TRICARE Claims Review Services (TCRS)

The Defense Health Agency (DHA) awarded a Firm Fixed Price (FFP) contract bridge extension for TRICARE Claims Review Services to Concept Plus on February 27, 2023 under contract HT9402-17-D-0001. The extension was issued sole-source in accordance with Federal Acquisition Regulation (FAR) 6.302-1, only one responsible source and no other supplies or services will satisfy agency requirements. The period of performance will be from March 01, 2023 - December 31, 2023 with the option to extend for an additional 2 months. The total potential period of performance is March 01, 2023 – February 29, 2024. A bridge extension was necessary to prevent a gap in support to mission critical DHA requirements until a follow-on contract is awarded and the awardee completes transition-in.

The DHA acquires compliance review services to assess the potential and actual risk of improper payments made by TRICARE purchased care contractors. The purpose of TCRS is for the contractor to provide independent, impartial review of healthcare claims reimbursement methodologies and TRICARE Encounter Data (TED) payment record coding and active duty dental record coding procedures utilized by the two Managed Care Support Contractors (MCSC), TRICARE Medicare Eligible Program (TMEP), TRICARE Pharmacy Program (TPharm), TRICARE Active Duty Dental Program (ADDP) contractors. TCRS compliance reviews have three primary components: (1) to evaluate purchased care contractor's claims processing procedures, reimbursement determinations, and compliance with TRICARE policies and directives when processing healthcare claims; (2) to measure and report to DHA Leadership and TRICARE Program Office Managers, purchased care contractor’s claims processing performance as stipulated in TRICARE Operations Manual (TOM), Chapter 1, Section 3, paragraph 1.6, Claims Processing Accuracy and Sections contracts; and (3) to comply with the Payment Integrity and Information Act of 2019 (PIIA, P.L. 116-117), by identifying and reporting improper payment in the Department of Defense (DoD) Financial Report (AFR).

Awarded contract HT9402-17-D-0001 to unknown vendor for unknown amount on 2023-02-27.