TPA RFI-Industry Response Matrix 10-11-2024.xlsx

Instructions

All responses/questions shall be sent by email to david.c.smith139.civ@health.mil Please ensure files are clearly labeled with your Organization's Name (for example: XYZ Company RFI-0133.xlsx)

Instructions for completing the Excel Worksheet:

The second tab are questions the Government has for Industry. Please include your general organizational information in the yellow highlighted area.

The third tab is to be used to submit questions to the Government directly related to the RFI content.

All responses are due not later than 4 November 2024

RFI Questions for Industry

2 Describe any commercial or industry best practices that would support the NDAA mandate or the required contractor capabilities.

3 Describe your company or team’s background, technical expertise, experience, staffing, ability to meet/comply with DoD System security requirements (T-5 TSM Chap 1) and other capabilities that demonstrate its capability to provide the anticipated TPA requirements.

4 Describe your capability and approach to manage all administrative functions including enrollment, QLEs, three enrollment options (self, self+1, and family), eligibility for multiple dental carriers (2-4) with standard and high-option plans, and split premium payment streams (beneficiary and Government).

5 Describe your capability and approach to combining premium payments, processing monthly invoices and reconciliations (especially with regards to retro eligibility), and providing DHA with an auditable bill/invoice.

6 Describe your capability and approach to interoperability (i.e., communicating and interacting with other systems).

7 Describe your recommended approach to a typical deployment and implementation of the TPA, including key activities, tasks, timelines, resources, and dependencies.

8 Does your company have a federal supply schedule contract with the scope and labor categories able to meet the requirements of this effort?

9 Considering solicitation characteristics such as contract type, options, etc., what specific solicitation characteristics would encourage your organization to submit a proposal in response to a solicitation for these services? Why?

10 What solicitation characteristics would discourage or prevent your organization from submitting a proposal?

2a-i Ability to train, and maintain a knowledgeable, courteous, and responsive call center staff resulting in highly satisfied beneficiaries.

2.a-ii Ability to provide trained customer service representatives fluent in both English and Spanish, and have the capability to provide other non-English/Spanish language support.

2.a-iii Ability to provide surge capability.

2.a-iv Ability to provide enrollment counseling services for beneficiaries to include management of Qualifying Life Events (QLE).

2.a-v Ability to communicate with beneficiaries through written correspondence or other approved methodologies.

2.a-vi Ability to respond timely to emails and other correspondence from users, as well as service calls in response to communications from TPA, carriers, the Services, or DHA.

2.a-vii Ability to collect and process beneficiary enrollment fees via debit/credit card payments, allotments, and automatic bank withdrawals where feasible on a monthly basis.

4.b Ability to provide support for maintenance, upgrades, and changes of software and hardware for current systems to include change request(s), design and code changes, conduct testing of changes, prepare or update documentation affected by required change(s), and coordination of change implementation through established configuration management procedures.

4.c Ability to host many thousands of concurrent users, and to provide surge capabilities with little or no interruption to TPA system users.

4.d Ability to exchange information with DMDC/DEERS, and numerous Government and military pay centers.

4.e Ability to operate and manage a fully functional website that is secure, user-friendly, informative, provides dental plan information, and provides beneficiaries with account information and decision support tools including dental premiums, benefit comparisons for TDP plans, and enrollment/disenrollment functionality.

6.a-i Ability to enroll beneficiaries based upon real-time, individual eligibility in DEERS (T-5 TSM Chapter 3).

6.a-ii Ability to reconcile premiums versus retroactive eligibility changes.

6.a-iii Ability to notify carriers of QLEs, and transfers.

6.a-iv Ability to process family members with different plans/carriers.

7.b Ability to serve as the “intermediary” for beneficiary enrollment in the TDPs, providing and exchanging enrollment-related information to the TDPs, DEERS, and any other participating entities as appropriate.

7.c Ability to provide streamlined processes which improves the beneficiary experience.

7.d Manage beneficiary submission of QLEs and address changes.

8.a-i Written materials used to publicize, inform, educate, or otherwise influence eligible TDP beneficiaries.

8.a-ii Publications, social media, beneficiary outreach, website management, TRICARE branding, and media relations as described in the T-5 TRICARE Operation Manual (TOM), Chapter 11, Section 6.

9.b. Ability to timely and accurately receive or transfer all required beneficiary records and information from or to a losing or gaining contractor with no impact to TDP beneficiaries.

10.a-i The Encounter effort would include the ability to collect and process data, to include medical and pharmacy encounter data, Other Health Insurance (OHI), Primary Care Manager (PCM) data in support of the competitive Plans and the Government.

10.a-ii An EEE contractor would need the ability to query DEERS for updated CATCAP/Deductible information as available and return an X12 271 Health Care Eligibility Benefit response transaction per T-5 TSM Chapter 3.

10.a-iii Ability to provide a customer service and a customer service call center.

10.a-iv Ability to collect and process beneficiary enrollments and enrollment fees.

10.a-v Ability to operate and manage a fully functional website that is secure, user-friendly, informative, provides CPD information, and provides beneficiaries with account information and decision support tools including CPD premiums, benefit comparisons for CPD, and enrollment/disenrollment functionality.

10.a.vi The number of Competitive Plan beneficiaries would be approximately 10,000 to 50,000.

&"-,Bold"&14DHA T-5 Procurement

General Questions from Industry

&"-,Bold"&14DHA T-5 Procurement