SOURCES SOUGHT
Q -- TRICARE Claims Review Services - TRICARE Claims Review Services
- Notice Date
- 12/22/2014
- Notice Type
- Sources Sought
- NAICS
- 541611
— Administrative Management and General Management Consulting Services
- Contracting Office
- Other Defense Agencies, Defense Health Agency, Contract Operations Division - Aurora, 16401 E. CenterTech Pkwy., Aurora, Colorado, 80011, United States
- ZIP Code
- 80011
- Solicitation Number
- DHA-RFI-15-TCRS
- Point of Contact
- Tim Evans, , Michael Sharpe,
- E-Mail Address
-
tim.evans.ctr@tma.osd.mil, Michael.Sharpe.ctr@dha.mil
(tim.evans.ctr@tma.osd.mil, Michael.Sharpe.ctr@dha.mil)
- Small Business Set-Aside
- Total Small Business
- Description
- Sources Sought Response Template Synopsis: This sources sought is follow-on market research to DHA-RFI-14-TCRS. The purpose of this sources sought is to identify small businesses which have the capacity, experience, and capability, and interest to perform as the prime contractor for the TRICARE Claims Review Services (TCRS). THIS IS A SOURCES SOUGHT ONLY. This Sources Sought is issued solely for market research only. It does not constitute a Request for Proposals. Interested small businesses shall not send proposals in response to this Notice nor shall they contact any other individuals about this Notice or the requirement. BACKGROUND: The DHA's mission is to achieve greater integration of the direct and purchased health care delivery systems to accomplish the Military Health System's (MHS) Quadruple Aim: Readiness, Population Health, Experience of Care and Per Capita Cost. DHA is tasked with making military medicine stronger, better and more relevant for the future. The MHS has a $50 billion budget and serves about 10.26 million beneficiaries.The MHS consists of two major care delivery systems: Direct care is provided in military treatment facilities (MTFs). Purchased care is provided by contractors including the Designated Providers (DP) under the Uniformed Services Family Health Plan (USFHP), the managed care support contractors (MCSCs), the TRICARE Overseas Program (TOP) contractor, the TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC), and pharmacy contractor. The Improper Payment Evaluation and Transition Branch (IPE&TB), under the DHA Budget & Resource Management Division of the Business Support Directorate, oversees DHA's implementation, enforcement, and compliance with key provisions of the Improper payment Information Act of 2002 (IPIA) and the Improper Payment Elimination and Recovery Act of 2010 (IPERA). The IPIA/IPERA requires agencies to examine the risk of improper payments in all programs and activities by identifying and reporting improper payment findings to the Office of Management and Budget (OMB) for publication in the annual DoD Agency Financial Report (AFR). In support of the IPE&TB, the TCRS contractor will audit compliance and assess the accuracy of the claims processing for the following TRICARE purchased care contracts: the Managed Care Support Contractors (MCSCs), TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC), TRICARE Pharmacy (TPHARM) Program, TRICARE Overseas Program (TOP) and the Active Duty Dental Program (ADDP).The TCRS contractor will conduct quarterly and semiannual compliance reviews of TRICARE purchased care contractor medical, dental and pharmaceutical healthcare claims to determine contractor compliance with TRICARE policy and contract requirements, and to validate the accuracy of healthcare claims payments. DHA will use the results from the quarterly and semiannual compliance reviews to appraise the purchased care contractors' performance against TRICARE claims processing performance standards as delineated in the TRICARE Operations Manual (TOM) Chapter 1, Section 3, Paragraph 1.7 or as stipulated in the purchased care contractors' contracts. In addition, the TCRS contractor will conduct annual compliance reviews of MCSCs' reimbursement determinations for underwritten healthcare. Results from the annual compliance reviews will be used to determine the total unallowed cost for underwritten healthcare. Due to the complexity of the TRICARE benefit and the all-encompassing reviews required to comply with federal statutes, all TCRS claims reviews are done manually. The TCRS requirement will include targeted reviews/focused studies, which DHA will use to validate the purchased care contractors' compliance with newly implemented TRICARE reimbursement or benefit programs. DHA will also use the TCRS targeted reviews/focused studies to support/validate potential improper payment trends identified as a result of ongoing compliance reviews or in response to analytical findings provided by other DHA entities (i.e. DHA Analytics, Program Integrity). SMALL BUSINESS DETERMINATION: The government is considering whether to set aside the proposed contract under a small business set-aside program in accordance with Federal Acquisition Regulation (FAR) 19, Small Business Programs. The North American Industry Classification System (NAICS) code for this requirement is 541611, Administrative Management and General Management Consulting Services. The small business size standard for NAICS 541611 is $15.0 million. The government is interested in all small businesses including Section 8(a), Historically Underutilized Business (HUB) Zone, Woman owned Small Business (WOSB) or Service Disabled Veteran Owned Small Businesses (SDVOSBs) who are capable and interested in performing this requirement as the prime contractor. The government requests interested parties submit a description of their company's capabilities, including business size (i.e. annual revenues and employee size), business status (i.e., Section 8(a), HUBZone, WOSB or SDVOSB), any anticipated teaming arrangements, and a description of similar services offered to the Government and to commercial customers. Any responses involving teaming agreements should delineate between the work the prime will perform and the work to be accomplished by the teaming partners. The Government will use this information in determining its small business set-aside decision. Small businesses are advised that FAR 52.219-14, Limitations on Subcontracting, will apply where at least 50 percent of the cost of contract performance incurred for personnel shall be expended for employees of the concern. In order for DHA to make a small business set-aside determination, it is emphasized that small businesses provide sufficient information to indicate their capacity and capability to successfully perform and manage all the requirements of these services. DHA requests interested small businesses submit a statement of capability outlining past work that is related to this requirement as stated above. Interested small businesses are requested to demonstrate they have the capacity, capability (IT systems, infrastructure, staff, and facilities) and experience to perform the services listed above in the format below. Small Business Sources Sought Response Format: DHA will only review capability statements from small businesses. DHA requests responses in MicroSoft Word (Times New Roman, 12-point font) and limited to 15 pages. Responses shall be submitted via email to all POCs with the "DHA-RFI-15-TCRS Small Business Response" in the subject line. Please submit responses in the following format: Section I. Title: TRICARE Claims Review Services Number: DHA-RFI-15-TCRS Company Name a. Address b. Point of Contact (POC) c. POC phone number(s) and e-mail addresses d. DUNS and Cage codes e. Small Business status (i.e. small business, disadvantaged, Hub Zone, woman-owned, etc.) f. Brief description of the company's business size g. Anticipated teaming arrangements (delineate between work accomplished by prime and work accomplished by teaming partners) Company name, mailing address; main phone number; web address; NAICS code(s); small business designation; and the name, title, phone number, fax, and email address of the designated point of contact (POC). Section II. 1. Description of recent (within the last 3 years), relevant contract experience (Government and Commercial) performing all of the TCRS requirements above. Please include the following for each contract: a. Name of company or organization which awarded the contract; b. POC name and contact information; c. Length of the contract; d. Contract dollar value and number of labor hours required/year; e. Description of the requirement, including NAICS code, contract type, tasks performed f. Magnitude (number/type of reviews, number of claims manually audited per year,) g. Place of performance 2. Provide a description of your small business's background, technical expertise, experience, staffing, financial resources and other capabilities that demonstrate the capacity, capability and experience to perform as the prime contractor for the TCRS requirements listed above. Please reference each paragraph that you discuss. Also, please include in the discussion of the size (number of facilities, reviews, and total dollar value) and complexity of the contracts/projects. 3. How long your company has been involved in this type of work? 4. Does your company have the capability and/or the desire to function as the prime on a contract of this size and complexity? 5. Would you intend to partner with another firm? If so, will your firm be capable of providing a minimum of 51% of the work? 6. Do you have a current GSA Schedule that could be used for a requirement such as this? If so, please provide the Contract Schedule #. THIS IS A SOURCES SOUGHT ONLY. This Sources Sought is issued solely for market research only. It does not constitute a Request for Proposal. Interested small businesses shall not send proposals in response to this Notice nor shall they contact any other individuals about this Notice or the requirement. Any information provided to DHA is strictly voluntary and given with no expectation of compensation, and is clearly provided at no cost to the Government. A solicitation will not be issued at this time, and this Notice shall not be construed as a commitment by the Government to issue a solicitation nor does it restrict the Government to a particular acquisition approach. The Government may issue a formal solicitation on the Federal Business Opportunities (fbo.gov) website at a future date. If the Government issues a solicitation, the Government will conduct any source selection in accordance with the Federal Acquisition Regulation (FAR), as supplemented. Any future information on this acquisition (statement of work, specifications, solicitation, etc.) will be posted on www.fbo.gov. It is the responsibility of the prospective offeror to review this site regularly for updates and/or changes. DHA will not respond to questions about this sources sought, its acquisition approach, or policy issues regarding it.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/notices/5373443fc0ac9a70b5c32445f77b0559)
- Place of Performance
- Address: Defense Health Agency, Contract Operations Division - Aurora, 16401 Centretech Parkway, Aurora, Colorado, 80011, United States
- Zip Code: 80011
- Zip Code: 80011
- Record
- SN03602336-W 20141224/141222234258-5373443fc0ac9a70b5c32445f77b0559 (fbodaily.com)
- Source
-
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