DHA TRICARE Medicare Eligible Program

This Request for Information solicits industry's feedback on capabilities currently available to meet the Military Health System (MHS) requirement detailed below and to gather information from potential offerors to be utilized by the Defense Health Agency (DHA) TRICARE Program as support in our continuous market research for upcoming contract requirements. The information will not be utilized for any purpose other than for market research in determining the proper acquisition strategy, type of contract and to achieve the overall objectives under the TRICARE program. CONTRACT PURPOSE: The Department of Defense, through the DHA, is required to offer healthcare coverage, to MHS beneficiaries (active duty family members, retired military service members, their spouses and children, and their surviving family members subject to the provisions in Chapter 55, Medical and Dental Care, Title 10, United States Code (USC) of the Uniformed Services, who have Medicare and TRICARE dual eligibility for medical and dental services rendered in the United States and the U.S. Territories. The purpose of the forthcoming solicitation and resulting contract is to provide claims processing and associated customer support services for claims submitted by and on behalf of MHS beneficiaries who are eligible for both Medicare and TRICARE benefits. The contractor shall provide the expertise of health care claims processing and its support services by incorporating and operating the best practices of the private sector in support of TRICARE. Of critical importance is the contractor's success in collaborating with and reaching agreements with the Centers for Medicare and Medicaid Services (CMS) Benefits Coordination and Recovery Center (BCRC) to transfer Medicare processed claims directly to the contractor for secondary processing. The following objectives are to be accomplished in an anticipated future contract: - Readiness: Timely and accurate delivery of claims processing and customer services - Better Care: Establish and maintain beneficiary satisfaction throughout the period of performance, through the delivery of a claims processing system and customer friendly program services. - Quality: Use cost effective management approaches to provide high quality necessary services, incorporating best business practices when practicable. Please review and provide your responses to the Government for possible consideration/alternatives for satisfying mission needs of the TRICARE Program. 1. Do the attached TRICARE standards in relation to claims processing, customer service and TRICARE Encounter Data (TED) record submission align with industry standards? If not, what standard(s) should be reevaluated or revised? 2. The Government is considering using a Contract Line Item Number (CLIN) structure with CLINs for claim rates and another for administration (anything but the claim rate). An example layout is attached. What impact do you see with a CLIN structure that would pay different contractor proposed claim rates for initial claims and adjustments? 3. The Center for Medicare and Medicaid Services (CMS) has different standards and processes for responding to beneficiaries and providers. What are the advantages and disadvantages of TRICARE separating the customer service standards into two categories one specific to beneficiaries and one specific to providers? 4. CMS sends Medicare Summary Notices (MSN) every 3 months for Medicare Part A and Part B services. Does this timeframe align with industry practices? What are the advantages and disadvantages of this timeframe? TRICARE currently allows for monthly summary notices to be sent to beneficiaries. What approaches, if any, could be used in this solicitation to ensure the timing of the Medicare and TRICARE notices are aligned? 5. TRICARE has a number of unique data processing requirements to include interfaces with the Defense Enrollment Eligibility Reporting System (DEERs) to determine eligibility, submitting payment records in support of claims processing activities (TED records), completion of required security clearances and/or background investigations for any personnel who will need access to DoD systems (Automated Data Processing/ Information Technology (ADP/IT) I or II designation) and Completion of National Institute of Standards and Technology (NIST) system security requirements (as identified in NIST Special Publications (SP) 800-53 and 800-53A.). What impact do these requirements have on costs and the level of interest in proposing on future contracts? 6. The Government is considering incentives for this solicitation. What areas would be advantage ous for the Government to consider and why? What approaches associated with incentivizing these areas can be realized? 7. What industry approaches are associated with increasing electronic claim submissions or decreasing paper claims, decreasing duplicate claim submissions and increasing Electronic Funds Transfer and Electronic Remittance Advice usage? 8. The current contract is a Firm Fixed Price Contract with a 1 year base period plus five 1 year options. Transition-In activities occur during the base period with claims processing and customer services beginning with Option 1. What would you recommend in terms of length and type of contract? Why? 9. What innovative technologies would be a viable environment you would want to consider as part of the requirements? What cost impact would be anticipated with moving toward such technologies? THIS NOTICE IS NOT A REQUEST FOR PROPOSALS. This notice constitutes solely a market research effort 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. 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. 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 the work. 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. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in Federal Business Opportunities. However, in no case shall responses to this notice be considered either a response to a solicitation or submission of an unsolicited proposal, as defined by FAR 2.101. 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). RESPONSES: 1. Responses to this RFI are due no later than December 15, 2017 at 1500 MST 2. Information gathered will not be posted to industry and is for market research purposes only 3. Provide information to Mr. Duane Foley at: duane.a.foley.civ@mail.mil Phone: 303-676-3678 GOVERNMENT AGENCY ADDRESS: Contracting Office Aurora 16401 E Centretech Pkwy Aurora, CO 80011