Tricare claims review service (tcrs)
Closed Solicitation Posted
- Solicitation number
- HT940224R0002
- Agency
-
Defense Health Agency
Department of Defense
- Responses due
- Set-aside
- No set-aside
Opportunity facts
- NAICS code
- 541611 Administrative Management and General Management Consulting Services
- PSC
- R702 Support- Management: Data Collection
- Place of performance
- United States
Notice details come from SAM.gov. Updated .
About this opportunity
The Defense Health Agency (DHA) is seeking a contractor to provide the TRICARE Claims Review Service (TCRS) to audit compliance and assess the accuracy of claims processing for various TRICARE purchased care contracts. This includes the Managed Care Support Contracts, TRICARE Medicare Eligible Program, TRICARE Pharmacy Program, TRICARE Overseas Program, and the Active Duty Dental Program. The objective is to support DHA's implementation and compliance with the Payment Integrity Information Act of 2019 by identifying and reporting improper payments. The contract will have a 6-month base transition-in period and seven 12-month option periods, for a total potential duration of up to 8 years. Offers are due by August 5, 2024.
This is an unrestricted solicitation, but there are small business, HUBZone, and service-disabled veteran-owned small business set-aside provisions. The government has not provided information on potential incumbents or award values. The estimated total claim volume across all option periods is approximately 65,000 claims, with quarterly and semi-annual compliance reviews to be conducted. The place of performance is the United States.
Notice text
3 versions
Update #3 · Latest ·
August 9, 2024: The purpose of this notice is to release the Government's responses to Industry's Questions and to officially close the questions and answer period. This notice also releases Amendment 0001, please replace Attachment 6 and Exhbit 8 with the amended versions. The proposal due date is hereby extended to August 26, 2024.
July 26, 2024: The purpose of this notice is to extend the TCRS proposal due date to Monday, August 19, 2024, while the Government contiues to repond to Industry's RFP Questions and make revisions to the RFP. An amendment is forthcoming that will include DHA's reponses to Industry's questions as well. The proposal due date may be reevaluated during that time but it will not be earlier than Monday, August 19, 2024.
DHA’s mission is to achieve greater integration of the direct and purchased health care delivery systems with contract performance objectives developed that support the accomplishment of the overarching Military Health System's Quadruple Aim: Achieve medical readiness, improve the health of our people, enhance the experience of care, and lower healthcare costs.
The Improper Payment Evaluation Branch (IPEB), which is under the DHA Budget & Resource Management Division, Contract Resource Management, oversees DHA 's implementation, enforcement, and compliance with key provisions of the Payment Integrity Information Act of 2019 (PIIA). The PIIA requires agencies to examine the risk of improper payments in all programs and activities by identifying and reporting improper payment findings to the Office of Management and Budget (OMB) for publication in the annual DoD Agency Financial Report (AFR).
In support of the DHA IPEB, the TCRS contractor will audit compliance and assess the accuracy of the claims processing for the following TRICARE purchased care contracts: the Managed Care Support Contracts (MCSCs), TRICARE Medicare Eligible Program (TMEP), TRICARE Pharmacy (TPHARM) Program, TRICARE Overseas Program (TOP) and the Active Duty Dental Program (ADDP).
Update #2 ·
July 26, 2024: The purpose of this notice is to extend the TCRS proposal due date to Monday, August 19, 2024, while the Government contiues to repond to Industry's RFP Questions and make revisions to the RFP. An amendment is forthcoming that will include DHA's reponses to Industry's questions as well. The proposal due date may be reevaluated during that time but it will not be earlier than Monday, August 19, 2024.
DHA’s mission is to achieve greater integration of the direct and purchased health care delivery systems with contract performance objectives developed that support the accomplishment of the overarching Military Health System's Quadruple Aim: Achieve medical readiness, improve the health of our people, enhance the experience of care, and lower healthcare costs.
The Improper Payment Evaluation Branch (IPEB), which is under the DHA Budget & Resource Management Division, Contract Resource Management, oversees DHA 's implementation, enforcement, and compliance with key provisions of the Payment Integrity Information Act of 2019 (PIIA). The PIIA requires agencies to examine the risk of improper payments in all programs and activities by identifying and reporting improper payment findings to the Office of Management and Budget (OMB) for publication in the annual DoD Agency Financial Report (AFR).
In support of the DHA IPEB, the TCRS contractor will audit compliance and assess the accuracy of the claims processing for the following TRICARE purchased care contracts: the Managed Care Support Contracts (MCSCs), TRICARE Medicare Eligible Program (TMEP), TRICARE Pharmacy (TPHARM) Program, TRICARE Overseas Program (TOP) and the Active Duty Dental Program (ADDP).
Update #1 ·
DHA’s mission is to achieve greater integration of the direct and purchased health care delivery systems with contract performance objectives developed that support the accomplishment of the overarching Military Health System's Quadruple Aim: Achieve medical readiness, improve the health of our people, enhance the experience of care, and lower healthcare costs.
The Improper Payment Evaluation Branch (IPEB), which is under the DHA Budget & Resource Management Division, Contract Resource Management, oversees DHA 's implementation, enforcement, and compliance with key provisions of the Payment Integrity Information Act of 2019 (PIIA). The PIIA requires agencies to examine the risk of improper payments in all programs and activities by identifying and reporting improper payment findings to the Office of Management and Budget (OMB) for publication in the annual DoD Agency Financial Report (AFR).
In support of the DHA IPEB, the TCRS contractor will audit compliance and assess the accuracy of the claims processing for the following TRICARE purchased care contracts: the Managed Care Support Contracts (MCSCs), TRICARE Medicare Eligible Program (TMEP), TRICARE Pharmacy (TPHARM) Program, TRICARE Overseas Program (TOP) and the Active Duty Dental Program (ADDP).
Files
| File | Type | Posted |
|---|---|---|
| Attachment 6 - TCRS Compliance Review Schedule 20240809.pdf | ||
| Exhibit 8 - Draft Quality Assurance Surveillance Plan (QASP) 20240809.docx | DOCX document | |
| Industry Questions and Government Responses 20240809.pdf | ||
| HT940224R0002 0001.pdf | ||
| CDRLs.zip | ZIP file | |
| RFP Attachments.zip | ZIP file | |
| RFP Exhibits.zip | ZIP file | |
| HT940224R0002.pdf |
Notice history
| Notice | Type | Posted |
|---|---|---|
| This notice | Solicitation | |
| Tricare claims review service (tcrs) -- cancelled | Solicitation | |
| Tricare claims review service (tcrs) synopsis | Special Notice | |
| Tricare claims review service (tcrs) draft RFP | Pre-Solicitation | |
| Tricare claims review service (tcrs) | Pre-Solicitation |
Similar open opportunities
| Opportunity | Agency | Set-aside | Responses due |
|---|---|---|---|
| TRICARE Medicare Eligible Program Second Generation (TMEP2) | Defense Health Agency | No set-aside |
On GovTribe
Work this opportunity
- Track it in your pipeline
- Find teaming partners
- Similar opportunities
- Ask GovTribe AI about this opportunity