Redacted JA CN FY26-0462 202603010.pdf

This is a Justification and Approval (J&A) document for other than full and open competition under FAR 6.103-1, issued by the Defense Health Agency (DHA) Managed Care Contracting Division for a 12-month bridge contract extension. The contract modification extends the existing firm fixed price contract HT940217D0001 with Concept Plus, LLC for TRICARE Claims Reimbursement Services (TCRS) from March 1, 2026 through February 28, 2027, with an estimated value of $6,001,310.90 in Operations and Maintenance funding. The current contract is set to expire on February 28, 2026, and this extension is necessary to maintain continuity of critical compliance review services while DHA completes the competitive procurement process for the next generation TCRS contract under RFP HT9402-24-R-0002.

TCRS provides independent, impartial compliance reviews to assess healthcare claim reimbursement methodologies, TRICARE Encounter Data, and Active-Duty Dental payment records across two managed care support contracts, the TRICARE Medicare Eligibility Program, the TRICARE Pharmacy Program, and the Active-Duty Dental Program. The incumbent contractor is the only source capable of immediately continuing these services without service disruption, possessing the specialized expertise, security clearances, DoD Common Access Cards, NIST-compliant infrastructure, and detailed knowledge of TRICARE operations required to meet rigorous quarterly reporting and Payment Integrity and Information Act (PIIA) compliance deadlines. DHA posted an RFI on February 7, 2026 and received six capability statements, of which only three demonstrated sufficient TRICARE experience; the remaining three lacked adequate relevant detail, confirming no other sources could reasonably perform the critical functions during the bridge period. The legal review confirms the justification is legally sufficient, and fair and reasonable pricing has been determined based on government cost estimates and analysis techniques.