TRICARE Claims Review Services (TCRS)
Awarded Limited / Sole Source Justification Posted
This opportunity was awarded. See its 3 award notices in the notice history.
- Solicitation number
- JA-23-0302B
- Agency
- Defense Health Agency Department of Defense
- Set-aside
- No set-aside
Opportunity facts
- Contract number
- HT9402-17-D-0001 Federal IDV award
- NAICS code
- 541611 Administrative Management and General Management Consulting Services
- Place of performance
- United States
Notice details come from SAM.gov. Updated .
About this opportunity
The Defense Health Agency published a Limited/Sole Source Justification Notice for TRICARE Claims Review Services. The agency awarded a firm fixed price bridge contract extension to Concept Plus to continue providing independent review of healthcare claims reimbursement methodologies and coding procedures used by TRICARE purchased care contractors from March 1, 2024 through February 28, 2025. This extension was necessary to prevent a gap in support for critical compliance review services that evaluate claims processing procedures, reimbursement determinations, and compliance with TRICARE policies until a follow-on contract can be awarded. The bridge contract extension under contract number HT9402-17-D-0001 allows the incumbent vendor to continue providing these mission critical TRICARE Claims Review Services to the agency for the one year period of performance.
Notice text
The Defense Health Agency (DHA) awarded a Firm Fixed Price (FFP) contract bridge extension for TRICARE Claims Review Services to Concept Plus on February 28, 2024 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, 2024 - February 28, 2025. A bridge extension was necessary to prevent agap 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 2024-02-28.
Attachments
| File | Type | Posted |
|---|---|---|
| HT940217D0001 TCRS Bridge JA Final Redacted.pdf |
Notice history
| Notice | Type | Posted |
|---|---|---|
| TRICARE Claims Review Services (TCRS) | Award Notice | |
| TRICARE Claims Review Services (TCRS) | Limited / Sole Source Justification | |
| TRICARE Claims Review Services (TCRS) | Award Notice | |
| TRICARE Claims Review Services (TCRS) | Limited / Sole Source Justification | |
| TRICARE Claims Review Services (TCRS) | Award Notice |
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