TMEP2 Industry Forum Presentation.pdf

UNCLASSIFIED

TRICARE Medicare Eligible Program 2nd Generation (TMEP-2)

Industry Forum

For Ongoing Market Research

Defense Health Agency

January 27, 2026

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Welcome Industry

• DHA Introductions

▪ Mr. Jesse Benavides, Project Manager, TMEP-2 Contract

▪ Ms. Kristin Moore, Contracting Officer & Chief, TRICARE Support

Branch

▪ Mr. Richard Morvatz, Program Management Office - Enterprise

Medical Services

▪ Ms. Vonda Lawson, Contracting Officer Representative, TMEP Contract

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Administrative Announcements

• Please remain on mute for the duration of this presentation.

• Items for discussion may be addressed in the individual one-on-one sessions.

• Additional questions shall be submitted in writing no later than 5

February 2026 by 5pm MT to:

kristin.m.moore13.civ@health.mil addison.t.sexton.civ@health.mil

• This presentation will not be recorded.

mailto:kristin.m.moore13.civ@health.mil mailto:addison.t.sexton.civ@health.mil

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Agenda

• Purpose

• Disclaimers

• TMEP Scope

• TMEP High Level Requirements

• Solicitation Process

• Small Business Goals

• Award Timeline

• TMEP – A Deep Dive

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Purpose

• This industry forum is intended for market research purposes to help the government better define requirements and engage with industry regarding its capabilities.

▪ Each one-on-one is an opportunity for a back-and-forth discussion about the requirements and your feedback.

▪ Use this time to educate our team so that we can provide the best service possible to our beneficiaries.

• This approach is authorized under FAR Part 10 – Market Research, specifically with regards to FAR 10.002(b)(2):

▪ (1) Contacting knowledgeable individuals in Government and industry regarding market capabilities to meet requirements

▪ (v) Participating in interactive, on-line communication among industry, acquisition personnel, and customers

▪ (vii) Conducting interchange meetings or holding pre-solicitiation conferences to involved offerors early in the acquisition process

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Disclaimers

• Any acquisition and technical information shared here today is considered pre-decisional and is subject to change before issuance of the final solicitation.

▪ Discussions this week do not restrict DHA to a particular acquisition approach.

• When the final solicitation is issued, all information contained within the final solicitation supersedes any draft solicitation documents and this industry forum.

• This briefing and the attendee roster will be shared with industry through sam.gov.

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TMEP Scope

• Claims processing and associated customer support services for claims submitted by and on behalf of Military Health System (MHS) beneficiaries.

• The Contractor shall:

▪ Provide the expertise of health care claims processing and its support services by incorporating the best practices of the private sector in support of the TRICARE Program.

▪ Fulfill the objectives of the contract while complying with requirements identified herein and in the applicable chapters and sections in the TRICARE Manuals.

▪ Deliver all services in a manner that supports the TRICARE fully integrated health care delivery and financing system for all MHS beneficiaries.

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TMEP High Level Requirements

• Claims Processing

• Customer Service

• Management Functions

▪ Quality Management and Quality Improvement

▪ Preventing fraud and abuse

• Transition Activities

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Solicitation Process

• The final solicitation will be posted on sam.gov (anticipated Q2

CY26).

▪ Pre-solicitation notice will be posted to sam.gov at least 15 days prior to initial issuance of the solicitation.

• Interested parties may register at sam.gov to receive notifications and updates/amendments.

• All instructions for submission will be included in the solicitation.

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DHA Small Business Goals

• DHA is committed to promoting and maximizing DHA prime contract and subcontracting opportunities.

Subcontracting Goals FY25*

Small Business 45.50%

HUBZone 3%

Service-Disabled Veteran Owned Small

Business

5%

Small Disadvantaged Business 5%

Women Owned Small Business 5%

*Subcontracting goals will be issued within the final solicitation

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Current TMEP 2.0 Award Timeline

Milestone As of 9/22/25 on sam.gov As of 1/27/26

Publish draft Section C & Section H Q4 CY25 Q4 CY25

Industry Day Q4 CY25/Q1 CY26 Q1 CY26

Final Request for Proposal Issue Q2 CY26 Q2 CY26

Proposal Due Q3 CY26 Q3 CY26

Contract Award Q2 CY27 Q2 CY27

TRICARE Medicare Eligible Program 2nd Generation (TMEP-2):

A Deep Dive

Ms. Vonda Lawson, TMEP Contracting Officer Representative

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TMEP Purpose

• To administer claims processing and customer support for dual-eligible beneficiaries in the U.S. and its territories.

• Support TRICARE’s integrated health care delivery and financing system by delivering services that mirror private sector best practices.

• This includes supporting Medicare coordination in the continental U.S. and U.S.

territories (Puerto Rico, Guam, U.S. Virgin Islands, American Samoa, and

Northern Mariana Islands).

• It applies to dual-eligible Active-Duty family members, retirees, reservists, and their survivors.

“Medically Ready Force…Ready Medical Force” 13

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Program Overview

“Medically Ready Force…Ready Medical Force”

• Generally, enrollment in Medicare Part B is required to maintain TRICARE eligibility.

• Medicare is primary to TRICARE in most cases.

• Beneficiary Impact:

▪ In most cases, no out-of-pocket costs when services are covered by both programs.

▪ TRICARE is primary for TRICARE benefits that are not covered by Medicare or if Medicare benefits have been exhausted.

▪ No enrollment required and no enrollment fees for TRICARE for Life.

▪ Prime Enrollment fees are waived for dual-eligible beneficiaries with Medicare Part B.

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• TMEP Contract History

▪ 4th iteration of the Dual Eligible Contracts

▪ Contract Awarded: April 30, 2021

▪ Base Period + 6 one-year options (contract ends April 30, 2028)

▪ Population: 2.7 million TRICARE/Medicare Dual Eligible Beneficiaries

▪ Historical Volumes by Calendar Year:

Contract History

Net Claim Receipts

2023 57,843,976

2024 60,462,293

2025 61,985,392

Telephone Calls Received

2023 2,399,823

2024 2,435,204

2025 2,410,802

Routine Correspondence

Receipts

2023 572,658

2024 675,997

2025 762,891

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• There are four main objectives outlined in the Performance Work

Statement (PWS):

1. Accurate and cost-effective claims processing

2. High-quality, beneficiary-focused customer service

3. Effective management and quality oversight

4. Smooth transition planning for continuity of service

Key Contract Objectives

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• The contractor shall:

▪ Use DEERS data to verify eligibility

▪ Process claims in compliance with TRICARE and Medicare coordination rules

▪ Validate provider authorization status before payment, when

TRICARE is primary payer

▪ Ensure claims data is accurate, secure, and timely

Claims Processing Requirements

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• Toll-free telephone inquiry system with customer service representative between 6:00am – 11:00pm EST.

• Contractor shall implement an Interactive Voice Response (IVR) unit that supports claim inquiries, eligibility, and benefits information.

• The contractor is also responsible for proactive beneficiary and provider education.

Customer Service Requirements

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• Contractor systems shall:

▪ Provide read-only access to claims data to the Government.

▪ Maintain data accessibility that reflects updates within the last 24 hours.

▪ Implement a comprehensive Quality Management (QM) and Quality

Improvement (QI) program.

▪ The Contractor shall implement a personnel security program which meets the TRICARE Systems Manual (TSM) requirements.

Management & Oversight

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• Ensure seamless operation at the start of Option Period 1.

• Coordinate with Centers for Medicare & Medicaid Services (CMS) for claims crossover processes.

• Send introductory letters to affected beneficiaries no later than

10 days prior to service start.

• Collaborate with DHA and the successor contractor during transition.

High-Level Transition Activities

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• A revised TRICARE Operations Manual (TOM) 2021 edition, Chapter 20, will be included with the final solicitation.

• Recommendations related to Call Centers, Customer Service, and

Beneficiary Portals will be reviewed.

• Integrated Product Team (IPT) participation requirement.

A Few Updates

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We look forward to learning from you!