S02 - Attachment 03 - TO Template - IV Buffer Support - 19AUG2026.pdf

TASK ORDER TEMPLATE

Insurance Entry and Verification [IV] Buffer Support Services

Task Order Number: [INSERT]

Parent IDIQ Contract Number: [INSERT]

Solicitation Number: [INSERT, IF APPLICABLE]

Order Date: [INSERT]

Contractor Legal Name: [INSERT]

Contractor UEI / CAGE: [INSERT]

Task Order Type: Firm-Fixed-Price

Task Order Status: [INITIAL / MODIFICATION NO. __]

Use of this template. Complete all bracketed fields that apply. This Task Order is issued under and subject to the parent IDIQ contract. It does not alter the parent IDIQ contract unless the Contracting Officer [CO] expressly modifies the parent contract in writing.

1. Order Authority and Purpose

1.1 Authority

This Task Order is issued under the parent Indefinite-Delivery/Indefinite-Quantity [IDIQ] contract identified above. Only the CO is authorized to issue, modify, extend, cancel, or otherwise bind the Government with respect to this Task Order.

1.2 Purpose

The Contractor shall provide Insurance Entry and Verification [IV] Buffer Support Services for the Government locations and period identified in this Task Order. Services include reverification actions and new-policy actions, including Medicare policy actions, as authorized by this Task Order and the parent IDIQ contract.

1.3 Order of Precedence

The parent IDIQ contract, including Section B, the Performance Work Statement [PWS], the Performance Requirements Summary Matrix [PRSM], the Quality Assurance Surveillance Plan [QASP], and all applicable contract clauses, applies to this Task Order.

If the Contractor identifies an actual or apparent conflict between this Task Order and the parent IDIQ contract, the Contractor shall promptly notify the CO in writing and request resolution. The Contractor shall follow the CO's written direction. This Task Order does not authorize performance outside the scope of the parent IDIQ contract.

2. Period and Locations

2.1 Task Order Period of Performance

Item Requirement

Start date [INSERT]

End date [INSERT]

Total period of performance [INSERT]

Delivery periods, milestones, or phased activation dates [INSERT OR “See Section 3.4”]

2.2 Covered Locations

The Contractor shall support the following CPACs, VA Medical Centers [VAMCs], facilities, or facility groupings:

CPAC / Region VAMC or Facility Station Number Scope / Assignment Priority, if applicable

[INSERT] [INSERT] [INSERT] [INSERT] [INSERT]

[INSERT] [INSERT] [INSERT] [INSERT] [INSERT]

[INSERT] [INSERT] [INSERT] [INSERT] [INSERT]

[INSERT] [INSERT] [INSERT] [INSERT] [INSERT]

[INSERT] [INSERT] [INSERT] [INSERT] [INSERT]

Applicable CPAC reference list: Mid-Atlantic CPAC [Station 730]; Mid-South CPAC [Station 731]; North Central CPAC [Station 732]; Florida Caribbean CPAC [Station 733]; Northeast CPAC [Station 734]; Central Plains CPAC [Station 735]; and West CPAC [Station 736].

2.3 Place of Performance

The Contractor shall perform from a secure work environment consistent with the parent IDIQ contract.

Government workspace will not be provided unless expressly identified below.

Task Order-specific place of performance instructions or Government workspace: [INSERT OR “None.”]

3. Scope and Workload

3.1 Required Services

The Contractor shall perform all services necessary to produce accepted completed insurance actions in accordance with the parent IDIQ contract, PWS, PRSM, QASP, CPAC guidebooks, VA policy, and this Task Order.

Authorized action types under this Task Order are listed below:

▪ Reverification actions

▪ New-policy actions, including Medicare policy actions

The Contractor shall determine and provide the staffing, supervision, quality control, internal processes, equipment, facilities, connectivity, and other Contractor-furnished resources necessary to meet the applicable requirements, except for Government-furnished resources expressly identified in Section 5 of this Task Order.

3.2 Workload Conditions and Assumptions

Workload item Task Order information

Estimated pending workload / backlog [INSERT]

Estimated reverification actions [INSERT]

Estimated new-policy actions, including Medicare policy actions [INSERT]

Anticipated source or queue [INSERT]

VA Care / Community Care applicability [INSERT]

Expected workload pattern, surge, or seasonal condition [INSERT]

Known payer, source-data, system, or access conditions [INSERT]

Government-provided historical or forecast data attachment [INSERT / “None.”]

All workload estimates, forecasts, backlog information, and workload-mix information are for Task Order planning and administration only. They do not guarantee workload volume, work mix, staffing level, payment, or ordering of the full estimated quantity or payment for unaccepted actions. The Government is obligated only to the extent of the authorized and funded Task Order amount.

3.3 Phased Start, Transition, and Ramp-Up

Select one:

▪ No Task Order-specific phased start, transition, or ramp-up applies.

▪ The following Task Order-specific phased start, transition, ramp-up, stabilization, or interim-performance requirements apply:

Phase / milestone

Start date

End date

Government dependency or input

Contractor performance expectation

Transition, mobilization, ramp-up, staffing, recruiting, Contractor-provided training, access administration, quality control, reporting, and other activities necessary to perform are included in the applicable fixed unit prices and are not separately payable.

3.4 Delivery Periods and Priorities

The Contractor shall complete assigned and available insurance actions within the delivery periods below. An action is available for Contractor processing when complete source information and required system access are available.

Action type / workload Delivery period

Priority or sequencing instruction

Measurement start point

Notes

Reverification actions [INSERT] [INSERT] Date assigned and available

[INSERT]

New-policy actions, including Medicare policy actions

[INSERT] [INSERT] Date assigned and available

[INSERT]

If a Government-controlled condition affects performance, including incomplete source data, unavailable required system access, credentialing delays, or VistA/provider-portal outages, the Contractor shall document and report the condition in accordance with Section 6. Such documented conditions will be addressed in accordance with the parent IDIQ contract, PWS, QASP, and this Task Order.

4. Pricing, Quantities, and Funding

4.1 Applicable Pricing

The Task Order shall use the applicable awarded parent-contract CLIN unit prices. Payment is limited to accepted completed actions as defined in the parent IDIQ contract and PWS.

4.2 Task Order CLIN Schedule

TO CLIN Insert Applicable

CLIN

Description Unit of Issue

Ordered Estimated Quantity

Unit Price

Total Amount

[INSERT] [INSERT] Accepted completed reverification actions

Each [INSERT] $[INSERT] $[INSERT]

[INSERT] [INSERT] Accepted completed new-policy actions, including Medicare policy actions

Each [INSERT] $[INSERT] $[INSERT]

Total Task Order Amount

$[INSERT]

Funding citation / accounting classification: [INSERT]

Funded Task Order amount: $[INSERT] The Contractor shall not perform work or incur costs in excess of the authorized and funded Task Order amount without a written Task Order modification signed by the CO.

4.3 Payment Rules

1. The Contractor may bill only accepted completed reverification actions and accepted completed new-policy actions, including Medicare policy actions, as applicable to this Task Order.

2. The Contractor shall bill an accepted completed action only once and shall not bill the same action under more than one CLIN.

3. Contractor-caused rejected actions are not billable and shall be corrected at no additional cost to the

Government.

4. Non-chargeable exceptions are not billable.

5. The applicable Task Order CLIN quantity is an ordering and funding limitation. It does not authorize payment for unaccepted work, Contractor-caused rejected actions, or non-chargeable exceptions.

5. Government-Furnished Resources and Dependencies

5.1 Government-Furnished Resources

Resource or support Government responsibility

Availability date / condition

Government point of contact

Notes

Authorized system access method

[INSERT] [INSERT] [INSERT] [INSERT]

Government-furnished equipment

[INSERT OR

“None.”]

[INSERT] [INSERT] [INSERT]

VistA or related application training

[INSERT] [INSERT] [INSERT] [INSERT]

Credentialing / onboarding support

[INSERT] [INSERT] [INSERT] [INSERT]

CPAC guidebooks or facility procedures

[INSERT] [INSERT] [INSERT] [INSERT]

Other [INSERT] [INSERT] [INSERT] [INSERT]

No Government resource is furnished unless expressly listed above. The Contractor shall provide all other resources necessary for performance in accordance with the parent IDIQ contract.

5.2 Access, Privacy, and Security

The Contractor shall comply with all parent-IDIQ requirements for access, privacy, confidentiality, information assurance, PII, PHI, HIPAA, VA security requirements, personnel suitability, required training, and Non-Disclosure/Non-Use Statements.

Task Order-specific access, security, incident-reporting, or facility instructions: [INSERT OR “None;

parent IDIQ requirements apply.”]

6. Reporting, Communication, and Meetings

6.1 Reports

Unless otherwise specified in this Task Order, the Contractor shall provide the reports required by the parent PWS. Reports are included in the unit prices and are not separately priced.

Report Due date Recipients Required Task Order detail or format

Monthly Itemized Statement

Fifth day of each month

COR; CPAC Insurance Verification Manager, Supervisor, or other official identified below

[INSERT]

Monthly Staffing Report

Fifth day of each month

COR; CPAC Insurance Verification Manager, Supervisor, or other official identified below

[INSERT]

Weekly Pending Workload Report

Monday of each week

COR; CPAC Insurance Verification Manager, Supervisor, or other official identified below

[INSERT]

Other Task Order-specific report

[INSERT] [INSERT] [INSERT]

The Monthly Itemized Statement and each invoice shall identify the applicable Task Order, CLIN, CPAC or facility, reporting/service period, action type, accepted completed quantity, unit price, and extended amount. The Contractor shall separately identify Contractor-caused rejected actions and non-chargeable exceptions; these actions are not billable.

6.2 Government Points of Contact

Role

Name Organization /

CPAC

Telephone Email

Contracting Officer [INSERT] [INSERT] [INSERT] [INSERT]

Contracting Officer's Representative [INSERT] [INSERT] [INSERT] [INSERT]

CPAC Insurance Verification Manager / Supervisor

[INSERT] [INSERT] [INSERT] [INSERT]

Technical monitor, if designated [INSERT] [INSERT] [INSERT] [INSERT]

Invoice / payment contact [INSERT] [INSERT] [INSERT] [INSERT]

6.3 Communications and Escalation

The Contractor shall direct routine operational communications about insurance actions, workload status, discrepancies, access issues, and performance concerns to the CPAC Insurance Verification Manager, Supervisor, or other Government official identified above, unless the COR provides different written instructions.

The Contractor shall direct communications about contract administration, changes, funding, payment, scope, price, or schedule to the CO. Neither the COR nor program personnel may authorize changes to the Task Order or parent IDIQ contract.

Task Order-specific escalation process, meetings, or communication cadence: [INSERT OR “The parent IDIQ contract and PWS requirements apply.”]

7. Performance, Surveillance, and Acceptance

7.1 Applicable Standards

The PWS, PRSM, and QASP performance standards apply to this Task Order. The following parent contract baseline standards apply unless this Task Order, consistent with the parent IDIQ contract, specifies an applicable delivery period, reporting due date, rating period, surveillance detail, or other authorized Task Order-specific requirement:

Performance area Standard / AQL

Timely completion of assigned and available insurance actions

At least 93 percent completed within the applicable delivery period during the rating period

Data accuracy Individual data-entry quality review does not fall below 95 percent during the rating period

Contractor-caused rejected actions 100 percent reviewed and corrected within five business days

Resolution of insurance-action questions and concerns

No more than three validated communication failures per quarter

Participation in required meetings No more than two missed calls per rating period; required key-person or authorized-representative attendance

Performance area Standard / AQL

Contractor-controlled access maintenance

No more than one access reset per month attributable to Contractor failure

Confidentiality and information security

No substantiated privacy or security violations

Monthly Itemized Statement and Monthly Staffing Report

100 percent on time, complete, and accurate by the fifth day of each month unless this Task Order states otherwise

Weekly Pending Workload Report 100 percent on time, complete, and accurate by Monday of each week unless this Task Order states otherwise

Task Order-specific surveillance method, sampling plan, reporting rating period, or authorized supplemental performance detail: [INSERT OR “The parent QASP applies without supplement.”]

7.2 Acceptance

The COR, within the limits of the written COR designation, will perform technical monitoring, review reports and deliverables, validate surveillance findings, and recommend acceptance, rejection, corrective action, and invoice approval as appropriate.

An insurance action is eligible for payment only when it is an accepted completed action under the parent IDIQ contract and PWS and is validated by the Government as accurate and properly documented and accepted in accordance with the CO’s delegation of authority and the contract’s invoice and acceptance procedures. Government receipt or review of a recurring report does not by itself establish acceptance of underlying actions or authorize payment.

7.3 Correction and Corrective Action

For a rejected written deliverable, the Contractor shall correct the identified deficiency and resubmit within five workdays unless the COR or this Task Order establishes another written timeframe. The Contractor shall correct Contractor-caused rejected actions at no additional cost within the timeframe specified in the PWS, PRSM, QASP, and this Task Order.

When requested, the Contractor shall submit a corrective action plan that identifies the root cause, corrective steps, responsible personnel, and expected completion dates.

8. Task Order-Specific Procedures

8.1 Facility Procedures and Work Instructions

The following facility-specific procedures, guidebooks, operational instructions, queue-management rules, payer portal protocols, or other in-scope work instructions apply:

Document / procedure

Version or date

Applies to

Government owner / contact

Attachment number

These procedures provide operational detail within the scope of the parent IDIQ contract and Task Order.

They do not change contract scope, price, quantity, funding, period of performance, delivery requirements, performance standards, or other contract terms unless changed by a written contract or Task Order modification executed by the CO.

8.2 Other Task Order Instructions

[INSERT TASK ORDER-SPECIFIC INSTRUCTIONS, OR “None.”]

9. Attachments The following attachments are incorporated into this Task Order only to the extent identified below:

Attachment No.

Title Date / Version

Included?

1 Task Order CLIN and Funding Schedule [INSERT] [YES /

NO]

2 Covered CPAC/VAMC/Facility List [INSERT] [YES /

NO]

3 Workload Forecast / Backlog Information [INSERT] [YES /

NO]

4 Facility-Specific Procedures / CPAC Guidebook Excerpts

[INSERT] [YES /

NO]

5 Government-Furnished Resource / Access Plan [INSERT] [YES /

NO]

6 Task Order-Specific Surveillance or Sampling Plan [INSERT] [YES /

NO]

7 Other: [INSERT] [INSERT] [YES /

NO]

10. Administration and Authorization

10.1 No Unauthorized Commitments

The Contractor shall not rely on oral direction or direction from personnel other than the CO to change Task Order requirements. If the Contractor believes direction changes the Task Order or parent IDIQ contract, the Contractor shall promptly notify the CO in writing and request written direction before proceeding.

10.2 Contractor Acknowledgment

The Contractor acknowledges receipt of this Task Order and agrees to perform in accordance with the parent IDIQ contract and this Task Order.

Contractor Authorized Representative Signature Date

Name and Title: [INSERT]

10.3 Contracting Officer Authorization

Contracting Officer Signature Date

Name and Title: [INSERT]

Pre-Issuance Checklist Before issuing the Task Order, the CO and program office should confirm that:

▪ The Task Order is within the scope of the parent IDIQ contract.

▪ The Task Order identifies the applicable contract CLINs, unit prices, ordered estimated quantities, funding, and firm-fixed-price amount.

▪ The Task Order period of performance falls within the 36-month ordering period, unless otherwise legally authorized.

▪ The Task Order amount, together with prior orders, does not exceed the IDIQ contract maximum.

▪ Funding is identified and sufficient for the Task Order amount.

▪ Task Order CLINs use the awarded parent-contract unit prices.

▪ Covered CPACs, VAMCs, facilities, workload conditions, delivery periods, and priorities are clearly identified.

▪ Government-furnished resources and dependencies are expressly identified, including access, equipment, training, credentialing, and onboarding support.

▪ Report recipients, submission methods, and points of contact are current.

▪ Any Task Order-specific procedures or attachments are within scope and do not change contract terms without CO-authorized modification.

▪ The Task Order contains no independently payable transition, ramp-up, staffing, training, reporting, or management line item unless the parent contract expressly authorizes it.

▪ No payment is authorized for contractor-caused rejected actions or non-chargeable exceptions.