T-5 Draft RFP 3 Section G 3.9.2021 FINAL.pdf

SECTION G

CONTRACT ADMINISTRATION DATA

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G.1. CONTRACT ADMINISTRATION

G.1.1. Contracting Officer (CO)

The CO is responsible for the administration of this contract and is solely authorized to take action on behalf of the Government. The CO for this contract is:

Evan Zaslow Defense Health Agency Managed Care Contracting Division (MC-CD) 16401 East Centretech Parkway Aurora, CO 80011-9066

G.1.2. Administrative Contracting Officer (ACO)

Defense Contract Management Agency (DCMA) ACO: The CO will delegate a limited number of functions listed in FAR 42 to the DCMA ACO. The Contractor will be provided copies of all delegation letters.

G.1.3. Contracting Officer’s Representative (COR)

The CO will designate a COR in writing, and provide a copy of the designation letter to the Contractor. The designation letter will delineate the scope of authority of the COR to act on behalf of the CO. The COR has no authority to make any commitments or changes that affect any term or condition of the contract.

G.1.4. Contractor Points of Contact Personnel

The names, addresses, phone numbers and email addresses of the Contractor’s primary and alternate point of contact (POC) for contract implementation and compliance are as follows:

Primary: Alternate:

G.1.5. Paying office

Defense Health Agency ATTN: Contract Resource Management (CRM) 16401 East Centretech Parkway Aurora, CO 80011-9066

G.2. PMPM MILITARY HEALTH SYSTEM (MHS) ELIGIBLE BENEFICIARIES

G.2.1. For the purpose of this CLIN, counts of MHS eligible beneficiaries under the PMPM includes all MHS eligible beneficiaries, underwritten and non-underwritten, with the exception of those covered under Uniformed Services Family Health Plan (USFHP) or under a

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Competitive Demonstration plan (see H.17). The contract region’s count of MHS eligible beneficiaries under the PMPM CLINs is based on the eligible beneficiary’s address as contained in Defense Enrollment Eligibility Reporting System (DEERS). This includes Prime enrollees who may be enrolled in a different region.

G.2.1.1. The count is taken from the MHS Data Repository (MDR) data derived from DEERS.

The MDR data reflects the information on beneficiary status and address on the first day of each month as currently known in the MDR at the time the PMPM data are tabulated.

G.2.2. The Government will unilaterally determine the number of MHS eligible beneficiaries prospectively two times for each option period under each PMPM SLIN, once for the first six months of each option period under SLIN X003AA and once for the seventh through twelfth months of each option period under SLIN X003AB (seventh – ninth months).

G.2.2.1. The number of MHS eligible beneficiaries will be based on an average of the most recent six previous months of eligible beneficiaries that are available at the time the PMPM data are tabulated from the MDR, as reported above.

G.2.2.2. Using the number of MHS eligible beneficiaries, the Government will calculate the PMPM quantity for the next semi-annual period as follows: The number of MHS eligible beneficiaries multiplied by the number of months (6) equals the number of member months (the quantity). The number of member months is then multiplied by the fixed unit price to determine the extended amount for the period.

G.3. STANDARDS ROUNDING LANGUAGE

G.3.1. Performance Standard Reporting: All numerical representations of performance standards need to be interpreted by the context of the standard and accompanying language.

Absent any narrative, normal rounding and significant digit convention shall be used. If any inconsistencies exist for the performance standard throughout the contract, then the Order of Precedence – Uniform Contract Format shall apply (see FAR 52.215-8). Performance standards represented in dollars or units shall be rounded to the nearest dollar or unit using standard rounding conventions (round half up).

G.3.1.1. For Government performance standards represented as percentages, each Contractor calculated performance standard percentage shall meet or exceed the respective Government contract performance standard to the hundredth of a percent in order to remain in compliance with the contract.

G.3.1.2. To ensure consistent practices for rounding and reporting of performance standards stated as percentages, all Contractor performance standard calculations and reporting shall be completed as follows:

Step 1 - Contractor Actual Performance Calculations:

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The Contractor shall carry out its performance standard calculations to the hundred thousandths decimal place. All digits following hundred thousandths decimal place shall be dropped.

Step 2 - Percentage Conversion: The calculated values from Step 1 shall then be converted to a percentage while retaining all remaining digits.

Step 3 - Rounding: The percentage values from Step 2 shall be rounded under standard rounding conventions (round half up) to the hundredth of a percent (ten thousandths decimal place under decimal values). Under standard rounding conventions, for the final digit, numerical values of 0- 4 are dropped, while values of 5-9 are dropped and the preceding digit is increased by 1.

G.4. INVOICING

The Contractor shall, when invoicing the Government, use one of the following submission methods: (1) TRICARE Encounter Data System (TEDS), (2) Wide-Area Workflow (WAWF), or

(3) Other.

G.4.1. TEDS Submittal Instructions (Underwritten and Non-underwritten Health Care)

G.4.1.1. The Contractor shall submit TEDS in accordance with TSM requirements. TEDS shall be grouped under the correct Batch/Voucher CLIN/ASAP Account Number (assigned by DHA- CRM) in accordance with TSM Chapter 2, Section 1.1., Paragraph 6.0.

G.4.1.1.1. All TED records submitted using an incorrect CLIN/ASAP Account Number in the Batch/Voucher and where a payment transfer has occurred will be reported daily on the Contractors Resource Center (CRC) website (https://dha-contractors.csd.disa.mil) by the

Examples:

Contract Performance

Step 1 Contractor Actual

Step 2

Step 3

Standard (Carried out to the hundredth of a percent)

Performance Percentage Conversion

Rounding Assessment

Example 1 X > 98.00% 3,924,500 = 0.98112 4,000,000

0.98112 = 98.112% 98.112% = 98.11% (Drop last digit)

Pass 98.11% > 98.00%

Example 2

X > 98.00%

3,918,300 = 0.97957 4,000,000

0.97957 = 97.957%

97.957% = 97.96% (Drop last digit, increase preceding digit by 1)

Fail 97.96% < 98.00%

Example 3

X < 1.50%

65,185 = 0.01629 4,000,000

0.01629 = 1.629%

1.629% = 1.63% (Drop last digit, increase preceding digit by 1)

Fail 1.629% > 1.50%

HT940220R0005 Page G4 of G19 following categories: (1) TED Record Indicator (TRI), and (2) by line item the calendar day following receipt of TED data by DHA.

G.4.1.2. The Contractor shall report all payment data on the daily NUW and UW Payment/Check Issue Data Report. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.4.1.2.1. The Contractor shall require its Bank to report all payment cleared data on the monthly NUW and UW Bank Cleared Data Report. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.4.2. Voucher Transmission Requirements

G.4.2.1. The Contractor shall transmit Batch/Vouchers by 10:00 AM Eastern time to be considered for that day’s business. Any Batch/Vouchers received after 10:00 AM Eastern time will be considered received the next business day for payment and check release authorization purposes. Batch/Vouchers must pass all TED header edits as specified in the TSM. If any header edits fail, the Batch/Voucher will be rejected and returned to the Contractor.

G.4.3. Voucher Integrity: Voucher header and detail amounts transmitted by the Contractor become “fixed” data elements in the finance and accounting system for purposes of control and integrity.

G.4.3.1. The Contractor shall process corrections or adjustments to reported (payment) amounts on separate voucher transmissions (TSM, Chapter 2, Section 1.1, paragraph 3.0.).

G.4.4. Reserved

G.4.5. Federal Fiscal Year-end Processing:

G.4.5.1. The Contractor shall submit its final fiscal year TED data no later than 10:00 AM Eastern time on September 28.

G.4.5.2. The Contractor shall not submit Batch/Vouchers to DHA between September 28, 10:00 AM Eastern time or before October 1. Any Batch/Voucher received during this time period will be rejected by DHA.

G.4.5.2.1. The Contractor shall resubmit any rejected Batch/Vouchers using next fiscal year Batch/Voucher CLIN/ASAP Account Numbers and associated bank accounts.

G.4.5.3. The Contractor shall submit TEDs related to Voided/Stale-dated payments using the same Batch/Voucher CLIN/ASAP Account Numbers associated with the original TED submission.

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G.4.5.4. The Contractor may test their new fiscal year’s transactions in TEDs benchmark starting September 1. Like production, benchmark data must be received at DHA by 10:00 AM Eastern time on September 28. After 10:00 AM Eastern time on September 28 until October 1, no benchmark data can be transmitted to DHA.

G.4.5.5. Federal Fiscal Year-end Processing of Non-TED Vouchers: September non-TED vouchers that are submitted in the month of October shall utilize the current fiscal year CLIN/ASAP Account Number.

G.5. UNDERWRITTEN HEALTH CARE (COST REIMBURSEMENT) - TEDS

G.5.l. The Government will reimburse the Contractor for each TED record that clears all TED detail edits. Reimbursement will occur within seven calendar days of acceptance.

G.5.1.1. TED records resulting in a credit due to the Government do not have to pass all TED detail edits. DHA will collect all Underwritten credits from the Contractor within one business day.

G.5.2. TED Adjustment Procedure for Additional Payment or Collections Citing an Active CLIN (Also See TOM Chapter 11 for Underwritten Underpayment)

G.5.2.1. The Contractor shall report additional payments or collections as an adjustment to the original TED record.

G.5.2.2. The Contractor shall use the “Begin Date of Care” for non-institutional or “Admission Date” for institutional claims to determine option period and then select the appropriate CLIN/ASAP Account Number. This should be the same CLIN/ASAP Account Number used to report the original payment or collection on TED records.

G.5.3. TED Underwritten CLIN Closure Procedures

G.5.3.1. The Government will close underwritten healthcare CLINs no earlier than 13 months after the expiration of the option period. An exception will be for the final Option Period where CLIN closure will occur no earlier than 30 calendar days after the end of healthcare delivery.

The CO will notify the Contractor at least 30 calendar days before the underwritten CLIN closure process is initiated.

G.5.3.2. The contactor shall, upon notification of CLIN closure, clear all rejected (Bad Master) claims before the scheduled CLIN closure date. On the date the CLIN is scheduled to be closed and after all TED data received before the 10:00 AM Eastern time cutoff has been processed, DHA-CRM will change the CLIN status from ‘Active’ to ‘Closed’. When the CLIN is closed any Batch/Vouchers that remain in a Rejected/Bad Master status will be manually closed by DHA-CRM. Any new TED data submissions received after CLIN closure and citing the ‘Closed’ CLIN shall be rejected.

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G.5.4. Reconciliation of the Closed CLIN

G.5.4.1. The Contractor shall work with the Government to conduct a reconciliation of the total amount billed against the CLIN. The reconciliation will include all Contractor invoices (TED data submissions and any non-TED vouchers) citing the CLIN prior to CLIN closure.

G.5.4.2. The Government will determine the value of the CLIN based on the payments made by DHA-CRM taking into account incorrect billings, manual closures, and transfers, therefore the total amount billed against the CLIN and the total (paid) value of the CLIN may be different.

G.5.4.3. CLIN closure does not constitute final settlement of the value of the CLIN. The CLIN closure only ends the TEDs transactional phase (billing and payment). Contract specified audits and future events may also affect the final value of the CLIN. Final CLIN closure occurs upon issuance of contract modification and contract closeout.

G.5.5. Resuming TED Claims Processing after CLIN Closure

G.5.5.1. The Contractor shall process all health care claims with dates of care that fall within a closed CLIN(s) period of performance as Non-Underwritten health care costs using the current fiscal year Non-Underwritten Bank Account. Claims processing as Non-Underwritten can resume immediately after the date of CLIN closure.

G.5.6. Fiscal Year Start-Up of Underwritten Health Care

G.5.6.1. The Contractor may resume TED data submissions on 1 October. Underwritten CLINs shall use the same Batch/Voucher CLIN/ASAP Account Numbers for the life of the contract.

G.5.6.2. The Contractor shall submit all TED Batch/Voucher Headers for the new fiscal year citing a Batch/Voucher Date equal to or greater than October 1. This includes any rejected data submissions prior to October 1.

G.5.7. Manual Process for the Approval of TED Invoices

G.5.7.1. The Contractor may request manual clearance for claims that cannot pass the TED edit process.

G.5.7.1.1. The Contractor shall submit the request to the COR and shall include the specific TED Record Indicators (TRIs) involved.

G.5.7.1.2. The Government, if approved, will clear the record and pay the Contractor the amounts due within seven calendar days.

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G.5.8. Wide-Area Work Flow (WAWF)

G.5.8.1. The Contractor shall submit its non-TED invoices in accordance with DFARS 252.232- 7003 and DFARS Clause 252.232-7006, included in Section I.

G.5.8.1.1. The Contractor shall use the following data elements for WAWF:

Pay Official DoDAAC HT0010 Issue By DoDAAC HT9402 Admin DoDAAC HT9402 Inspect By DoDAAC N/A Ship To Code HT0064 Ship From Code N/A Mark For Code N/A Service Approver (DoDAAC) Service Acceptor (DoDAAC) HT0064 Accept at Other DoDAAC N/A LPO DoDAAC N/A DCAA Auditor DoDAAC HAA150 Other DoDAAC(s) N/A Send Additional Email Notifications: dha.buckley.crm.mbx.aurcrm-invoices@mail.mil (mandatory data element).

G.5.9. WAWF Invoices and Payments

The Contractor shall, for the following CLINs, submit invoices according to the instruction below:

G.5.9.1. Transition-In

G.5.9.1.1. The Contractor may request an interim payment of 50% of the transition-in price upon the start of health care delivery at the conclusion of the base period (transition).

G.5.9.1.2. The Contractor may request payment of the remaining 50% of the transition-in price after the first full month of healthcare delivery.

G.5.9.2. Underwritten Health Care - Fixed Fee

G.5.9.2.1. The Contractor shall submit invoice monthly after the end of the month.

G.5.9.3. PMPM

G.5.9.3.1. The Contractor shall submit invoices monthly after the end of the month for no more than one-sixth (rounded to the nearest dollar) of the extended SLIN amount.

mailto:dha.buckley.crm.mbx.aurcrm-invoices@mail.mil

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G.5.9.4. Earned Performance Incentive

G.5.9.4.1. The Contractor shall invoice as instructed by the CO following determination of any performance incentive amounts.

G.5.9.5. Transition-Out

G.5.9.5.1. The Contractor shall submit an invoice after accomplishing the required Transition- Out requirements.

G.5.9.6. Award Fee CLINs X005 and Award Fee, Transition-Out CLIN 9002

G.5.9.6.1. The Contractor shall invoice as instructed by the CO following determination of any award fee amounts.

G.5.9.7. Modifications

G.5.9.7.1. The Contractor shall invoice for change order definitizations, Clinical Support Agreements, Service Assist Teams, MTF/Guard/Reserve/MSO/VSO Briefings or other modifications after the CO provides instructions and authorization to invoice.

G.6. OTHER INVOICING METHODS

G.6.1. The Contractor shall submit all credit invoices to DHA-CRM via email at dha.buckley.crm.mbx.aur-crm-invoices@mail.mil with a copy to the COR as WAWF cannot process credit invoices. The email must clearly state ‘WAWF not used’ in the subject line.

G.6.2. The Contractor may, if WAWF is unavailable and instructed by DHA-CRM, submit their invoices to DHA-CRM at dha.buckley.crm.mbx.aur-crm-invoices@mail.mil with a copy to the COR. Email invoice(s) that are not submitted thru WAWF must clearly state “WAWF not used’ in the subject line. The email receipt date shall be used as the invoice receipt date.

G.6.3. Procedure if TEDS is Not Available

G.6.3.1. The Contractor may use the following process for underwritten invoicing in the event that the TED system is unavailable:

G.6.3.1.1. The Contractor shall, upon notification by the CO, submit summary invoices by Batch/Voucher Headers (data elements listed below) as a MS Excel spreadsheet email attachments and sent to dha.buckley.crm.mbx.aur-crm-invoices@mail.mil.

ELN Element Name 0-001 Header Type Indicator 0-005 Contract Identifier 0-010 Contract Number mailto:dha.buckley.crm.mbx.aur-crm-invoices@mail.mil mailto:dha.buckley.crm.mbx.aur-crm-invoices@mail.mil

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0-015 Batch/Voucher Identifier 0-020 Batch/Voucher Number 0-025 Batch/Voucher ASAP Account Number 0-030 Batch/Voucher Date YYYYDDD 0-035 Batch/Voucher Sequence Number 0-040 Batch/Voucher Resubmission Number 0-045 Total Number of Records 0-050 Total Amount Paid

G.6.3.1.2. Manual payments will be made within seven calendar days of receipt of invoice. All amounts paid based on manual invoices submitted during healthcare claims processing system outages shall be considered interim payments and will be offset against payments based on actual TED data submissions when claim processing resumes.

G.6.3.1.3. The Contractor shall have 30 calendar days to clear all vouchers where interim payments have been made thru the TED header edits (as specified in the TRICARE Systems Manual, Chapter 2).

G.6.3.1.4. Failure to clear all header edits for any vouchers where the Contractor was paid under this contingency process shall result in the Government collecting back any missing/rejected voucher header(s) totals via payment offset.

G.6.3.1.5. When the missing/rejected vouchers clear the header edits, any monies collected via payment offset shall be refunded to the Contractor (without interest or penalty).

G.7. NON-UNDERWRITTEN HEALTH CARE – TEDS

G.7.1. The Contractor shall adjudicate claims and distribute Government funds for the health care services listed in Section H.1. These costs are paid using the bank account set-up in accordance with G.7.2. Establishment of Non-Underwritten Bank Accounts.

G.7.2. Establishment of Non-Underwritten Bank Accounts

G.7.2.1. The Contractor shall establish bank account(s) for non-underwritten payments with a commercial bank that has Federal Reserve Wired Network (Fedwire) capability. The bank account will be non-interest bearing and maintain a zero-dollar balance.

G.7.2.1.1. The Contractor shall establish this bank account(s) no later than 90 calendar days prior to the start of health care delivery (SHCD) and for each subsequent federal fiscal year.

G.7.2.2. This bank account(s) with Fedwire capability, along with the Department of Treasury’s Automated Standard Application for Payments (ASAP) system, provide a mechanism for disbursement of Government funds for health care services received by TRICARE beneficiaries.

These systems allow the Contractor to draw funds directly from the Federal Reserve Bank (FRB) to cover payments clearing the Contractor’s bank account.

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G.7.2.3. The Contractor shall, once the bank account is established, submit bank information to DHA-CRM no later than 60 calendar days prior to the beginning of processing claims on a new bank account(s).

G.7.2.3.1. The Contractor shall include the following information to DHA-CRM:

• Name of Bank

• Overnight mail address

• American Banking Association (ABA) routing number

• The Contractor’s DUNS number

• The Bank’s DUNS number

• Taxpayer Identification Number (TIN) (must be the same TIN used for payment)

• Contractor’s bank account number (if separate checking and deposit accounts are used, both need to be provided)

• Individual point of contact at the bank and an alternate, including phone numbers and e-mail addresses

• Individual point of contact at the Contractor and an alternate, including phone numbers and e-mail addresses.

G.7.2.4. DHA-CRM will establish the ASAP bank account with the Treasury Department.

G.7.2.4.1. DHA-CRM will notify the Contractor once the bank account(s) have been established and provide codes or other information necessary for the Contractor’s bank to make draws against the ASAP account using Fedwire.

G.7.2.4.2. DHA-CRM will establish daily and total dollar limits that can be drawn from the ASAP account(s) and will notify the Contractor of these limits. DHA-CRM will be able to increase these limits if needed. The dollar limits only represent an administrative ceiling and does not constitute any authority to draw funds.

G.7.2.5. The Contractor shall submit a monthly Non-Financially Underwritten Bank Account Reconciliation Report and the associated bank account statements for each account until the bank account is closed. Reports are to be submitted to DHA-CRM. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.7.3. Authority to Release Non-Underwritten Payments

G.7.3.1. The Contractor shall obtain approval from the DHA-CRM Budget Office prior to releasing payments to providers, beneficiaries, or other entities for non-underwritten claims processed.

G.7.3.1.1. The Government will provide payment release authority to the Contractor each business day no later than 5:00 PM Eastern time by fax or email.

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G.7.3.1.2. Authorization will specify contract number, ASAP Account ID Number, and total dollar amount of funds that may be released based on information contained in the Batch/Voucher Header.

G.7.3.1.3. The Government will approve funds release provided the following criteria are met:

(1) Voucher submissions must pass all header edits as specified in TSM, Chapter 2, Section 4.1 Header Edit Requirements; and (2) DHA-CRM Budget Officer has confirmed that funding is available to cover payments.

G.7.3.1.4. The Contractor shall release (EFT) or mail benefit payments no later than two business days after DHA-CRM approval.

G.7.4. The Contractor shall only draw funds from the ASAP account(s) for payments approved for release by DHA-CRM and clearing the Contractor's financial institution on the day the draw is being accomplished. The following types of draws are prohibited: (1) payments to self unless specifically authorized in the contract or approved in advance by DHA-CRM; (2) advance payments; and (3) bank fees or other bank charges.

G.7.4.1. TED records that do not pass all TED detail edits are considered insufficient justification to support draws from the ASAP account(s). TEDs must pass all TED detail edits within 90 calendar days after initial notice of edit failures is sent to the Contractor by DHA-

CRM.

G.7.4.1.1. DHA-CRM will, if not corrected in 90 calendar days, collect the total amount of improper payments that have not cleared all TED edits by offsetting other payments to the Contractor. DHA-CRM may return these collections to the Contractor upon correction of the TEDs involved or some other resolution is reached.

G.7.5. Authorization to release payments does not constitute DHA’s acceptance that all payments are valid and correct. Detailed records will be audited by the Government for financial compliance. All payments drawn from the ASAP account(s) must be valid and justified. All disputed amounts will remain in the possession of the Government until no longer in dispute.

G.7.5.1. The Contractor may request an Alternate (Manual) Payment Release for non-underwritten benefits due to problems with DHA TED record processing. Upon notification by the Government that the TED Record processing system is not operating, the Contractor’s request for manual check release shall include amounts by Batch/Voucher Headers (data elements listed below). The request shall be submitted to the following email address: dha.buckley.crm.mbx.crm-budget@mail.mil.

G.7.5.1.1. The Contractor shall submit the following data elements as a MS Excel spreadsheet (See TRICARE Systems Manual, Chapter 2, Section 2.3 Data Requirements – Header Record Data):

ELN Element Name mailto:dha.buckley.crm.mbx.crm-budget@mail.mil

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0-001 Header Type Indicator 0-005 Contract Identifier 0-010 Contract Number 0-015 Batch/Voucher Identifier 0-020 Batch/Voucher Number 0-025 Batch/Voucher ASAP Account Number 0-030 Batch/Voucher Date YYYYDDD 0-035 Batch/Voucher Sequence Number 0-040 Batch/Voucher Resubmission Number 0-045 Total Number of Records 0-050 Total Amount Paid

G.7.5.1.2. DHA-CRM will return to the Contractor a signed release within four hours of receipt.

G.7.5.1.3. The Contractor shall release payments to providers and beneficiaries in accordance with G.7.3.1.4.

G.7.5.1.3.1. The Contractor shall not release payments until this approval is received.

G.7.5.1.4. The Contractor shall, upon notification by the Government that the TED Record processing system is operating again, discontinue the alternate manual payment release process.

G.7.5.1.5. The Contractor shall submit and clear all vouchers (TED data) held during the alternate manual payment release process within 30 calendar days of notification that the TED Record processing system is operating normally.

G.7.5.1.6. Failure to clear all header edits for any vouchers where the Contractor was authorized under this contingency process to release payments will result in the Government collecting back the rejected voucher header totals via payment offset. When the vouchers clear the header edits, the monies collected via payment offset will be refunded to the Contractor (without interest or penalty).

G.8. ASAP DRAWS ON THE FEDERAL RESERVE

G.8.1. The Contractor shall ensure that cash draws do not exceed the payments authorized, less deposits, as they clear the bank on a given day. Computation of the amount of the draw must include any deposits of funds into the account. These deposits will reduce the amount of cash needed for the draw down on the day of the deposit.

G.8.1.1. The Contractor shall not collect or hold non-underwritten benefit funds before dissemination to the beneficiary or provider and shall ensure that any excess draws are immediately returned to the ASAP account.

G.8.2. The Government will charge interest and a penalties beginning the day after the account is overdrawn and will continue until the overdrawn amount is returned. Interest will accrue daily

HT940220R0005 Page G13 of G19 and is based on the Treasury Current Value of Funds Rate. The penalty will accrue daily and is based on the penalty rates in the Code of Federal Regulations, Title 31, Part 5, Subpart B Sec.5.5. DHA-CRM may initiate immediate payment offset against any payments to the Contractor for the interest, penalties and/or the overdrawn amount.

G.8.3. The Contractor shall prevent the commingling of funds between bank accounts. Failure to properly associate transactions with the correct bank account could result in the over-execution of DHA-CRM budget authority. Transfers of funds between bank accounts are strictly prohibited except for correcting deposits that are in the wrong account.

G.8.3.1. The Contractor shall report immediately to DHA-CRM any transactions citing one bank account and erroneously charging against a different bank account. DHA-CRM will instruct the Contractor as to what action to take to correct the error.

G.8.4. The total amount of funds drawn on the FRB is based on the daily total of benefit payments presented to the bank for payment.

G.8.4.1. The Contractor shall adjust any estimated draws (due to timing of reports) to match the actual draw within one business day.

G.8.4.2. U.S. Treasury regulations do not allow the deposit of funds to an ASAP Account in excess of draws.

G.8.4.2.1. The Contractor is authorized to deposit and hold the funds in their corporate bank account associated with the DHA assigned ASAP account without returning them to the U.S.

Treasury via FRB ASAP return process when the Contractor receives collections in excess of ASAP Draws (this should only happen at the beginning of a new federal fiscal year).

G.8.4.2.2. The Contractor is authorized to use the excess collections to offset any payments (reducing the draw on the ASAP account) presented to the bank in accordance with G.8.1.

G.9. FISCAL YEAR START-UP OF NON-UNDERWRITTEN ASAP ACCOUNTS

G.9.1. The Contractor shall establish a separate bank account for each new Government fiscal year following the procedures specified in G.7.2. Establishment of Non-Underwritten Bank Accounts.

G.9.1.1. All payments issued for benefit payments and all refunds received shall be processed against the new account effective the first day of the new fiscal year.

G.9.1.2. The Contractor shall transfer all recoupment installment payments to the new account from the previous year’s account.

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G.9.2. The Contractor shall continue to make cash drawdowns against the prior fiscal year’s bank account (if required) until all payments from the prior year have either cleared or have been cancelled (void/stale-dated).

G.9.2.1. The drawdown authority will discontinue no later than 31 March of the following fiscal year (six months) after the last payments have been made. In case of the final Option Period, close out procedures are described in TOM Chapter 2.

G.9.3. The Government will close ASAP bank accounts no later than 31 March, following the fiscal year end.

G.9.3.1. The Contractor shall work with the Government to conduct a final bank account reconciliation beginning no sooner than 30 calendar days following bank account closure.

G.9.3.2. All transactions that were not previously approved by DHA-CRM shall be explained with supporting documentation on the final Non-Financially Underwritten Bank Account Reconciliation Report. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.9.3.3. The Government reserves the right to not accept these transactions.

G.9.4. The Contractor shall reimburse DHA for any outstanding balance in the account no later than the required submission date of the final Non-Financially Underwritten Bank Account Reconciliation Report. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J. This balance may be subject to interest if it includes overdrawn amounts that were required to be submitted at an earlier date.

G.9.5. Non-Underwritten Payment Adjustments

G.9.5.1. The Contractor shall submit an adjustment TED record when making an additional payment to, or collection against a previously submitted TED record.

G.9.5.1.1. The Contractor shall report adjustments using the current fiscal year CLIN/ASAP ID without regard to the fiscal year or CLIN/ASAP ID of the previously submitted TED record. The Contractor shall report all TED and adjustment TED records on the monthly Non-Financially Underwritten Bank Account Reconciliation Report. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.9.5.1.2. The Contractor shall report Non-Underwritten debts on the Accounts Receivable Summary Report. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.10. INVOICE AND PAYMENT NON-UNDERWRITTEN - NON-TEDS

The Contractor shall group and electronically process Non-TED vouchers by the correct non-underwritten cost category identified below as a manual Non-Underwritten payment.

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G.10.1. Capital and Direct Medical Education Costs (CAP/DME)

G.10.1.1. The Contractor shall make payments from the Non-Underwritten Bank Account to hospitals requesting reimbursement under the TRICARE/CHAMPUS DRG-Based Payment System (excludes children’s hospitals). (See TRM Chapter 6, Section 8).

G.10.1.2. The Contractor shall submit a monthly CAP/DME voucher in a .csv format to DHA- CRM dha.buckley.crm.mbx.aur-crm-invoices@mail.mil no later than the 20th calendar day of the month following receipt of the hospital’s request for payment. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.10.1.3. The Contractor shall submit supporting documentation, including 1) copies of the hospital’s claim (.PDF), and 2) the payment calculation in .csv format.

G.10.1.3.1. The Contractor shall submit supporting documentation electronically to dha.buckley.crm.mbx.aur-crm-invoices@mail.mil using approved formats specified in TRM Chapter 6, Section 8.

G.10.1.4. The DHA-CRM will, upon receipt of the CAP/DME voucher, provide authority to release payments to hospitals.

G.10.1.4.1. The Contractor shall subsequently release payments in accordance with section G.7.3.1.4.

G.10.1.4.2. The Contractor shall, for any adjustment CAP/DME transactions (e.g., voids, stale-dated checks, additional payments) report to DHA-CRM on the next voucher, with supporting documentation and notations as to the type of transaction (e.g., void, refund, etc.).

G.10.1.4.3. The Contractor shall report Debts established under this paragraph and related transactions on the monthly Accounts Receivable Report. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.10.1.5. The Contractor shall, for Fiscal Year-End processing of CAP/DME vouchers, refer to section G.4.5. Federal Fiscal Year-end Processing for guidance.

G.10.2. Bonus Payments (HPSA/PSA)

G.10.2.1. Bonus payments are an addition to the amount normally paid under the allowable charge methodology in order to provide services in medically underserved areas [Health Professional Shortage Areas (HPSA) and Physician Scarcity Areas (PSA)].

G.10.2.2. The Contractor shall, on a monthly basis, submit the HPSA/PSA non-TED voucher, and supporting documentation electronically, citing the current fiscal year CLIN/ASAP ID. The voucher is to be sent to dha.buckley.crm.mbx.aur-crm-invoices@mail.mil.

mailto:dha.buckley.crm.mbx.aur-crm-invoices@mail.mil

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G.10.2.3. The Contractor shall release payments in accordance with section G.7.3.1.4.

G.10.2.4. The Contractor shall, for adjustment HPSA/PSA transactions (e.g., voids, stale-dated checks, additional payments) report to DHA-CRM on the next monthly non-TED voucher, with supporting documentation and notations as to the type of transaction, e.g., void, refund, etc.).

G.10.2.4.1. The Contractor shall report debts established under this paragraph and related transactions on the monthly Accounts Receivable Report.

G.10.2.5. The Contractor shall submit monthly vouchers in .csv format containing the following information:

a. Format for Vouchers

- CLIN/ASAP Account Number

- Period Covered

- Provider Name

- Taxpayer ID Number (TIN) of Provider

- Provider Address

- Provider Zip Code

- Provider Number (NPI)

- Amount Paid/Collected for Bonus

G.10.2.6. The Contractor shall, for Fiscal Year-End processing of HPSA/PSA vouchers, refer to section G.4.5. Federal Fiscal Year-end Processing for guidance.

G.10.3. Demonstrations/New Benefit Programs.

G.10.3.1. The Contractor shall, for Demonstrations/New Benefit Programs, submit non-TED vouchers when data is incompatible with TED formats.

G.10.3.2. The Contractor shall, on a monthly basis, submit the Demonstrations/New Benefit Programs non-TED voucher, and supporting documentation electronically, citing the current fiscal year CLIN/ASAP ID. The voucher is to be sent to dha.buckley.crm.mbx.aur-crm-invoices@mail.mil.

G.10.3.3. The Contractor shall release payments in accordance with section G.7.3.1.4.

G.10.3.4. The Contractor shall, for adjustment Demonstrations/New Benefit Programs transactions (e.g., voids, stale-dated checks, additional payments) report to DHA-CRM on the next monthly non-TED voucher, with supporting documentation and notations as to the type of transaction, e.g., void, refund, etc.).

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G.10.3.4.1. The Contractor shall report debts established under this paragraph and related transactions on the monthly Accounts Receivable Report.

G.10.3.5. The Government will provide detailed instructions in contract modification(s) or other correspondence when such programs are established.

G.10.3.5.1. These payments and any related credits or collections shall be identified on the Non- Financially Underwritten Bank Account Reconciliation Report as additional lines listed by Demonstrations/New Benefit Program. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.10.4. Other non-Underwritten non-TED Payments

G.10.4.1. Other adjustments are rare situations where a payment needs to be made by the Contractor, but does not fall into routine processing such as TEDs, etc. For example, payments related to a claim which cannot be processed through the TED system, legal settlements, or payments directed by DHA.

G.10.4.2. For Government directed non-Underwritten non-TED Payments

G.10.4.2.1. The CO will provide the Contractor with detailed instructions, authorizing the Contractor to prepare the payment(s) to the individual, or entity.

G.10.4.2.1.1. The Contractor shall, after release approval by DHA-CRM, make payment in accordance with G.7.3.1.4.

G.10.4.2.1.2. The Contractor shall report these payments on the Non-Financially Underwritten Bank Account Reconciliation Report under DHA approved manual transactions. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.10.5. For Contractor identified non-Underwritten non-TED Payments

G.10.5.1. The Contractor shall submit the request for a non-TED voucher to the COR, CO, and to DHA-CRM with supporting documentation explaining the issues that do not allow a TED record to be created, a copy of the claim (if applicable), computation of the amount to be paid, and other related documents.

G.10.5.1.1. The CO may provide authorization to the Contractor to prepare the payment(s) to the individual, or entity.

G.10.5.2. The Contractor shall, if approved, contact DHA-CRM for payment release authorization.

G.10.5.2.1. The Contractor shall make payments in accordance with G.7.3.1.4.

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G.10.5.2.2. The Contractor shall report these payments on the Non-Financially Underwritten Bank Account Reconciliation Report under DHA approved manual transactions. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.10.5.3. The Contractor shall, for Fiscal Year-End processing of Other non-Underwritten non- TED Payments, refer to section G.4.5. Federal Fiscal Year-end Processing for guidance.

G.11. TRICARE RESERVE SELECT (TRS), TRICARE RETIRED RESERVE (TRR),

TRICARE YOUNG ADULT (TYA), CONTINUED HEALTH CARE BENEFIT

PROGRAM (CHCBP, EAST REGION ONLY), TRICARE PRIME, AND TRICARE

SELECT FEES/PREMIUMS

G.11.1. The Contractor shall establish a separate, non-interest bearing account for the collection and disbursement of fees/premiums.

G.11.2. The Contractor shall deposit fee/premium collections to the established account daily.

G.11.3. DHA-CRM Finance and Accounting Office will provide the Contractor with the Government’s bank account for wire-transfers.

G.11.4. The Contractor shall wire-transfer the fees/premium collections, net of refund payments, twice monthly (1st and 15th) to the specified Government bank account.

G.11.5. The Contractor shall notify DHA-CRM by email, within one business day of the deposit, specifying the date and amount of the deposit.

G.11.6. The Contractor shall submit monthly reports supporting the wire transfers for each type of fees/premiums. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

G.12. TRANSITION OUT AT END OF CONTRACT.

G.12.1. Procedures for processing at the end of the contract are described in TOM Chapter 2, Section 10, paragraph 14.0. Budget, Finance & Accounting.

G.13. REPORTING

G.13.1. The Contractor shall provide a copy (annually) of the Contractor’s System and Organization Controls Report (SOC-1) as prescribed by the American Institute of Certified Public Accountants - Statement of Standards for Attestation Engagements (SSAE) 18 and sub- Contractor’s SOC-1. For reporting requirements, see Contract Data Requirements List (CDRL), DD Form 1423, located in Section J.

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G.13.2. The Contractor shall, upon Government request, provide annual Bridge Letters for the Contractor and subcontractors addressing any changes that may have occurred between the time of publishing the SOC-1 and the end of the Government fiscal year.