TMEP2 Govt Responses to Post Industry Day Questions.pdf

Government Responses to TMEP2 Industry One-on-One Follow Up Questions

# Subject Question/Comment Government Response

Accumulator Establishment at Transition

For TRICARE Medicare-eligible beneficiaries, how should offerors assume deductible, cost-share, and catastrophic cap accumulators are established at transition? Please advise whether balances are provided, recalculated prospectively, or reconciled post-cutover.

The Defense Enrollment Eligibility Reporting system (DEERS) stores deductible and catastrophic cap data in a central repository. The current and four prior years are stored. See the TRICARE Operations Manual (TOM), Chapter 8, Section 7 and the TRICARE Systems

Manual (TSM), Chapter 3, Section 4.2 for additional information on Catastrophic Cap and

Deductible Data (CCDD).

2 Historical TED Data Will historical TED submissions be made available to the incoming contractor for benchmarking, validation, or reconciliation purposes?

The Government does not provide historical TEDs data.

Government Read-Only

Access

Will Government read-only access include visibility into historical claims and transition reconciliation activity?

The requirement is for the Government to have read and print access for all claims data.

Note: The Government is unclear on what is meant by "transition reconciliation activity".

4 Cutover Model Does DHA intend the TMEP2 transition to follow a date of service cutover model, a date of receipt cutover model, or a hybrid approach?

DHA will follow a date of receipt model. The final solicitation will include a draft TOM

Chapter 20, and Section 2 will address Transition requirements.

5 Claims Spanning Cutover How should the Contractor handle claims with dates of service prior to the start of Option

Period 1 that are received, adjusted, or reprocessed after cutover?

The incoming contractor is responsible for claims received at the start of Option Period 1 regardless of dates of service. Transition requirements for incoming and outgoing contractors will be provided in TOM Chapter 20, released with the final solicitation.

6 Historical Claims Data

Will historical claims data be provided to the TMEP2 contractor at transition-in, and if so, what lookback period should be assumed and which claim types will be included such as paid, denied, adjusted, cancelled, or reversed?

Yes, historical claims data will be provided by the outgoing contractor in accordance with the transaction requirements timeline laid out in TOM Chapter 2, Sec 6.

Historical Accumulator

Data Scope

Will DHA provide any historical accumulator or cost-share balance data for reference or reconciliation purposes during transition, and if so, what lookback period should be assumed?

See response to #6 above.

8 Data Usage Expectations Is historical data expected to be migrated for operational use or provided for reference and audit purposes only?

The historical data will be required for operational use.

9 CMS Dependency Timing Will CMS crossover timing variability be considered an allowable dependency during early performance measurement?

This agreement needs to be in place 120 days prior to start of services delivery. TRICARE processing timelines are based on date of receipt of claims to include crossover claims.

Transition Model

Expectations

Does DHA have a preferred transition approach based on prior TMEP experience, or should offerors propose their own transition model?

The contractor will be required to propose its own transition approach, which includes an

Integrated Master Plan and an Integrated Master schedule, defined in TOM Chapter 20, and correlating CDRLs.

In-Flight Claims

Ownership

Under the intended cutover model, will the incumbent contractor retain responsibility for completing in-flight claims, or will responsibility transfer to the TMEP2 contractor for completion, including Medicare crossover claims?

The incumbent contractor will be responsible to process any claims, to include adjustments, received during its period of services delivery. The incoming TMEP2 contractor will begin processing claims received at the start of services delivery.

Early Performance

Measurement

Will performance guarantees and incentives be enforced immediately at the start of Option

Period 1, or will there be a defined transition stabilization period?

Yes, performance guarantees will be applied at the start of Option Period 1 unless otherwise stated in the solicitation. Performance incentives will begin six months after the start of

Option Period 1.

Accumulator-Related

Performance Impact

How will performance guarantees and beneficiary satisfaction metrics be applied for claims impacted by post-cutover accumulator reconciliation in a dual-eligible environment?

The performance guarantees will begin start of service delivery and the beneficiary satisfaction metrics (survey results) will begin the third quarter of the first option period.

The Government is unclear on what is meant by "post-cutover accumulator reconciliation".

TED Performance During

Transition

How will TED timeliness and edit accuracy be measured during early operations for claims impacted by pre-award dates of service or delayed Medicare crossover data?

The solicitation will include the claims processing timeliness which are calculated based on the date of receipt of the claim by the TMEP2 contractor. The solicitation will also include a section related to the TEDs timeliness -initial submission TEDs are submitted once the claim has been processed to completion. Neither performance calculation should be impacted by delayed Medicare crossover data.

15 Transition Can DHA provide a comprehensive list of systems that will require integration with the claims system for evaluation as part of a phased transition?

System integration requirements are listed in TOM Chapter 2 and the TMEP2 requirement will be further defined in the draft TOM Chapter 20 which will be released with the final solicitation.

16 Transition Does DHA intend to follow a phased transition schedule with payments tied to milestone completion, or is another approach being considered?

DHA does not plan to use milestone payments; there will be a one time transition payment.

17 Transition Does DHA anticipate using the roadmap in the current TOM (including milestones and performance verification)?

Yes, with some exceptions that will be defined in the draft TOM Chapter 20 which will be released with the final solicitation.

18 Transition

Is DHA aware of any large commercial entities (greater than 20 million covered lives) that procure both technology and services together and could serve as a model for a phased transition?

DHA is not in a position to comment on this question.

19 Operations Will DHA publish the historical frequency and volume of change orders?

Yes, DHA will publish the historical frequency and volume of change orders, either with the solicitation or prior to.

20 Expansion of Competition Is there value if a Small Business offeror is able to perform 100% of the contract requirements?

As this effort will be solicited under full and open competition, all offerors, including small businesses, are welcome to submit a proposal.

21 Expansion of Competition Are current TRICARE contractors (other than the TMEP incumbent) conflicted out of competing for TMEP2?

In the event of a conflict of interest, potential offerors will be required to submit a plan in accordance with FAR Part 9.

22 TOM Requirements What evaluation criteria, if any, will be used to assess offeror knowledge and experience related to the TOM?

Evaluation criteria will be included with the final solicitation.

23 TOM Requirements Will DHA evaluate an existing contractor at the same level as an otherwise analogous offeror?

DHA will evaluate all proposals in accordance with the criteria provided in the solicitation.

24 TOM Requirements Is DHA open to including an innovation CLIN to enable the implementation of automation, AI, and other efficiencies?

DHA will consider adding contract language and/or a special CLIN to allow for future innovations.

25 Tricare ID number consists of how many digits? Alpha or numeric or alphanumeric?

DoD Benefits number (DBN) format is 123456789-00, but the TMEP2 contractor will be required to also identify beneficiaries using a Social Security number or a DoD ID number which is 10 digits (Example-1234567899).

26 Provider Participation Agreement, what does this entail?

Certain providers (i.e. Skilled Nursing Facilities, Residential Treatment Centers) require a participation agreement. The contractor has a role in approving participation agreements.

This includes obtaining the participation agreement from the contractor authorizing the provider or, if a participation agreement is not available the contractor must request one from the provider. The contractor must maintain a copy of the participation agreement. See the

TRICARE Policy Manual (TPM), Chapter 11 for detailed sections on the different required participation agreements.

The transition period, will compare files be run to confirm processing consistency between vendors?

The transition requirement will be listed in TOM Chapter 2 and TMEP2 requirements will be further defined in the draft TOM Chapter 20 which will be released with the final solicitation. There is no comparison between the outgoing and incoming vendors.

28 Tricare reimbursement rates when Tricare is primary payor? See the TRICARE Reimbursement Manual for reimbursement methodologies.

The initial letter to be sent to all members, is this all 2.7 million members, or are families rolled up?

The contractor is required to send Introductory letters to all households who had claims activities in the past 12 months.

30 What is required to validate a provider when Tricare is primary?

When required to verify if a provider is TRICARE authorized, the Contractor will do so by using the DHA centralized TRICARE Encounter Provider Records (TEPRV). If a provider’s status is not listed in the TEPRV, then the Contractor shall obtain and maintain documentary evidence to certify that the provider meets the criteria set forth in 32 CFR Part 199.6 and the

TPM.

31 Is COB and subrogation pursued if Tricare is the primary payor?

Yes, the TMEP2 contractor will coordinate benefits with other health insurance (OHI) to which the beneficiary is entitled/enrolled as required by 32 CFR 199.8, the TPM, and TRM.

For Third Party Recovery Claims, see TOM Chapter 10, Section 4.

32 Teaming Arrangements Will Contractor Teaming Arrangements (CTAs) be permitted under this procurement? Yes.

33 Teaming Arrangements

If CTAs are permitted, how will past performance be evaluated for CTA team members?

This will be addressed in the final solicitation.

• Will past performance from all CTA members be considered collectively?

• Or will evaluation be limited to the lead or principal offeror?

This information will be addressed in the final solicitation.

34 Teaming Arrangements If a traditional prime/subcontractor structure is proposed instead of a CTA, will subcontractor past performance be considered, and if so, to what extent?

This information will be addressed in the final solicitation.

35 Teaming Arrangements Are there any anticipated limitations or requirements regarding workshare percentages for

CTA members versus subcontractors?

There are currently no anticipated limitations or requirements regarding workshare percentages for CTA members versus subcontractors.

36 Teaming Arrangements Will the Government require identification of key subcontractors or CTA members at the time of proposal submission?

Yes.