TRICARE Claims Review Services (TCRS)

INTRODUCTION: The Defense Health Agency (DHA), DHA Contracting Activity (DHACA), Managed Care Contracting Division (MC-CD), is issuing this Request for Information pursuant to Defense Federal Acquisition Regulation Supplement (DFARS) Procedures, Guidance, and Information (PGI) 206.302-1, only one responsible source and no other supplies or services will satisfy agency requirements. The DHA intends to issue a sole-source bridge action to continue the provision of services provided under the existing TCRS contract, HT9402-17-D-0001, to Concept Plus. This contract modification to extend performance is necessary to continue to meet mission critical requirements and to support the transition to a competitively awarded follow-on TCRS contract. The period of performance will be 12 months from March 01, 2026 – February 28, 2027. The extension is necessary to prevent a gap in support to critical DHA requirements after the end of the current TCRS contract on February 28, 2026, until a competitive follow-on contract is awarded, and the awardee completes transition-in.

Background: The Defense Health Agency (DHA) supports health services for more than 9.4 million beneficiaries of the Military Health System (MHS). The purpose of the TCRS contract is to assist the DHA Improper Payment Evaluation Branch (IPEB) in identifying and reporting improper payments and discrepancies in payment recording for the MHS. TCRS support provides an independent impartial review of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors and assesses purchased-care contractor compliance with TRICARE policies and directives by evaluating the accuracy of claims payment and payment record coding for the MCSC, TMEP, TPharm, TOP, and ADDP contracts. TCRS helps support IBEP’s requirement to assess the potential risk of improper payments and to identify and report improper payments to the Office of Management and Budget (OMB) for publication in the Department of Defense (DoD) Agency Financial Report (AFR) pursuant to Public Laws 107-300, and the Payment Integrity Act of 2019 (PIIA), Public Laws 116-117. A new contractor would require a minimum of 6 months to complete the transition-in requirements given the startup requirements associated with staff recruiting and training, meeting the Personnel Security, and System Security and connectivity requirements. The current TCRS contractor, Concept Plus, is the only known contractor that can provide these services within the needed time frame.

AUTHORITY: DHACA Managed Care Contracting Division (MC-CD) is issuing this Request for Information for the purpose of market research prior to releasing a sole-source bridge action as required by DFARS PGI 206.302-1.

DISCLAIMER AND IMPORTANT NOTES: THIS NOTICE IS NOT A REQUEST FOR ROPOSALS. Any proposals submitted will not receive a response. This notice solely constitutes a market research effort, for informational purposes only, as described under FAR 10.002. This notice does not obligate the Government to award a potential contract or otherwise pay for the information provided in response. Responses to this RFI are not offers and cannot be accepted by the Government to form a binding contract. The Government reserves the right to use results of the communications with industry for any purpose consistent with, and not otherwise prohibited by FAR Part 10.

NEXT STEPS: Interested parties wishing to submit a relevant capabilities statement with information demonstrating experience with reviewing/auditing healthcare claims must make their submittals to the Government via email to the Primary Point of Contact (below) not later than 2pm Mountain Standard Time (MST) on February 13, 2026. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s qualifications to perform healthcare claims reviews.

PRIMARY POINT OF CONTACT: Please respond or submit inquiries (via email) to the Defense Health Agency, Managed Care - Contracting Division, TRICARE Support Branch, support contractor Mr. Justin O’Hara at justin.a.ohara2.ctr@health.mil. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted.

CONFIDENTIALITY: No proprietary, classified, confidential, or sensitive information should be included in your response. Industry responses will be shared with DHA staff for the purpose of market research. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

ADMINISTRATIVE: PSC Code: R408 Program Management/Support Services NAICS Code: 541611 - Administrative Management and General Management Consulting Services