D -- Outpatient Prospective Payment System Pricer Software

Combined Synopsis Solicitation Outpatient Prospective Payment System - Pricer Software This is a combined synopsis/solicitation for commercial items prepared in accordance with Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation and is being issued as a Request for Quotation (RFQ) to a single source. The RFQ number is H94002-06-Q-0079 and has a response due date of August 11, 2006, not later than 12:00 pm MST. The FOB Destination shall be Aurora, CO, 80011 and the contract action will result in a Firm Fixed Price contract. The Contractor shall be registered in Central Contractor Registration (www.ccr.gov) before an award can be made. Send quotations to Mr. Daniel H. Poturalski, Office of the Assistant Secretary of Defense Health Affairs, TRICARE Management Activity, 16401 East Centretech Parkway, Aurora, Colorado 80011-9066, or by facsimile to +1 (555) 000-0000. Facsimile quotes should be followed by signed, hardcopy forwarded to the address stated above. The quotation submitted by the contractor against this requirement shall clearly state the following: Request For Quotation Number; the time specified for receipt of offers; Name, address, telephone number of the Offeror's point of contact; Terms of warranty; price; and discount terms and an acknowledgement of all quotation amendments (if applicable). TRICARE requires the following: I. Introduction: TRICARE Management Activity (TMA) is responsible for editing and processing hospital outpatient claims for TRICARE eligible beneficiaries. 3M Health Information Systems has developed an Outpatient Code Editor (OCE) for editing and processing hospital outpatient claims which will be utilized upon implementation of TRICARE's Outpatient Prospective Payment System (OPPS) tentatively scheduled for implementation on June 1, 2007. The supplemental functionality required by TMA is for licensing a mainframe version of a TRICARE specific OPPS Pricer that can be fully integrated with the 3M OCE, and licensing PC Versions that integrate both the OCE and Pricer software and are compatible with the TRICARE mainframe software. II. Purpose: The purpose of this Statement of Work is to outline TMA's requirements for licensing a commercial mainframe version of a TRICARE specific OPPS Pricer that can be fully integrated with the 3M OCE, and licensing PC versions that includes both the OCE and Pricer software for auditing and verification of accuracy of payment for hospital outpatient claims. This procurement will be for the licensing, maintenance and updating of both the mainframe and PC software versions as they become available. The maintenance, to include quarterly updates, will have a 12 month period of performance for the Base year and four successive one year Option Periods. III. Background: a. TMA is legislatively mandated to follow all Centers for Medicare and Medicaid Services (CMS) reimbursement methodologies whenever practicable. As a result, TMA has been working on the development, in conjunction with 3M, and implementation of a prospective payment system for processing hospital outpatient claims. OPPS is comprised of two components: 1. The first component is the Outpatient Code Editor (OCE) designed for editing and processing hospital outpatient claims. Since 3M maintains CMS OCE they agreed to develop and maintain a similar TRICARE OCE. They will retain proprietary rights to the software. 2. The second component is the Pricer that determines how to price claims based on the output from the OCE. Due to the complexity of TRICARE's OPPS, the TRICARE Management Activity has decided to license a commercial mainframe TRICARE Pricer to include quarterly updates that coincide with those of CMS. (a) TRICARE is congressionally mandated to follow CMS OPPS reimbursement methodology where practicable. It is critical the Contractor have access to advance copies of CMS OCE changes in order to meet quarterly updates. In accordance with 32 C.F.R. 199.1 (c)(2)(ii), CMS has agreed to allow 3M to provide TRICARE with advance copies of OCE changes due to the delegated authority given to the Assistant Secretary for Health, DHHS, to consult with the Secretary of Defense, or a designee and to approve and issue joint regulations implementing 10. U.S.C. chapter 55. (b) TMA has decided to license a mainframe version of the TRICARE Pricer software in order to ensure: i. Uniformity of Pricing among Regions ii. Programmatic control to ensure consistent and timely updates(requires quarterly updating of pricing files) iii. Consistency with CMS pricing methodologies iv. Integration between TRICARE specific OCE and Pricer software v. Portability of Pricer software for future contract transitions IV. Deliverable/s: The Contractor shall deliver the following: Line Item 0001 TRICARE Mainframe Pricer Software License.1 each Consists of: 7 cartridges for TMA's Managed Care Support Contractors(MCSCs), their subcontractors and the TRICARE Dual Eligibility Fiscal Intermediary Contractor (TDEFIC). An updated list of TRICARE contractors, including address and contact person shall be provided annually to the Contractor by TMA. This will include maintenance for one year initiating from date of acceptance. Maintenance shall include but will not be limited to: Technical support, debugging and upgrades. Line Item 0002 PC Version, Integrated OCE/Pricer Software License 5 each Licenses to be distributed as required to TMA designated recipients. This will include maintenance for one year initiating from date of acceptance. Maintenance shall include but will not be limited to: Technical support, debugging and upgrades. Line Item 0003 Installation/User Manuals for Mainframe and PC Software..12 each Consists of: Manuals supporting the seven mainframe software cartridge recipients, and the five PC version recipients. This includes quarterly updates (January 1, April 1, June 1, and October 1) providing changes to include but are not limited to software, coding, prices, etc. Mainframe software updates to be delivered by overnight mail to TMA, TRICARE MCSCs, their subcontractors and the TDEFIC. PC version software updates to be delivered by overnight mail to TMA to coincide with the mainframe pricer updates. Line Item 1001 - Option Period I: Maintenance, TRICARE Mainframe Pricer Software Line Item 1002 - Option Period I: Maintenance, PC Version - TRICARE OCE/Pricer Software Line Item 1003 - Option Period I: Installation/User's Manuals - Mainframe and PC Software Line Item 2001 - Option Period II: Maintenance, TRICARE Mainframe Pricer Software Line Item 2002 - Option Period II: Maintenance, PC Version - TRICARE OCE/Pricer Software Line Item 2003 - Option Period II: Installation/User's Manuals - Mainframe and PC Software Line Item 3001 - Option Period III: Maintenance, TRICARE Mainframe Pricer Software Line Item 3002 - Option Period III: Maintenance, PC Version - TRICARE OCE/Pricer Software Line Item 3003 - Option Period III: Installation/User's Manuals - Mainframe and PC Software Line Item 4001 - Option Period IV: Maintenance, TRICARE Mainframe Pricer Software Line Item 4002 - Option Period IV: Maintenance, PC Version - TRICARE OCE/Pricer Software Line Item 4003 - Option Period IV: Installation/User's Manuals - Mainframe and PC Software V. Schedule: Line Item 0001 Base Period: TRICARE Mainframe Pricer Software License.. 12/01/2006 Effective date of January 1, 2007. Maintenance as described in Line Item 0001, Deliverables, above. Maintenance period of performance 01/01/07 through 12/31/07 Line Item 0002 Base Period: PC Version - OCE/Pricer Software License.01/31/2007 Maintenance as described in Line Item 0002, Deliverables, above. Maintenance period of performance 01/31/07 through 12/31/07 Line Item 0003 Base Period: Installation/User's Manuals - Mainframe and PC Software as described in Line Item 0003, Deliverables, above. Mainframe Pricer Software12/01/2006 thru 12/31/2007 PC Software01/31/2007 thru 12/31/2007 Line Item 1001 Option Period I: TRICARE Mainframe Pricer Software Maintenance as described in Line Item 0001, Deliverables, above. Maintenance period of performance 01/01/08 through 12/31/08 Line Item 1002 Option Period I: PC Versions - TRICARE OCE/Pricer Software Maintenance as described in Line Item 0002, Deliverables, above. Maintenance period of performance 01/01/08 through 12/31/08 Line Item 1003 Option Period I: Installation/User's Manuals - Mainframe and PC Software as described in Line Item 0003, Deliverables, above. Mainframe Pricer Software..01/01/2008 thru 12/31/08 PC Software.01/01/2008 thru 12/31/08 Line Item 2001 Option Period II: TRICARE Mainframe Pricer Software Maintenance as described in Line Item 0001, Deliverables, above. Maintenance period of performance 01/01/09 through 12/31/09 Line Item 2002 Option Period II: - PC Versions - TRICARE OCE/Pricer Software Maintenance as described in Line Item 0002, Deliverables, above. Maintenance period of performance 01/01/09 through 12/31/09 Line Item 2003 Option Period II: Installation/User's Manuals - Mainframe and PC Software as described in Line Item 0003, Deliverables, above. Mainframe Pricer Software01/01/2009 through 12/31/2009 PC Software01/01/2009 through 12/31/2009 Line Item 3001 Option Period III: TRICARE Mainframe Pricer Software Maintenance as described in Line Item 0001, Deliverables, above. Maintenance period of performance 01/01/10 through 12/31/10 Line Item 3002 Option Period III: - PC Versions of the TRICARE OCE/Pricer Software Maintenance as described in Line Item 0002, Deliverables, above. Maintenance period of performance 01/01/10 through 12/31/10 Line Item 3003 Option Period III: Installation/User's Manuals - Mainframe and PC Software as described in Line Item 0003, Deliverables, above. Mainframe Pricer Software01/01/2010 thru 12/31/2010 PC Software01/01/2010 thru 12/31/2010 Line Item 4001 Option Period IV: TRICARE Mainframe Pricer Software Maintenance as described in Line Item 0001, Deliverables, above. Maintenance period of performance 01/01/11 through 12/31/11 Line Item 4002 Option Period IV: PC Versions - TRICARE OCE/Pricer Software Maintenance as described in Line Item 0002, Deliverables, above. Maintenance period of performance 01/01/11 through 12/31/11 Line Item 4003 Option Period IV: Installation/User's Manuals - Mainframe and PC Software as described in Line Item 0003, Deliverables, above. Mainframe Pricer Software...01/01/2011 thru 12/31/11 PC Software..01/01/2011 thru 12/31/11 VI. Performance Criteria: a. Line Item 0001 1. The Contractor shall ensure Pricer compatibility with 3M's Mainframe Outpatient Code Editor (OCE); that is, Pricer must be able to accurately price hospital outpatient claims based on output from 3M's OCE. 2. The Contractor shall be able to obtain advance copies of all CMS Pricing File changes in order to meet scheduled annual and quarterly updates. The Contractor shall request data from TMA in a timely fashion to meet scheduled quarterly updates. For example, request CHAMPUS Maximum Allowable Charge (CMAC) fee schedules and statewide prevailings for those procedures reimbursed outside the OPPS. 3. The Contractor shall ensure the Pricer software meets the pricing methodology as outlined in the TRICARE Reimbursement Manual, Chapter 13. b. Line Item 0002 1. The Contractor shall ensure PC OCE/Pricer accurately prices hospital outpatient claims in accordance with pricing methodology as outlined in the TRICARE Reimbursement Manual, Chapter 13. 2. The Contractor shall be able to obtain advance copies of all CMS Pricing File changes in order to meet scheduled quarterly updates (January 1, April 1, July 1, October 1). The Contractor shall request data in a timely fashion to meet scheduled quarterly updates. For example, request CHAMPUS Maximum Allowable Charge (CMAC) fee schedules and statewide prevailings for those procedures reimbursed outside the OPPS. c. Line Item 0003 The Installation and User's Manuals should provide concise and accurate information for ease of installation and operation of Pricer software. VII. Government Furnished Material Data sources as specified in the TRICARE Reimbursement Manual, Chapter 13, Section 3. III.L.1 and 2. Updates to referenced manual are available on TMA's website at www.http://manuals.tricare.osd.mil/. VIII. Inspection and Acceptance: a. The inspection and acceptance of the software provided hereunder shall be accomplished by TMA's Office of Medical Benefits and Reimbursement Systems. TRICARE is the name of the Department of Defense's managed health care program for active duty military, active duty service families, retirees and their families, and other beneficiaries. For more information about TRICARE, please feel free to visit: http://www.tricare.osd.mil. The offeror must comply with the following commercial item terms and conditions: FAR 52.212-1, Instructions to Offerors Commercial Items; FAR 52.212-3 Offeror Representations and Certifications Commercial Items (MUST be completed and submitted by the offeror with the response to the RFQ); FAR 52.212-4 Contract Terms and Conditions Commercial Items; FAR 52.212-5, Contract Terms and Conditions Required to Implement Statutes or Executive Orders Commercial Items - Deviation: FAR 52.217-5, Evaluation of Options; FAR52.217-8, Option to Extend Services; FAR 52.217-9, Option to Extend the Term of the Contract; and FAR 52.232-19, Availability of Funds For the Next Fiscal Year. Pursuant to FAR Clause 52.212-5 the following clauses are incorporated by reference: FAR 52.203-6, Restrictions on Subcontractor Sales to the Government; FAR 52.213-2, Invoices; FAR 52.213-3, Notice to the Supplier; FAR 52.232-33, Payment by Electronic Funds Transfer - Central Contractor Registration; FAR 52.247-34, F.O.B. Destination.