Attachment 6 - TCRS Compliance Review Schedule 20240809.pdf

PDF 1 MB Posted Aug 9, 2024

Attached to: TRICARE CLAIMS REVIEW SERVICE (TCRS)
Solicitation number: HT940224R0002
Issued by: Defense Health Agency

About this file

Written by GovTribe AI · Aug 9, 2024

This document is the TRICARE Claims Review Service (TCRS) Compliance Review Schedule for Option Periods 1 through 7 from March 1, 2025 through February 29, 2032. It provides the estimated claim volume, dates when the list of claims selected for review will be issued by the Defense Health Agency (DHA), and the estimated dates when the claims information from the Purchased Care Contractor (PCC) will be due to the TCRS contractor.

The key details include quarterly and semi-annual compliance reviews for various TRICARE programs such as the Managed Care Support Contracts, TRICARE Medical Eligible Program, TRICARE Overseas Program, TRICARE Pharmacy Program, and the Active Duty Dental Program. The total estimated claim volume across all option periods is approximately 65,000 claims. This information is provided to support the TCRS contract (Solicitation Number HT940224R0002) awarded by the Defense Health Agency to audit the compliance and accuracy of TRICARE purchased care claims processing.

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Other files

File	Type	Posted
Exhibit 8 - Draft Quality Assurance Surveillance Plan (QASP) 20240809.docx	DOCX document	Aug 9, 2024
HT940224R0002 0001.pdf	PDF	Aug 9, 2024
Industry Questions and Government Responses 20240809.pdf	PDF	Aug 9, 2024
CDRLs.zip	ZIP file	Jun 21, 2024
HT940224R0002.pdf	PDF	Jun 21, 2024
RFP Exhibits.zip	ZIP file	Jun 21, 2024
RFP Attachments.zip	ZIP file	Jun 21, 2024

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Attachment 6

. Compliance Review Cycle

Estimated Claim Volume

Estimated Date List of Claims Selected for

Review Issued by

DHA

Estimated Date Claims Information from PCC

Due to TCRS Contractor

Jan-Mar 25 4,800 Apr-25 May-25 Apr-Jun 25 4,800 Jul-25 Aug-25 Jul-Sep 25 4,800 Oct-25 Nov-25 Sep-Dec 25 4,800 Jan-26 Feb-26

Feb-Apr 25 2,393 May-25 Jun-25 May-Jul 25 2,393 Aug-25 Sep-25 Aug-Oct 25 2,393 Nov-25 Dec-25

Nov 25-Jan 26 2,393 Feb-26 Mar-26

Dec 24-Feb 25 1,875 Mar-25 Apr-25 Mar-May 25 1,875 Jun-25 Jul-25 Jun-Aug 25 1,875 Sep-25 Oct-25 Sep-Nov 25 1,875 Dec-25 Jan-26

Jan-Mar 25 2,800 Apr-25 May-25 Apr-Jun 25 2,800 Jul-25 Aug-25 Jul-Sep 25 2,800 Oct-25 Nov-25 Sep-Dec 25 2,800 Jan-26 Feb-26

Nov 24-Apr 25 1,250 May-25 Jun-25

May-Oct 25 1,250 Nov-25 Dec-25

West Region 7,500 Mar-25 Apr-25 East Region 7,500 Apr-25 May-25

64,972

TRICARE

Pharmacy Program

(Tpharm)

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 1 Mar 1, 2025 - Feb 28, 2026

QUARTERLY COMPLIANCE REVIEWS

T-5 Managed Care Support Contracts (MCSCs)

East Region West Region

TRICARE

Medical Eligible Program (TMEP)

TRICARE

Overseas Program

(TOP) Contract

Total Estimated Claim Volume

SEMI-ANNUAL COMPLIANCE REVIEWS

Active Duty

Dental Program

(ADDP)

MCSC Unallowed Health Care Cost (UHCC) Reviews

Jan-Dec 24

TCRS HT940224R0002, Attachment 6 - TCRS Review Schedule

Review Cycle

Estimated Claim Volume

Estimated Date List of Claims Selected for

Review Issued by

DHA

Estimated Date Claims Information from PCC

Due to TCRS Contractor

Jan-Mar 26 4,800 Apr-26 May-26 Apr-Jun 26 4,800 Jul-26 Aug-26 Jul-Sep 26 4,800 Oct-26 Nov-26 Sep-Dec 26 4,800 Jan-27 Feb-27

Feb-Apr 26 2,393 May-26 Jun-26 May-Jul 26 2,393 Aug-26 Sep-26 Aug-Oct 26 2,393 Nov-26 Dec-26

Nov 26-Jan 27 2,393 Feb-27 Mar-27

Dec 25-Feb 26 1,875 Mar-26 Apr-26 Mar-May 26 1,875 Jun-26 Jul-26 Jun-Aug 26 1,875 Sep-26 Oct-26 Sep-Nov 26 1,875 Dec-26 Jan-27

Jan-Mar 26 2,800 Apr-26 May-26 Apr-Jun 26 2,800 Jul-26 Aug-26 Jul-Sep 26 2,800 Oct-26 Nov-26 Sep-Dec 26 2,800 Jan-27 Feb-27

Nov 25-Apr 26 1,260 May-26 Jun-26

May-Oct 26 1,260 Nov-26 Dec-26

West Region 7,500 Mar-26 Apr-26 East Region 7,500 Apr-26 May-26

64,992

MCSC Unallowed Health Care Cost (UHCC) Reviews

Jan-Dec 25

Total Estimated Claim Volume

Active Duty Dental Program

(ADDP)

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 2 Mar 1, 2026 - Feb 28, 2027

QUARTERLY COMPLIANCE REVIEWS

T-5 Managed Care Support Contracts (MCSCs)

East Region West Region

TRICARE

Medical Eligible Program (TMEP)

TRICARE

Overseas Program

(TOP) Contract

TRICARE

Pharmacy Program

(Tpharm)

SEMI-ANNUAL COMPLIANCE REVIEWS

Review Cycle

Estimated Claim Volume

Estimated Date List of Claims Selected for

Review Issued by

DHA

Estimated Date Claims Information from PCC

Due to TCRS Contractor

Jan-Mar 27 4,800 Apr-27 May-27 Apr-Jun 27 4,800 Jul-27 Aug-27 Jul-Sep 27 4,800 Oct-27 Nov-27 Sep-Dec 27 4,800 Jan-28 Feb-28

Feb-Apr 27 2,393 May-27 Jun-27 May-Jul 27 2,393 Aug-27 Sep-27 Aug-Oct 27 2,393 Nov-27 Dec-27

Nov 27-Jan 28 2,393 Feb-28 Mar-28

Dec 26-Feb 27 1,875 Mar-27 Apr-27 Mar-May 27 1,875 Jun-27 Jul-27 Jun-Aug 27 1,875 Sep-27 Oct-27 Sep-Nov 27 1,875 Dec-27 Jan-28

Jan-Mar 27 2,800 Apr-27 May-27 Apr-Jun 27 2,800 Jul-27 Aug-27 Jul-Sep 27 2,800 Oct-27 Nov-27 Sep-Dec 27 2,800 Jan-28 Feb-28

Nov 26-Apr 27 1,270 May-27 Jun-27

May-Oct 27 1,270 Nov-27 Dec-27

West Region 7,500 Mar-27 Apr-27 East Region 7,500 Apr-27 May-27

65,012

MCSC Unallowed Health Care Cost (UHCC) Reviews

Jan-Dec 26

Total Estimated Claim Volume

Active Duty Dental Program

(ADDP)

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 3 Mar 1, 2027 - Feb 29, 2028

QUARTERLY COMPLIANCE REVIEWS

T-5 Managed Care Support Contracts (MCSCs)

East Region West Region

TRICARE

Medical Eligible Program (TMEP)

TRICARE

Overseas Program

(TOP) Contract

TRICARE

Pharmacy Program

(Tpharm)

SEMI-ANNUAL COMPLIANCE REVIEWS

Review Cycle

Estimated Claim Volume

Estimated Date List of Claims Selected for

Review Issued by

DHA

Estimated Date Claims Information from PCC

Due to TCRS Contractor

Jan-Mar 28 4,800 Apr-28 May-28 Apr-Jun 28 4,800 Jul-28 Aug-28 Jul-Sep 28 4,800 Oct-28 Nov-28 Sep-Dec 28 4,800 Jan-29 Feb-29

Feb-Apr 28 2,393 May-28 Jun-28 May-Jul 28 2,393 Aug-28 Sep-28 Aug-Oct 28 2,393 Nov-28 Dec-28

Nov 28-Jan 29 2,393 Feb-29 Mar-29

Dec 24-Feb 28 1,875 Mar-28 Apr-28 Mar-May 28 1,875 Jun-28 Jul-28 Jun-Aug 28 1,875 Sep-28 Oct-28 Sep-Nov 28 1,875 Dec-28 Jan-29

Jan-Mar 28 2,800 Apr-28 May-28 Apr-Jun 28 2,800 Jul-28 Aug-28 Jul-Sep 28 2,800 Oct-28 Nov-28 Sep-Dec 28 2,800 Jan-29 Feb-29

Nov 27-Apr 28 1,280 May-28 Jun-28

May-Oct 28 1,280 Nov-28 Dec-28

West Region 7,500 Mar-28 Apr-28 East Region 7,500 Apr-28 May-28

65,032

MCSC Unallowed Health Care Cost (UHCC) Reviews

Jan-Dec 27

Total Estimated Claim Volume

Active Duty Dental Program

(ADDP)

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 4 Mar 1, 2028 - Feb 28, 2029

QUARTERLY COMPLIANCE REVIEWS

T-5 Managed Care Support Contracts (MCSCs)

East Region West Region

TRICARE

Medical Eligible Program (TMEP)

TRICARE

Overseas Program

(TOP) Contract

TRICARE

Pharmacy Program

(Tpharm)

SEMI-ANNUAL COMPLIANCE REVIEWS

Review Cycle

Estimated Claim Volume

Estimated Date List of Claims Selected for

Review Issued by

DHA

Estimated Date Claims Information from PCC

Due to TCRS Contractor

Jan-Mar 29 4,800 Apr-29 May-29 Apr-Jun 29 4,800 Jul-29 Aug-29 Jul-Sep 29 4,800 Oct-29 Nov-29 Sep-Dec 29 4,800 Jan-30 Feb-30

Feb-Apr 29 2,393 May-29 Jun-29 May-Jul 29 2,393 Aug-29 Sep-29 Aug-Oct 29 2,393 Nov-29 Dec-29

Nov 29-Jan 30 2,393 Feb-30 Mar-30

Dec 28-Feb 29 1,875 Mar-29 Apr-29 Mar-May 29 1,875 Jun-29 Jul-29 Jun-Aug 29 1,875 Sep-29 Oct-29 Sep-Nov 29 1,875 Dec-29 Jan-30

Jan-Mar 29 2,800 Apr-29 May-29 Apr-Jun 29 2,800 Jul-29 Aug-29 Jul-Sep 29 2,800 Oct-29 Nov-29 Sep-Dec 29 2,800 Jan-30 Feb-30

Nov 24-Apr 29 1,290 May-29 Jun-29

May-Oct 29 1,290 Nov-29 Dec-29

West Region 7,500 Mar-29 Apr-29 East Region 7,500 Apr-29 May-29

65,052

MCSC Unallowed Health Care Cost (UHCC) Reviews

Jan-Dec 28

Total Estimated Claim Volume

Active Duty Dental Program

(ADDP)

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 5 Mar 1, 2029 - Feb 28, 2030

QUARTERLY COMPLIANCE REVIEWS

T-5 Managed Care Support Contracts (MCSCs)

East Region West Region

TRICARE

Medical Eligible Program (TMEP)

TRICARE

Overseas Program

(TOP) Contract

TRICARE

Pharmacy Program

(Tpharm)

SEMI-ANNUAL COMPLIANCE REVIEWS

Review Cycle

Estimated Claim Volume

Estimated Date List of Claims Selected for

Review Issued by

DHA

Estimated Date Claims Information from PCC

Due to TCRS Contractor

Jan-Mar 30 4,800 Apr-30 May-30 Apr-Jun 30 4,800 Jul-30 Aug-30 Jul-Sep 30 4,800 Oct-30 Nov-30 Sep-Dec 30 4,800 Jan-31 Feb-31

Feb-Apr 30 2,393 May-30 Jun-30 May-Jul 30 2,393 Aug-30 Sep-30 Aug-Oct 30 2,393 Nov-30 Dec-30

Nov 30-Jan 31 2,393 Feb-31 Mar-31

Dec 29-Feb 30 1,875 Mar-30 Apr-30 Mar-May 30 1,875 Jun-30 Jul-30 Jun-Aug 30 1,875 Sep-30 Oct-30 Sep-Nov 30 1,875 Dec-30 Jan-31

Jan-Mar 30 2,800 Apr-30 May-30 Apr-Jun 30 2,800 Jul-30 Aug-30 Jul-Sep 30 2,800 Oct-30 Nov-30 Sep-Dec 30 2,800 Jan-31 Feb-31

Nov 29-Apr 30 1,300 May-30 Jun-30

May-Oct 30 1,300 Nov-30 Dec-30

West Region 7,500 Mar-30 Apr-30 East Region 7,500 Apr-30 May-30

65,072

MCSC Unallowed Health Care Cost (UHCC) Reviews

Jan-Dec 29

Total Estimated Claim Volume

Active Duty Dental Program

(ADDP)

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 6 Mar 1, 2030 - Feb 28, 2031

QUARTERLY COMPLIANCE REVIEWS

T-5 Managed Care Support Contracts (MCSCs)

East Region West Region

TRICARE

Medical Eligible Program (TMEP)

TRICARE

Overseas Program

(TOP) Contract

TRICARE

Pharmacy Program

(Tpharm)

SEMI-ANNUAL COMPLIANCE REVIEWS

Review Cycle

Estimated Claim Volume

Estimated Date List of Claims Selected for

Review Issued by

DHA

Estimated Date Claims Information from PCC

Due to TCRS Contractor

Jan-Mar 31 4,800 Apr-31 May-31 Apr-Jun 31 4,800 Jul-31 Aug-31 Jul-Sep 31 4,800 Oct-31 Nov-31 Sep-Dec 31 4,800 Jan-32 Feb-32

Feb-Apr 31 2,393 May-31 Jun-31 May-Jul 31 2,393 Aug-31 Sep-31 Aug-Oct 31 2,393 Nov-31 Dec-31

Nov 31-Jan 32 2,393 Feb-32 Mar-32

Dec 30-Feb 31 1,875 Mar-31 Apr-31 Mar-May 31 1,875 Jun-31 Jul-31 Jun-Aug 31 1,875 Sep-31 Oct-31 Sep-Nov 31 1,875 Dec-31 Jan-32

Jan-Mar 31 2,800 Apr-31 May-31 Apr-Jun 31 2,800 Jul-31 Aug-31 Jul-Sep 31 2,800 Oct-31 Nov-31 Sep-Dec 31 2,800 Jan-32 Feb-32

Nov 30-Apr 31 1,310 May-31 Jun-31

May-Oct 31 1,310 Nov-31 Dec-31

West Region 7,500 Mar-31 Apr-31 East Region 7,500 Apr-31 May-31

65,092

MCSC Unallowed Health Care Cost (UHCC) Reviews

Jan-Dec 30

Total Estimated Claim Volume

TRICARE

Overseas Program

(TOP) Contract

TRICARE

Pharmacy Program

(Tpharm)

SEMI-ANNUAL COMPLIANCE REVIEWS

Active Duty

Dental Program

(ADDP)

TRICARE

Medical Eligible Program (TMEP)

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 7 Mar 1, 2031 - Feb 29, 2032

QUARTERLY COMPLIANCE REVIEWS

T-5 Managed Care Support Contracts (MCSCs)

East Region West Region

OP 1

OP2

OP3

OP4

OP5

OP6

OP7

File details come from the government source that posted it. Updated Aug 26, 2025.