to allow bidders to vary the unit costs between Junior Enlisted (E-1 to E-4) and E5 and above. The specific SLINS are X001AA, X001AB, X002AA and X002AB.

The template permits values for those SLINS, but quantities have not been provided and the Total Prices do not get rolled up into the Ordering Period Totals.

Is it the Government’s intention to allow bidders to vary the unit costs by rank? Furthermore, the quantities on the template (J-20) are not populated on Section B.

Please advise.

Please do not input values in grey boxes, J-20 has been updated to remove formulas in SLINs.

Section B has been updated accordingly.

10 OTHER

General Extension

Would DHA consider offering an extension of the Request for Proposal (RFP) due date because of data discrepancies in the TDP data set, elements of that data set that need clarification, and questions about MDR data? Bidders will need adequate time to respond to corrected data sets as well as answers to questions.

The Government believes the data set inconsistencies are minor, and correct information was provided shortly after the issue was presented. At this time an extension is not being considered.

11 OTHER

General Assume no EEE contractor

Should bidders responding to the TDP6 RFP assume that none of the scope of work in the RFP will be conducted by an enrollment, eligibility, and encounter/claims processing (EEE) contractor?

Correct

12 OTHER

General No EEE contractor transition

The TDP6 RFP provides no information about a possible enrollment, eligibility, and encounter/claims processing (EEE) contractor. Should bidders assume there will be no transition to an EEE contractor during any of the TDP6 Operating Periods?

The solicitation reflects the government's currently known requirements. DHA is aware of proposed legislation that could require a future EEE contractor. Any future modifications to the government's requirements must also comply with other applicable law and regulations, and in certain matters must also comply with the federal rulemaking process. Additionally, the government reminds offerors that the solicitation anticipates award of an indefinite-delivery, indefinite-quantity contract with the minimum guarantee as stated in the solicitation.

C.5.9. and Attachment J-10 MDR Edit Protocols

We understand that TDP claims payment data is to be submitted by the contractor to the MHS Data Repository (MDR) as referenced in Attachment J-10. We understand that the TRICARE Encounter Data (TED) processes do not apply to TDP claims payments. Are there specific edit protocols that the government conducts on incoming MDR data to validate the quality of information being sent by the TDP contractor? Is there a requirements document on MDR data editing similar to the TRICARE Encounter Data (TED) editing protocols noted in the TRICARE System Manual (TSM) Chapter 2? If so, can the editing requirements on MDR submissions be provided?

1) No, there are not edit protocols. 2) No, there are not specified edit protocols and therefore no document similar to the TRICARE System Manual (TSM) specifying editing requirements.

M.4.1. Evaluation Ratings

Section M cites a new rating category when assessing the merit of a proposal technical component, now distinguishing between a Strength and a Significant Strength. The definitions for these in the RFP are essentially the same. Can DHA provide examples of criteria used to distinguish a Strength versus a Significant Strength?

Please refer to the solicitation definitions for how evaluations will be conducted.

Examples will not be provided by the Government.

Attachment J-10 and CDRL M060

Reporting Adjustment Claims in MDR Submissions

When providing the monthly MDR claims processed data as defined in Attachment J-10, for adjustment claims, should the net dollar values of the adjustment be submitted or should the complete new resulting value of the claim payment be submitted? For example, the original dental claim processed to pay $100. A subsequent adjustment to that claim is required to pay an additional $10. In the MDR for the adjustment claim, should $10 be reported or should $110 be reported?

The MDR can accommodate a complete update replacement; in the example provided, the $110 final record would be reported.

Attachment J-10 and CDRL M060 Adjustment Claims in MDR Submissions

The MDR claim payment data is to be submitted monthly to DHA. When claim adjustments are made during the same month, should only the final adjusted claim be submitted with the total new payment values, or should the original claim and every adjustment made to that claim be submitted separately in the same monthly MDR submission?

The MDR can accommodate a complete update replacement each month; only the final adjusted claim would be reported in the event there are multiple adjustments during the month.

Attachment J-10 MDR Data Elements

In the monthly MDR file sent to DHA, for those line item data elements that do not have reportable values (such as data elements for tooth 2 through 4 when only one tooth was treated), what is the default value to be used? Should they be zero-filled, null, or some other value?

Null is the appropriate value.

Attachment J-11 Transition-In Data From Outgoing Contractor

In Attachment J-11 Transition, it states the outgoing contractor will provide Processed Orthodontic Claims Histories to the incoming contractor. This would represent only a partial accounting of dental claims history. For Fraud/Abuse detection, customer service, and other reasons, will DHA require the outgoing contractor to provide at least two years of complete dental claims processed history to the incoming contractor?

No, see Attachment J-11 2.8. Receipt of Files.

Attachment J-11

Outgoing Contractor Processed Claims Data Format

Attachment J-11, 2.9 states "The outgoing contractor will prepare all specified ADP files in non-proprietary electronic format and transfer to the incoming contractor in accordance with the schedule set at the Transition Specification Meeting unless otherwise negotiated by the incoming and outgoing contractors, and DHA. The contractor shall include non-proprietary file specifications and documentation as may be necessary for interpretation of these files". In order to adequately prepare and estimate Transition-In cost, please provide what the standard non-proprietary formats will be.

See Attachment J-11 2.9. Transfer of Automated Data Processing (ADP) Files.

Attachment J-16 CMMC Not A Requirement

Please confirm our assumption that the Cybersecurity Maturity Model Certification (CMMC) Requirement noted in Attachment J-16, TSM Chapter 1 Section 1.1 Paragraph

3.4.5. does not apply at this time for the TDP contract.

Please also confirm that if CMMC becomes a future TDP requirement, it will be directed by government change order

The CMMC is not required until after October 1, 2025. If CMMC becomes a future requirement, it will be directed by the Government via appropriate contract modification.

Attachment J-16 Duplicate Claim System

Please confirm that the DHA/TRICARE Duplicate Claims System (DCS) activities noted in Attachment J-16, TSM Chapter 1 Section 1.1. Paragraph 7.9 are not applicable to the TDP contractor

DCS does not apply to TDP. See Section C 2.0 for Definitions, Acronyms, And Applicable Publications/Instructions.

Attachment J-5 Section 6.0 DD Form 2813

In Attachment J-5 Program Ops V2, section 6.0 it states "Upon request, network providers shall complete the DD Form 2813 (Active Duty/Reserve/Guard/Civilian Forces Dental Examination Form) provided at Attachment J-7a, at no additional cost to the enrollee. The contractor shall collect the Reserve Component Service Member’s dental readiness classification information from providers and shall report this information on the TDP Claims File Data Elements monthly data feed..."

1. What conditions or requirements define the term "when required?" Will it be required every time dental care is provided, annually, or on some other timeframe?

2. If dental care is provided by a non-network provider, is the completion of this form still required?

3. Classification information is to be included in the monthly claims data to MDR submission. Would the classification be provided on every claim processed for the reservist or guard in the event the enrollee has multiple claims in a month, or just one claim?

1) It will be required every time care is rendered.

2) Yes the form will be required if care is provided by a non-network provider. 3) The DRC will be captured each time care is rendered.

Attachment J-5 Section 6.0 Reject claim if Form 2813 not provided

If Form 2813 is required from the network dental care provider for reserve/guard members but the form is not provided to the contractor, should the claim be rejected?

Alternatively, should the claim be processed/paid, thus leaving field 55 on the claims data sent to MDR null or blank? If the claim is to be rejected/denied, is not receiving Form 2813 an appealable action?

The network provider shall complete the DD Form 2813 per Attachment J-5 6.0. If the form is not filled out, the claim will be denied. If the form is not received by the contractor, the claim will be denied until the form is received.

L.6.3.1 L.6.3.2.1 and L.6.3.2.

Please confirm that C.5.1.2.1 as referenced in Section L.6.3.1 should actually be moved to L.6.3.2.

The Government agrees to having the reference moved to paragraph L.6.3.2.

General Calls by country

Please provide the annual volume of calls by country.

That information was not included in the data provided.

DHA does not track calls by country therefore, this data is not available.

General Other Dental Health Insurance Information

Will the outgoing contractor provide to the incoming contractor detailed information on beneficiaries who have other dental health insurance? Does the incumbent contractor upload to DEERS other dental health insurance information at the beneficiary level when they identify it is in place? If so, does DEERS provide other dental insurance information to the contractor for claims processing purposes?

Per TSM, Chapter 3, Section 4.2, ..."The contractor system is the database of record for OHI. The contractor shall use OHI data received as part of the claims inquiry as part of the claims adjudication process. If the contractor has evidence of additional or more current OHI information, the contractor shall either 'pend' the claim, submit the new OHI information to DEERS, and then reprocess the claim, or develop business processes to simultaneously accomplish both DEERS OHI update and claims processing using the newly discovered OHI data. Within MDR, the payment amount of the other carrier would be visible however, the carrier name and dates of coverage would not be visible. Any process executed by the contractors must not interfere with the contractors required claims processing time lines...." Transition requirements for outgoing contractors do not require OHI data to be transferred to the incoming contractor as the information is visible via DEERS.

J-20, RFP Section B

Align Schedule B Quantities

Should the quantity amounts captured in J-20, schedule B be captured in the RFP Section B? Currently the RFP has blank quantities.

Section B has been updated.

C.3.5.3 ID Cards

Will a new awardee be required to send new TDP ID cards to all enrollees or will the DMDC be responsible for sending the ID cards?

DMDC will notify enrollees that a new ID Card is available for download within its web site.

Section B, L.8.8. and L.8.9.

CLINs X005 and X006 Reimbursement

Please provide examples of elements for which cost would be included in CLIN X005 (Reimbursement for Costs in Excess of Allowable Charges for OCONUS Claims) and CLIN X006 (Reimbursement for Cost Shares and Additional Allowable Charges for Orthodontic Costs Charge for OCONUS Claims). In Section B, they are both listed as being "Cost Reimbursable, No Fee." How is the contractor to submit invoices for cost reimbursement against those CLINs? What is the billing period, monthly or annually? Is there a CDRL or format for submission to

DHA?

Each monthly report must contain the following:

Claim Number, Provider Name, Address, City, Zip Code, Country, TOPD indicator (yes or no), Sponsor Name, Sponsor SS Number, Procedure Code (the contractor may be required to identify the procedure codes.) The Procedure Description, (every procedure code must be broken out separately), The Date of Service, The Billed Charges, Allowed Charges, Difference between billed and allowed charges, Paid cost shares, The total invoice amount, Yes CDRL M040 OCONUS Payment Report

Section B, L.8.8. and L.8.9.

Foreign Exchange Rate Reimbursement

For overseas dental claims processed where payment will be made by converting US dollars into a foreign currency:

1) Is the contractor to include the actual cost of currency exchange rates in CLINs X005 and X006?

2) If so, should that cost be invoiced to DHA monthly or annually?

3) It does not appear that currency exchange rates are included with the claim MDR. Is there a CDRL or format for reporting currency exchange rates?

All invoicing must be converted to US Dollars and submitted on a monthly basis.

M.5.2.2. Past performance on contracts that are the most similar to the requirements for TPD6 are the most relevant for assessing the offeror’s ability to meet the solicitation’s requirements.

For the purposes of the relevancy assessment, the following primary criteria will be used for comparing the scope, magnitude of effort, and complexities of the offeror’s past performance contract references:

- Scope: dental care;

- Magnitude of effort: a CONUS provider network, OCONUS services, total enrollment per year of 24.2M, and total claims per year of 3.6M; and

- Complexities: benefit management (including OCONUS services), CONUS provider network management, customer service, and claims processing.

These criteria are intended to provide clarity on how the Government defines the TDP6 scope, magnitude of effort, and complexities. They do not otherwise limit the discretion of the Government in the determination of relevancy ratings.

Past Performance Reference Criteria

In section M.5.2.2, the RFP indicates DHA is looking for references similar in scope and effort to the TDP6 project.

The past performance criteria references contracts with 24.2M enrollment and 3.6M claims. As the quantities listed in J-20 represent roughly 660,000 annual members (3.3M over the life the contract) is the past performance evaluation criteria misaligned with the size of TDP?

Section M.5.2.2. updated with correct annual enrollment. The past performance evaluation criteria is not misaligned to the size of TDP.

General J.20 Quantities

Would DHA please confirm that the quantities listed in J- 20 (CLIN xxx1, xxx2, xxx3, xxx4) represent annual member months?

The Government confirms the quantities represent annual member months.

General Application of Cost Accounting Standards

Section 1.5, the RFP references how the TDP administrative efforts are "consistent with the contractor’s commercial practices". The pricing of the TDP FFP premiums will also follow commercial actuarial and underwriting best practices. Also, the TDP product aligns to in-force commercial dental products that are sold to the general public. Section L.2.2.2 also states that there is "high probability of adequate price competition in this acquisition."

When you compare the need to apply the Cost Accounting Standards against FAR Part 12.214 "Cost Accounting Standards (CAS) do not apply to contracts and subcontracts for the acquisition of commercial products or commercial services when these contracts and subcontracts are firm-fixed-price or fixed-price".

Would the DHA consider eliminating the CAS requirement from this contract? The DHA will have access to cost and pricing information if required as indicated in L.2.2.2.

The solicitation will remain subject to the currently included CAS provisions, as well as subsequent contract clauses as appropriate.

General

NIST and Physical & Personnel Security Pricing

If a bidder's disclosed cost accounting practices involving physical and personnel security costs are pooled, the bidder will be in direct violation of the cost accounting standards and disclosed practices if bidders are required to charge direct to the CLIN (final cost objective). How should bidders who pool and allocate security costs represent these costs in CLIN xxx7?

Offerors are encouraged to consult with the appropriate professional advisors regarding CAS compliance requirements and methodologies.

H.3.1.3. Network Provider Retention. This positive incentive is based on the contractor retaining a minimum of 95% of all network providers (general and specialty). The incentive will be administered annually during each contract OP beginning with OP 1 (see Section C.5.1.1.3.c.). For OP 1 the COR shall validate the baseline 6 months after start of dental care delivery. The baseline shall be reset at the beginning of each OP, and the COR shall re-validate at the end of the OP in accordance with the Section J, Exhibit B, CDRL) M020, Provider Network Access Report. If more than 95% of network providers are retained annually, the contractor shall be awarded an incentive of:

Network Provider Retention Measure

Is this metric based upon voluntary and involuntary turnover? Would DHA consider eliminating involuntary turnover as there is a portion of the network that would be terminated by the contractor (fraud concerns) or would be a result of the dentist (retirement, acquisition).

1) The metric is based on all turnover. 2) DHA will not consider eliminating involuntary turnover.

C.5.1.1.3. Mobile Dental Units

Would DHA please specify the frequency of on-site service by the Mobile Dental Units (MDUs) required to support Fairbanks, Alaska and Ft Irwin, CA? Is there an expectation of daily coverage and can this be scheduled by the offeror to reflect historical and anticipated demand?

The frequency and requirements for scheduling a MDU are identified in Attachment J-5 Section 5.3.

Section B, L.8.8. and L.8.9. Currency Conversion

Would the Government please provide the breakdown of OCONUS claims requiring currency conversion?

The Dental Program does not track or have a breakdown of OCONUS claims requiring currency conversion.

General TDP Data Set

In the data provided by DHA, in the Benefit Category Code field there are several types of codes that are not defined in Appendix 4 for the datasets. Please provide the definitions for the following values found in the Benefit Category field: CONSUL, D MED, D XRAY, DME, IMMUN, INJECTC, JUNQUE,O MM V, PROST, ROUTIN.

Confirmed the following: CONSUL =

CONSULTATION, D MED= DIAGNOSTIC MEDICAL, D

XRAY= DIAGNOSTIC X-RAY, DME= DURABLE

MEDICAL EQUIPMENT, IMMUN= IMMUNIZATION,

INJECT= INJECTIONS, JUNQUE= JUNQUE, O MM V=

OUTPATIENT MEDICAL/MENTAL VISITS, PROST=

PROSTHETIC DEVICES, ROUTIN= ROUTINE SERVICES

G.3.2.1 Transition In Invoicing

RFP states that contractor can invoice for transition in when transition in is complete. Would Government allow for contractor to invoice during the 1-year transition when certain milestones are met?

A milestone invoicing process will not be implemented.

Attachment J-5, paragraph 5.2

Non-Compliant General Dentist Network Access Standards

RFP states "When more than 25% percent or more than 200 enrollees in a specific five digit ZIP code area are unable to obtain a periodic or initial (nonemergency) dental examination appointment with a network provider within the access standards specified in C.5.1.1.3.a, then DHA will designate that area as non-compliant with the general dentist network access standard." How are the 25% or 200 enrollees calculated or ascertained? What data is used to derive compliance or non-compliance?

1) Based on the DEERS summary report. 2) The beneficiary address.

Attachment J-5, paragraph 5.3 Mobile Dental Units

RFP states "The contractor shall deploy Mobile Dental Units (MDUs), with DHA approval, in accordance with the standard stated in C.5.1.1.3.d. for areas of the country where there are 200 or more enrollees who do not have access to dental care because there are no practicing dentists within 50 driving miles of a beneficiary’s place of residence or because 200 or more enrollees reside in a non-compliant area (see paragraph 5.2 Non-compliant General Dentist Network Access Standard)." Please explain the reference and relevancy to paragraph 5.2. Is it correct to anticipate that the contractor will only have to deploy RDUs to the two locations specified in 5.3 and no more than two other locations as specified in 5.3.1?

1) There are two designated locations each ordering period for MDUs. 2) At DHA's discretion we may authorize up to two additional MDUs (not authorized at the two current designated locations) across the country each ordering period.

C.5.7.3 DHA Data

C.5.7.3 requires post payment utilization reviews for high volume beneficiaries "when performing post payment utilization reviews, the contractor shall consider high volume beneficiaries as those beneficiaries whose charges exceed $25,000 during a 12-month reporting period".

Can DHA provide data on the number of high volume beneficiaries?

The beneficiary is liable for all costs above the maximum. DHA does not see the beneficiary expenses due to the contractor at risk for claims.

General TDP Data Set

In dataset spreadsheet “Admn Data 1 of 2 TDP CONUS_OCONUS data May 2017 - August 2022_.xlsx," in tab “OCONUS Plans” the total plans each month is a larger number than the covered lives total listed in the “OCONUS Enrollment” tab for the same month. There should always be more covered lives than there are plans (for example, a family with three members would count as three covered lives enrolled but just one plan). We respectfully request an explanation of this apparent discrepancy or please provide corrected information that accurately reflects enrollment plans and covered lives in

OCONUS.

See the revised Admn Data File 1 of 2. A revised tab "Total Enrollment" was added and the tab "OCONUS Enrollment" lists revised monthly data.

RFP Section H.3.1.3.1. and CDRL M020 Provider Retention Rate

In calculating the provider network retention rate as reported in CDRL M020, we assume the contractor should exclude from the network retention calculation those providers who leave our network involuntarily, such as the death of the provider or if they lose their license due to fraud. We respectfully request confirmation of this assumption

The Provider Retention Rate is based on all turnover. DHA will not consider eliminating involuntary turnover.

Attachment J-6a, OCONUS Program Ops V2, Section 8.1 states that enrollees who reside OCONUS must be Command Sponsored in order to receive OCONUS TDP cost-share benefits (Section J, Attachment J-4, Cost Shares). Non-Command Sponsored TDP enrollees who receive dental care OCONUS are responsible for CONUS cost-shares as well as any difference between the dentist’s charge and the contractor’s allowances for treatment. In order for us to understand the provided data, can DHA provide the counts of OCONUS TDP enrollees and eligible beneficiaries who are Command Sponsored as we do not find that information in the data provided? Can DHA provide the count of claims processed from OCONUS beneficiaries who were Non- Command Sponsored and are there any Command Sponsored beneficiary specifics that applies in CONUS?

To all of the questions no. DEERS does not identify Command Sponsorship.

The contractor makes the determination based on beneficiary enrollment in the OCONUS TRICARE Prime or TRICARE Prime Remote medical benefit.

For those members not under the OCONUS TRICARE Prime or TRICARE Prime Remote medical benefit, the contractor will need to communicate directly with the beneficiary to obtain proof of the beneficiary having command sponsorship in order to deliver the OCONUS TDP benefit.

No-There are no command sponsored beneficiary specifics applicable to CONUS care.

Question Sheet