Industry Questions and Government Responses 20240809.pdf

Question Answer Please specify whether provided volumes are per annual option period or per stated reporting period for each. That is, for line items X001, are the specified 19,200 Quarterly Compliance Reviews per quarter (meaning 76,800 per year) or per full year (meaning 19,200 per year)? And the same for all others?

Line items reflect annual volume.

Please clarify which volume of MCSC AHCC audits prevails. The maximum sample size is 10,000 per managed care region. The actual estimated sample size is 7,500 per managed care region, which equals 15,000 total.

Which positions or tasks reflecting labor will require a background investigation? All positions require background checks.

What specific data under the contract must be protected in an environment that complies with NIST 800-171?

Does the contract require that the contractor maintain CUI on any environment, or will all CUI be on a government system?

All Contractor information systems must be protected in compliance with NIST 800-171. The TCRS contractor is required to maintain CUI, PHI, and PII.

The Contractor shall submit requests to vary from NIST SP 800-171 in writing to the Contracting Officer, for consideration by the DoD CIO.

What percent of compliance review documentation will be received in electronic format?

What percent of compliance review documentation will be received in paper format?

100% Electronic.

Please clarify if the government will include in its random sample audit all claims or only those claims we found the PC Contractor in error?

The subsample for QA consists of erred and non-erred claims. There is not a 100% QA review of errors assessed unless there is a specific issue that requires it.

Please clarify if the government meant “paid amount” instead of “billed” amount. This is contract dependent. T-5 will be paid amount. All others are currently billed amount.

Please specify which tasks must be accomplished and approved by the Government before proceeding. All tasks and access approvals described in PWS 5.3.1.2.1 must be complete before the readiness test can occur.

Will DHA allow automation of the various required queries via an Application Programming Interface or Robotic Process Automation (API or RPA) so long as its compliant within the security infrastructure?

Similarly, can results and accompanying detailed explanations be uploaded via an API or RPA?

Not at this time. TCRS contractor will not have the type of access necessary to automate these tasks.

Will DHA allow automation of the various required queries via an API for batch processing capabilities, for example, for DEERS, so long as its compliant with the security infrastructure?

Not at this time. TCRS contractor will not have the type of access to DEERS necessary to automate this task.

Please provide a breakdown of claims by type for competitive pricing purposes, given inpatient facility-related reviews take longer than all other claim types per length of stay.

What percent are inpatient? What percent are outpatient?

Currently near-equal population of inpatient/outpatient claims, but this could vary audit-to-audit.

Does the contractor calculate payment and occurrence error rates in the same manner as for quarterly reviews?

Or does the contractor calculated the extrapolated IP rate for these particular reviews (calculations by MSCS)?

Based on TCRS contractor findings, the payment and occurrence error rates are calculated and reported by the TED Audit application and DHA. Extrapolations are performed by the Government.

Please clarify if the focus studies encompass: (1) analysis of data for a specified claim type; (2) additional primary and secondary research to supplement analysis of claims data; or (3) both options.

Potentially both.

What is the maximal extent of the workload involved in these “additional discussions?”

How often does the Government’s request rise to a rebuttal response, whereby individual records would need to be reexamined by the contractor to appease the Government?

The workload involved will depend on the magnitude of the issue. Generally, the discussions would consist of one meeting and follow up email conversation until resolution. The Government would not submit a formal rebuttal, but in rare cases, a full review of the impacted claims may be required.

Does “not limited to” imply a medical records review will routinely equal a compliance review plus all additional questions listed?

These sections apply to medical record reviews only. The phrase "but not limited to" acknowledges that the examples provided may not include all possible documentation required to adjudicate the claim. Documentation will vary from claim-to-claim.

Please provide anticipated volumes per option period of medical record reviews. To be determined during contract performance. Please see PWS 5.5.2.

What responsibility, if any, does the TCRS contractor bear for the number or proportion of MR 1 outcomes? None

There are discrepancies between these two QASP documents related to performance requirements.

Please clarify which document prevails.

Exhibit 8 has been revised. Please see Amendment 0001.

Please clarify if “receipt of claims documentation” means all/completed claims documentation or any claims documentation.

Does the clock start when the contractor receives any documentation for a claim sampled or only when the contractor receives all of what the PC Contractors offer within the time allotted for them to submit claim documentation?

Upon receipt of the complete claims package from the PC contractor. Please see revised Exhibit 8 in Amendment 0001.

Please revise the references to the final Performance Requirements Summary to align with the final RFP citations as

5.2.3.5 and 5.2.3.6

Exhibit 8 has been revised. Please see Amendment 0001.

We request that DHA reconsider the 1% and .5% Acceptable Quality Levels (or alternately reviewed, 99% and 99.5% AQL levels) to align with industry standard and healthcare best practices. Consider these points: For example, CMS and, and American Health Information Management Association (AHIMA) cite 95% AQLs. See:

CMS HHS-RADV Initial Validation Audit Entity Inter-Rater Reliability Submission and Validation Process, HHS-RADV Webinar Series IV, 10/16/2019 American Health Information Management Association (AHIMA) practice briefs call for 95% AQLs American Academy of Professional Coders (AAPC) also calls for 95% accuracy rates Download Free eBrief - Finding the Right E/M Pass Rate Threshold - AAPC

This program will continue to report results as error rates. The RFP wording matches the reporting language. Changing would have an impact on other contracts and systems.

Please clarify if bidders are to include royalty/copyright fees as part of their price proposals (i.e., reflected in price/claim).

Or is the TCRS contractor covered under the DoD license with AMA regarding use of the cited items?

No need to include royalty/copywrite fees in price proposal.

Does the phrase “The TCRS contractor manually re-adjudicates claims…” restrict the contractor in any way from using innovation and automation in performing the re-adjudication of claims?

Innovation and automation may be allowed if approved by the Government. Some tasks must be performed manually.

Are the US Family Health Plan contracts included in the TCRS effort? No Are Key Personnel required to be identified, and are resumes required for key personnel? There are no "key personnel" requirements.

Is a direct integration with DEERs a possibility?

a.Documented requirement to access DEERS in 5.1.7.3 - specific to Cat Cap and Deduc ble data for audit Not at this time. TCRS contractor will not have the type of access to DEERS necessary to automate this task.

Can TPAs send their claims in HIPAA format (e.g., 837)? Audit packages are not submitted in 837 format.

Format of TED data; are these data provided in lieu of claim data or in addition to 837 data?

a. Likely covered in 5.1.10

In addition to 837 claim data.

When referring to a manual solution, are you referencing a human-in-the-loop approach?

a. Is the DHA open to pursuing an automated approach that includes AI/Machine Learning (ML) that includes a human-in-the-loop within the process?

Innovation and automation may be allowed if approved by the Government. Some tasks must be performed manually.

If a failure is found in the audit, e.g. the beneficiary is not eligible, would the audit be considered complete or should the rest of the claim audits steps be checked.

The entire claim must be reviewed to the maximum extent possible.

Is it your expectation that for every claim received, the medical record documentation will be reviewed and compared to the codes provided on the claim?

100% of the time for medical record reviews. Case-by-case for all other reviews.

Paragraph 5.4.2.1.1 states: "The transmittal letter instructs the purchased-care contractor(s) to (for each record/claim selected for review) compile and submit directly to the TCRS contractor, legible copies of processed claims information (i.e., medical claim forms (CMS 1500, UB04), Explanations of Benefits (EOBs), eligibility determinations, etc.) and any additional claims processing documentation and/or information (i.e. network negotiation rates, medical necessity determinations, referral/authorization requirements, etc.) used to substantiate the reimbursement or coding procedures utilized by the purchased-care contractor in the course of adjudicating the health care claim form."

Q: Can the Government confirm that the referenced records provided will represent the complete record required for the compliance review, including the medical record, which will be provided to the TCRS contractor by the purchased care-contractor at no cost to the TCRS contractor?

Section 5.4.2.1.1 is not an all-inclusive list, but does describe the most common documentation provided for each claim. All documentation relevant to the outcome of claim adjudication must be provided. This documentation is provided by the purchased care contractors, with no cost to the TCRS contractor.

Under Paragraph 5.5.1.2.2, the Government provides estimated annual volumes for Focus Studies.

Q: Can the Government also provide information on historical workload volumes for Focus Studies similar to Exhibit 5 and Exhibit 6?

Historically, focus study quantities have ranged from approximately 800 to 2,000 claims per study.

Under Paragraph 5.5.2.2.1, the Government does not provides estimated annual volumes for Medical Record Reviews (as it does for Focused Studies under Paragraph 5..5.1.2.2).

Q: Can the Government provide estimated annual volmes and information on historical workload volumes for Medical Record Reviews similar to Exhibit 5 and Exhibit 6?

Historically, medical record review quantities have been approximately 800 claims per study.

Paragraph 6.10.3 states: "Private address space using Network Address Translation will not be permitted."

Q: Can the Government clarify if Network Address Translation IP addressing could be used for the internal IP addresses within the contractor system?

No.

The instructions state: "The offeror’s proposal shall include its Program Management Plan (PMP) in the format and description required by CDRL AP020. The offeror shall describe the process for integrating the proposed PMP to ensure accuracy and timeliness of services and products delivered." Some of the items listed in Paragraph 5.1.2.1 for the PMP (required as an annual CDRL) may not reasonably be complete at the time of propsal submission, for example: Disaster Recover Test Results Report.

Q: Can the Government clarify the instructions to indicate that the offeror describe its approach or processes or procedures for integrating or developing the PMP versus the inclusion of the actual PMP (following CDRL AP020)?

Elements of the PMP should be submitted in draft format completed to maximum extent possible. Please see revisions to page 128 of the RFP, found in Amendment 0001.

This Paragraph states: "The contractor shall utilize the most appropriate version of the Tricare Manuals when evalating Healthcare Claims."

Q: Can the Goverment clarify this statement to indicate that the Government will determine and inform the TCRS contractor which version(s) of the TRICARE Manuals are most appropriate when evaluating healthcare claims?

The TRICARE Manual website (https://manuals.health.mil/) identifies the most appropriate version for each contract. Please see PWS 2.3.1.

This Paragraph states: "Prior to the first day of Option Period 1, the contractor shall demonstrate the ability to accurately review purchased-care contract claims. A readiness test will be administered and finalized by the COR and other Government and/or contract personnel at least sixty

(60) days prior to the first day of Option Period 1." The Readiness Test to be administered at least 60 days prior to the first day of Option Period 1 has the general effect of decreasing the transition-in period from 6 months to 4 months.

Q: Will the Government consider extending the transition-in period from 6 months to 8 months given the requirement for the Readiness Test 60 days prior to the end of the transition-in period?

No. Claim volume may be adjusted to meet timing requirements.

This Paragraph states: "The transmittal letter instructs the purchased-care contractor(s) to (for each record/claim selected for review) compile and submit directly to the TCRS contractor, legible copies of processed claims information (i.e., medical claim forms (CMS 1500, UB04), Explanations of Benefits (EOBs), eligibility determinations, etc.) and any additional claims processing documentation and/or information (i.e. network negotiation rates, medical necessity determinations, referral/authorization requirements, etc.) used to substantiate the reimbursement or coding procedures utilized by the purchased-care contractor in the course of adjudicating the health care claim form.

Q: Can the Government confirm and clarify that the reference to "purchased-care contractors" (used in the section and other sections of the RFP) refers to each of the contractors for the contracts to be reviewed by the TCRS contractor: MCSCs, TMEP, TOP, TPharm, and ADDP?

Correct.

Paragraph 5.5.1.2.1 states: "Once a study topic has been identified, the COR will work with DHA Program Offices and/or entities directing purchased-care contractors to have claims information transmitted directly to the contractor within a designated time-frame. The COR will provide copies of notification letters to the contractor for information purposes only." Paragraph 5.4.2.1.1 contains details regarding claims information for compliance reviews to be transmitted to the contractror by the purchased-care contractors that is not contained in paragraph

5.5.1.2.1 regardng claims information for focus studies.

Q: Can the Government clarify and confirm that the referenced records provided will represent the complete record required for the focus study, including the medical record, which will be provided to the TCRS contractor by the purchased care-contractor at no cost to the TCRS contractor?

Claims audit documentation production costs are the responsibility of the purchased care contractors.

Paragraph 5.5.2.2.4 states: "Once the Government panel has selected a review topic, the COR will work with DHA Program Offices and/or entities to direct purchased-care contractors to obtain copies of medical records requiring review. Purchased-care contractors will obtain the appropriate documentation from the provider of services within a designated timeframe and will submit the medical records directly to the contractor via the contractor’s DMS. The COR will provide copies of notification letters to the contractor for informational purposes." Paragraph 5.4.2.1.1 contains details regarding claims information for compliance reviews to be transmitted to the contractror by the purchased-care contractors that is not contained in paragraph 5.5.2.2.4 regardng claims information for medical record reviews.

Q: Can the Government clarify and confirm that the referenced records provided will represent the complete record required for the medical record review, including the medical record, which will be provided to the TCRS contractor by the purchased care-contractor at no cost to the TCRS contractor?

Claims audit documentation production costs are the responsibility of the purchased care contractors.

For the deliverable R010 Transtion-in Plan, the Government indicates the Medium/Format to be used is Microsoft Project.

Q: Will the Government consider accepting an alternative project tool/format?

Yes. An comparable program may be used if the Government approves. Please see revised PWS 7.2.

The Acceptable Quality Levels specificy "100%" for each review to be completed within the timeframe given. A requirement for 100% would seem to not allow for any variance.

Q: Would the Government consider that even in a high level of performance that some variance may occur and that a requirement of 90% or 95% would satisfy the level of performance required?

All reviews must be completed within the required timeframes. Extension requests will be considered on a case-by-case basis.

"The contractor shall also ensure that professionals at the nurse practitioner or physician level are available for consultation if necessary."

Will the Government please clarify whether Contractors are required to include consultation pricing for these “physician-level resources,” or are Contractors are solely required to coordinate schedule availability with “physician-level resources” funded by an external source?

Medical Record Review proposals should include consultation cost estimates when the requirement of a Medical Record Review arises.

The Government mentions TRICARE CORE 3M Grouping Software. Is there a specific version/ update of the software needed to perform tasks required for this proposal?

Most current version with current and historical pricing tables.

Is there a requirement to maintain the latest version of the TRICARE CORE 3M Grouping Software? Yes.

Would the customer confirm the contractor is required to purchase the TRICARE CORE 3M Grouping Software? Yes.

The solicitation states, “the Contractor is not required to perform services on recognized holidays.” Would the Government require the Customer to work on holidays to reduce backlog of claims?

No, the contractor determines the appropriate staffing to meet contractual requirements.

Does the Government have workload metrics per employee for each CLIN (i.e. claims reviewed per hour or per day) to determine the number of people needed to support each CLIN?

No, the contractor determines the appropriate staffing to meet contractual requirements.

RFP, Hours of Operations, Page 45. Is there a core set of hours of operation the Contractor needs to perform responsibilities (i.e. 0800 ET through 1700 ET, Monday through Friday)?

Contractor may propose business hours that meet coverage requirements. Monday-Friday during generally accepted business hours is preferred. Pleasee see revised PWS 1.7.3, included in Amendment 0001.

TCRS Compliance Review Schedule. Will Attachment 6 be updated to include the transition to the T-5 contracts and, relatedly, should residual T-2017 MCSC claims be included in this attachment as well, until their claims review cycles are closed?

T-5 is included on attachment 6. No residual T-17 audits are anticipated. Please see revised Attachment 6 included in Amendment 0001.

What is the Offeror’s responsibility in reviewing claims from the outgoing West region MCSC when these contracts/regions change 01 January 2025? Will an MOU be required with the outgoing West region contractor, HNFS? Timing and claims run out, how would rebuttals be handled with outgoing West contractor?

TBD. An MOU with the outgoing contractor will be required.

Contractor Readiness Testing. Scheduled for 60 days prior to first day of OP-1 or approximately in January 2025, will the Government be able to process non-incumbent employee’s security background checks and grant access to DHA systems (TA and PCDIS) prior to contractor readiness testing?

If timing issues arise, readiness testing schedule will be adjusted to align with employee access.

TRICARE CORE 3M Grouping Software. Can the Government confirm that this software is still being utilized and can be provided to the Contractor from 3M Health Information System?

Yes.

The RFP (pg. 54) states, “3.4 Equipment: The Government: Will NOT provide Equipment in support of this contract.

As a result, this paragraph is Not Applicable.” Will GFE computers be provided to the contractor?

No.

The RFP (pg. 45) states, “1.8 Contractor Travel: The contractor shall be required to travel within the Continental United States (CONUS) to attend meetings held by DHA. Generally, a 14-day notice will be provided for all meetings hosted by DHA at one of its Government locations. Contractor should assume two meetings per year. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor. The RFP states, “1.9 Other Direct Costs (ODC): Reserved.”

a.

For pricing estimating purposes can the Government please provide additional details regarding travel – how many contractors will be required for the meetings, duration of travel for meetings, and location(s) of the meetings? If additional details cannot be provided, would the Government consider providing a NTE amount for travel costs?

TBD. Anticipated to be less than $10,000 annually.

The RFP states, “The contractor shall be required to travel within the Continental United States (CONUS) to attend meetings held by DHA. Generally, a 14-day notice will be provided for all meetings hosted by DHA at one of its Government locations. Contractor should assume two meetings per year. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor.”

How many meetings does the contractor need to incorporate into its plan and pricing?

See PWS 1.8.

This section is reserved.

Please provide the key personnel requirements for this opportunity.

There are no "key personnel" requirements defined at this time.

The RFP states, “FSO/Company's Security POC shall notify the DHA Personnel Security Office after being awarded a contract that requires access to a DoD system. Contractor personnel requiring access to the HA/DHA networks for performance of their tasks require a background investigation and the security awareness training. The contractor shall be prepared for this process as it could take two (2) or more weeks. The FSO/Security POC shall submit a Standard Form (SF) 85/86 to DHA's Personnel Security Office for a background investigation.”

Will access be provided for readiness testing during the implementation phase?

If timing issues arise, readiness testing schedule will be adjusted to align with employee access. Please see revised PWS 1.16.1 included in Amendment 0001

The RFP states, “The contractor shall grant the Government access to its DMS. The COR will determine what Government personnel require access to the DMS and provide a list to the contractor prior to the first day of Option Period 1. The contractor shall provide training to the Government on the functionality and utilization of its DMS.”

Please provide an approximate number of Government personnel that would require access so we can adequately price.

Based on current staffing, a minimum of 5 staff members will need access. Please see revised PWS 5.1.8.6 in Amendment 0001.

The RFP states, “The contractor shall grant the Government access to its DMS. The COR will determine what Government personnel require access to the DMS and provide a list to the contractor prior to the first day of Option Period 1. The contractor shall provide training to the Government on the functionality and utilization of its DMS.”

Please provide details about the access required. For example, is this read and write access or read access only?

Read only access.

The RFP states, “The offeror’s proposal shall include its Program Management Plan (PMP) in the format and description required by CDRL AP020. The offeror shall describe the process for integrating the proposed PMP to ensure accuracy and timeliness of services and products delivered.”

Is the full PMP expected at time of submission or a description of the PMP?

Description. Please see RFP page 128 in Amendment 0001.

The RFP document states "Contractor should assume two meetings per year. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor." Should these costs be priced as ODCs? Can the government provide a placeholder number so all proposals can have an equal plug-in amount?

No, anticipated to be less than $10,000 annually.

In reference to section 5.1.7.2, can the government confirm that Claim Check TM is the current product being used? Claim Check and Claim Check equivalents are being used.

Does a DMS exist today? If so, does it have an Authority to Operate? A DMS is in place, but the TCRS contractor will be required to have their own. An ATO is not required.

Is the DMS to be hosted at the contractor's controlled location? Yes.

Will the DMS require an Authority to Operate (ATO)? If so, can this deliverable be added to the RFP with a realistic deliverable time?

It is not required.

Can the government estimate the rough number of changes to documents, such as systems of records notices (SORN), annually in the DMS?

No.

Can the government identify its Mean Tolerable Downtime and Recovery time for the DMS? 24 hours. Please see revised PWS 5.1.12 in Amendment 0001.

The RFP document states "6.9.1 If there is an external system connection to a DoD IS required, then the contractor shall, in accordance with contract requirements, connect to the DHA B2B Gateway via a contractor procured Internet Service Provider (ISP) connection." How will the contractor charge for these costs? Will this be a request that needs to be approved?

This is a firm fixed-price contract, these costs should be included in your final price.

Can the government identify what systems the government will host and what systems/components the contractor will need to host?

Contractor hosts the DMS. Government will provide access to required Government systems.

Can the government provide a workflow diagram as to how the data/systems work together? No connection to Government data systems is required.

In order to determine the type of environment the contractor needs to set up in the facilities, will the government specify the type of secret facilities clearance required?

None

What type of GRC system is the government currently using? Will the contractor interact with the government's GRC tools?

Contractor will not interact with Government GRC tools.

Is the government expecting the contractor to perform the training, or will the government provide the training during the program?

The contractor will develop and deliver a training program.

If the contractor maintains the data on the government's site, we need to understand the compliance effort. Is there any reporting that we need to provide to the government regarding the environment?

The contractor will maintain data at their own worksite.

Section 1.2, Description of Services/Introduction, states that the contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform TCRS as defined in this Performance Work Statement (PWS), except for those items specified as Government-furnished property and services. What are the other specified Government-furnished property or services?

None.

Please confirm that the actual IQMP Plan is not required with the proposal submission until after award? Finalized plan is due after award.

Is Objective 3 - Medical Record Reviews supported in the current incumbent contract? Yes.

Can the Government please inform as to the number and type of credentialed incumbent staff provided for this effort?

No.

How does DHA define "appropriate credentialing required to render a professional/expert opinion to the accuracy of medical record coding and validity/completeness of medical record documentation"?

Medical coders and nurse-level practitioners likely. Higher level and specialty professional less frequently.

While we are familiar with what is likely needed for this transition in, to eliminate ambuguity, Can the government give more detail on the "certain tasks which the contractor must accomplish and receive Government approval".

All tasks and access approvals described in PWS 5.3.1.2.1 must be complete before the readiness test can occur. (Please specifically cite the tasks and where they are described in the PWS)

To be clear, the Readiness Test will be conducted during the Transition-In option correct? Correct As the Readiness Test is an onsite test, will this be considered as one of the two meetings per year? And the year is per calendar year (i.e. Transition-In starts August 2024, so calendar year is through August 2025) and not per option period, correct?

No, the readiness test is a separate requirement from the periodic meetings.

For pricing purposes, should we consider that the meetings will likely be held at DHHQ in Falls Church, VA or in Aurora, CO? Or are there other Government Locations that have a high likelihood where meetings might be held?

What are the locations that the incumbent has traveled to in the past 2 years?

In-person meetings will be held in Aurora, Colorado.

Does DHA have a preferred cloud or cloud region (i.e. GovCloud vs FedRAMP commercial region) AWS GovCloud

Claim volumes do not appear to change much over the years in attachment 6 however, Section 5.4.1.4 states that the volume estimates may fluctuate over the course of the contract. Are the estimates in the Attachment an average or the highest volume experienced? As the Option periods quantities are based on these estimates, it would be good to know that the quantity will not exceed the number stated per option.

Claim volumes are not anticipated to materially increase above provided estimates; however, volume is subject to change based on Government need.

Will the contractor be responsible for purchasing licenses for the TRICARE 3M Core Grouping Software? If so, please confirm how this should be represented in the price proposal template.

Yes, the contractor is responsible for obtaining licenses for the 3M Grouper. This is a firm fixed-price contract, these costs should be included in your final price

We believe vendors could provide cost efficiencies by proposing service level agreements and corresponding productivity levels per FTE for each MCSC type rather than fixed price per unit pricing. Will the government entertain alternate pricing strategies in proposal responses?

No

Will the government please confirm whether claims through the forthcoming Competitive Plans Demonstrations will be subject to inclusion in the sampling?

Unknown at this time.

During a previous round of Q&A, the government indicated that inpatient and outpatient claims were represented in approximately equal proportions. Can you please confirm that this remains the case for the new iteration of this requirement?

Yes, this is still true.

Will the government please provide information on the approximate split of institutional vs pro fee claims? This could vary from audit to audit, but likely similar quantities of each.

Please confirm that the certifications listed are specifically required for the medical record reviewers and not required for all individuals performing aspects of the compliance reviews.

Correct.

Will the Contractor be responsible for designing and selecting samples for claims reviews? Or will the Government select samples and provide them to the Contractor?

The Government will provide.

If the Government selects samples, will the Contractor have access to the work papers or a memo describing the Government's sample selection? E.g., total universe and population of claims, filters and limitations applied, total claims volume and reimbursement dollars by service type, etc.?

If the Government determines there is a need for this information in order to complete reviews/analysis, it will be provided.

Will the government confirm whether all personnel need to be US citizens and working on-shore? Yes Given the expected period of performance for this requirement, please confirm whether the offeror will need to enter into MOUs with only the T-5 East and West vendors, or also with the T-2017 incumbents for any retrospective analysis. Based on the anticipated timing of the Contractor Readiness Testing, the new T-5 West Region vendor will have just started Health Care Delivery a few weeks prior to the event; please confirm whether the Contractor Readiness Testing will take place based on T-2017 claims packages and whether additional testing will need to take place as new purchased care vendors transition in during the TCRS PoP.

Readiness testing will be based on T-17 claims for the East and West regions.

Please confirm whether the reference to 'contractor-reviewed' in 5.2.3 is referring to the TCRS contractor or to the MCSC contractor; i.e., are you reviewing the TCRS contractor's work, or is the government directly reviewing claims internally reviewed by Humana, ESI, etc.

Government is reviewing the TCRS contractor's work.

The software application named ClaimCheck is referenced in this section. Please provide the reference to obtain the ClaimCheck application.

ClaimCheck equivalent is acceptable. Please see PWS 5.1.7.2.

This section says: "Purchased-care contractors will obtain the appropriate documentation from the provider of services within a designated timeframe and will submit the medical records directly to the contractor via the contractor’s DMS." Please specify the format of the medical records and clarify how the medical records will be submitted.

Will be defined by the MOUs between the purchased-care contractor and the TCRS contractor.

Please provide a link that works or otherwise make the contents of this link available to bidders:

https://info.health.mil/cos/admin/hr/IO/SitePages/Home.aspx.

Please see revised PWS 1.11 in Amendment 0001 for instructions regarding contract personnel.

Please provide a link that works or otherwise make the contents of this link available to bidders:

https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx.

Please see revised PWS 1.11 in Amendment 0001 for instructions regarding contract personnel.

Please revise the numbering scheme to reflect that Medical Record Reviews should be 5.5.2 per the RFP’s numbering schematic.

This section has been revised, see Amendment 0001, page 73.

Please confirm that Medical Record Reviews will be negotiated with supplemental agreements (italics ours added) aligned with how Focused Studies will be negotiated.

Confirmed.

Please define “ordering period” in Exhibit 8 and clarify if Part 7 or Exhibit 8 prevails. Exhibit 8 has been revised. In the event of any inconsistency, Part 7 of the RFP prevails. Please see Amendment 0001, where Exhibit 8 has been revised.

Please clarify where bidders are to include this information among the existing Volumes. We also request this is excluded from any page limits.

See the revised General section in Amendment 0001, page 126.

Please reconsider page limitations to the Price Proposal in line with a long history of federal RFP standards excluding page limits for price proposals

The page count for Price Proposal has been removed. Please see 52.212-1, Proposal Submission Instructions, page 125 of the RFP.

Please provide detail on what is required in the 10-page Price Proposal. Are bidders required to provide a labor breakdown/justification, salary data, indirect rate data, etc.?

Offeror's shall provide the information requested in 52.212-1, Price Proposal, on page 131 of the RFP.

Please verify the PMP per AP020 is excluded from proposal page counts and should be included as an Attachment. The PMP will be counted towards the Technical Proposal's page count. The page limit for the Technical Proposal is increased to 30 pages, please see 52.212-1 Proposal Submission Instructions, page 125 of the RFP.

We request the Transition Plan including milestones be excluded from the page count for reasonableness. The Transition Plan will be counted towards the Technical Proposal's page count. The page count for Technical Proposal has been changed to 30. Please see 52.212-1 Proposal Submission Instructions, page 125 of the RFP.

Please clarify if offerors are to include the past performance questionnaires as they are instructed to here or send them directly to the Government, as they are instructed to within the Past Performance Questionnaire, Exhibit 2, itself. Or both?

PPQs shall be submitted directly to the Government as stated in Exhibit 2. Please see 52.212-1 Past Performance, page 129 of the amended RFP.

“The offeror shall provide its rationale for CLIN price changes between option periods and the assumptions used. The offeror shall include its forecast sources…The offeror shall provide copies of the escalation forecasts as support documentation in the proposal. Submitted files shall contain all formulas, calculations, and worksheet/workbook links used to compute the proposed amounts.”

Is this referring only to forecast sources or are offerors required to provide full detailed excel buildups of their pricing? The template only includes the fully burdened unit pricing.

Offeror's shall provide only the Pricing information per the instructions found in 52.212-1 Price Proposal, page 131 of the RFP.

Please clarify if the Price Proposal should be sanitized. Please see 52.212-1 Price Proposal, page 131 of the RFP, "submitted files shall contain all formulas, calculations, and worksheet/workbook links used to compute the proposed amounts. The formulas, calculations, and links shall not be hidden in order for the Government to verify the accuracy of the data."

Please clarify instructions for those offerors who do not have these POCs. Shall we replace them with other federal agency pricing system approval contacts?

Please see revised 52.212-1 Price Proposal page 132 of the RFP.

The opportunity is designated as unrestricted. Is the Size Standard of $24.5M, correct? This opportunity is being procured through full and open competition, but yes, $24.5M is the small business size standard under

NAICS 541611.

Are ODCs allowed to be bid? No.

Will the government provide redacted and conformed copies of TRICARE purchased care contracts deemed pertinent to the performance of the compliance reviews as reference material in support of vendors responding to this RFP?

Yes, please see PWS Section 3.5, page 54 of the RFP.

This paragraph states that the contractor will NOT provide Contractor Furnished Services. Is this correct? Please explain the meaning of this paragraph.

Yes, this is confirmed. Please see PWS Section 4.1, page 57 of the RFP.

Will an Industry Day be scheduled for this opportunity? No, it will not.

Does the requirement to provide a PMP in the format of CDRL AP020 count against the 20-page technical proposal page count? Or are bidders to describe within its technical proposal narrative "describe the process for integrating the proposed PMP to ensure accuracy and timeliness of services and products delivered" as instructed by the second half of question 2, and then include the full PMP as an addendum to the volume, exempted from the page count?

The PMP will be counted towards the Technical Proposal's page count. The page limit for the Technical Proposal is increased to 30 pages, please see 52.212-1 Proposal Submission Instructions, page 125 of the RFP.

The RFP informs bidders that the Small Business Participation Plan is distinctly separate requirement from the Small Business Subcontracting Plan. Can the Government clarify, if a bidder is required to provide a Small Business SUBCONTRACTING Plan, if that plan is due at the deadline of proposal submission or someting that is submitted after evaluation/upon award?

Yes, and the Small Business Subcontracting plan, required for Large Business only, is due at the time of proposal submission.

The RFP does not indicate any requirements for the naming of final file submissions or the file format (i.e. native files or text documents must be in PDF, etc.). Does the Government have a preference?

There is no file naming format required. Offeror's shall follow directions under 52.212-1 Proposal Submission Intructions, page 125 of the RFP.

Q: Given the holiday period during the propsal response timeframe, as well as other factors such as the timeframe for customers to complete PPQs, would the Government consider granting a two-week extension for the proposal submission date?

Please see the amendment for the new proposal due date.

Q: Can the Government confirm that the Offeror is expected to provide a fixed price for Transition-in under CLIN 0001 and will this be included in the Total Evaluated Price?

Confirmed, a fixed-price Transition In CLIN, which is part of the TEP, shall be provided. Please see 52.212-1 Price Proposal page 131 of the RFP.

In developing a total evaluated price, it is important to understand the complete scope and price elements, including option line items. On Page 3 (or Page 4) of 140, the Option Period 1 Line Items do not include a line item for Focus Studies, as defined under Paragraph 5.5.1.2.2.

Q: Will the Government be revising the Line Items (CLINS) for Option 1 and the other option periods to include a CLIN with quantities to be priced for the Focus Studies?

Focused Studied and Medical Record Reviews will both be handled via a separate negotiation, after the requirement is known.

Therefore, they are not part of the TEP. Please see PWS Section 5.5 beginning on page 71 of the RFP.

In developing a total evaluated price, it is important to understand the complete scope and price elements, including option line items. On Page 3 (or Page 4) of 140, the Option Period 1 Line Items (CLINS) do not include a line item for Medical Record Reviews, as defined under Paragraph 5.5.2.2.1.

Q: Will the Government be revising the Line Items (CLINS) for Option 1 and the other option periods to include a CLIN with quantities to be priced for Medical Record Reviews?

Focused Studied and Medical Record Reviews will both be handled via a separate negotiation, after the requirement is known.

Therefore, they are not part of the TEP. Please see PWS Section 5.5 beginning on page 71 of the RFP.

The Contractor Travel Paragraph states: "All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor."

Q: Will the Government consider reimbursing the contractor for these travel costs?

No, these costs will not be reimbursed. Please see PWS Section 1.8, page 45 of the RFP.

Q: Can the Government confirm that the Offeror is expected to provide a fixed price for Transition-Out under CLIN 1007 and for each subsequent option period (through CLIN 8007) and that the Transition-Out for each option period will be included in the Total Evaluated Price?

Yes, a Transition Out CLIN should be included for each option period. Please see 52.212-2 Evaluation of Factor 3, Price, page 139 of the RFP.

Under D.3, Attachment 17 is listed as: "Attachment 17 - Reserved for Service Contract (SCA) Wage Determination(s)".

The Attachment 17 was not included in the solicitation.

Q: Can the Government confirm that as this attachment is listed as reserved, because it is does not apply to this solicitation and this is the reason it is not included?

This Attachment does apply to the solicitation. The attachment is currently reserved because the place of performance is currently unknown.

The Subcontractor' Consent Paragraph states: "If a subcontractor or other teaming relationship is proposed, the offeror shall submit the consent of its proposed subcontractor(s) and teaming partners, as applicable, to disclose past performance information to the offeror along with the offeror's proposal submission (see Exhibit 3 Subcontractor Consent Letter)." The Past Peformance Proposal section does not reference Exhibit 1 - Sample Client Authoriation Letter.

Q: Can the Government clarify that the offeror is expected to also include it's client authorization letter(s) in the Past Performance proposal section and that this (nor the Subcontractor consent letter(s)) will not count toward the 15 page narrative page count?

The Client Authorization letters should be submitted along with the Past Performance Proposal. They will not count against the Page Limit. Please see revised Exhibit 1 and revised Past Performance, page 128 of the RFP.

The instructions state: "The offeror’s proposal shall include its Program Management Plan (PMP) in the format and description required by CDRL AP020. The offeror shall describe the process for integrating the proposed PMP to ensure accuracy and timeliness of services and products delivered."

Q: If the PMP is to be included, can the Government clarify whether the PMP is expected to count towards the 20 pages of page count allowed in the instructions for the Technical Proposal?

The PMP will be counted towards the Technical Proposal's page count. The page limit for the Technical Proposal is increased to 30 pages, please see 52.212-1 Proposal Submission Instructions, page 125 of the RFP.

The Paragraph states: "The offeror shall send the PPQ to the customer (Government or non-Government), receive the signed questionnaire back from the customer and provide the completed questionnaire as a part of the offeror’s past performance record."

Q: Can the Government confirm that the PPQ completed by the customer is to be included in the Past Performance proposal section along with the past performance narrative or would the Government allow the customer completed PPQs to be included in an appendix to the proposal?

PPQs shall be submitted directly to the Government as stated in Exhibit 2. Please see 52.212-1 Past Performance, page 129 of the amended RFP.

The Paragraph states: "The offeror shall send the PPQ to the customer (Government or non-Government), receive the signed questionnaire back from the customer and provide the completed questionnaire as a part of the offeror’s past performance record."

Q: Would the Government consider accepting that the offeror may submit proper contract identification information (which the Government may specify) for those contracts for which a CPAR is available and the Government then utilizing the CPAR system to review the identifed contract past performance in lieu of the offeror submitting a PPQ with the proposal?

No, the Government does not consider CPARS in lieu of PPQs. The Government will use CPARS to gain further information regardless of a PPQ being submitted or not. Please see Evaluation of Factor 2, Past Performance, page 137 of the RFP.

This Section states: "The Small Business Subcontracting Plan is separate from the Small Business Participation Plan and is required for contractors with a business size designation of “large” in accordance with FAR clause 52.219-9, Small Business Subcontracting Plan, Alt II and DFARS clause 252.219-7003, Small, Small Disadvantaged, and Women- Owned Small Business Subcontracting Plan (DOD Contracts)." There is also a reference to these plans under the Evaluation section on page 139.

Q: Can the Government clarify and confirm that the offeror is required to submit both a Small Business Subcontracting Plan and Small Business Participation Plan, as part of the Small Business Participation proposal section at the time of proposal submission?

Any large business offering on the contract will need to submit both plans. A small business would need to submit only a Small Business Participation Plan.

This Paragraph states: "Will NOT provide Equipment in support of this contract. As a result, this paragraph is Not Applicable."

Q: Can the Government clarify that this statement does not apply to the CAC Request Process (Attachment 15) and the issuance of a CAC card(s) to the TCRS contractor?

Confirmed.

This section states: "A complete SF 1449 including all unit prices and Total Evaluated Price (TEP)." Completing the SF 1449 per the information on Page 1 of 140 indicates the offeror should complete blocks 12, 17, 23, 24, & 30.

Q: Can the Government confirm that the offeror is to submit the entire 140 page SF 1449 as a separate file/document with the completed blocks (per the instructions on page 1) as part of the proposal submission?

Confirmed. Per 52.212-1, "Proposals must be submitted on the SF 1449 and accompanied by all requested items elsewhere specified in the solicitation." See the revised General section in Amendment 0001, page 126 of the RFP.

This section states: "The offeror shall separately label and clearly identify each Part. The offeror shall ensure each Part contains a Table of Contents and a list of Tables and Drawings if applicable."

Q: Can the Government clarify that each "Part" being referred to are the list of items above to include: Cover Letter, Price, Technical, Past Performance, Small Business Participation, and SF 1449, with each to be separately labelled and clearly identified as a separate file/document (or volume) for the propsal submission?

Confirmed.

This section states: "Offerors shall identify SCA labor categories and labor rates within the price proposal and warrant on the first page of its Price Proposal, that the prices proposed do not include any allowance for contingency to cover increased costs for which adjustment is provided under FAR Clause 52.222-43 – Fair Labor Standards Act and Services Contract Act – Price Adjustment (Multiple Year and Option Contracts)."

Q: Can the Government clarify the requirement to identify the SCA labor category and labor rate would only apply to non-exempt (hourly) employees and not to exempt (salaried) employees?

Confirmed.

This section states: "Offerors shall identify SCA labor categories and labor rates within the price proposal and warrant on the first page of its Price Proposal, that the prices proposed do not include any allowance for contingency…