Department of Defense (CMP), Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043

Q -- MARKET SURVEY. THE DOD IS IN THE PROCESS OF PLANNING FOR THE TRICARE DENTAL PROGRAM FOR FAMILY MEMBERS OF ACTIVE DUTY MEMBERS OF THE SEVEN UNIFORMED SERVICES (ARMY, NAVY, AIR FORCE, MARINE CORPS, COAST GUARD, PUBLIC HEALTH SERVICE AND NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION). SOL N/A!! DUE 042399 POC Cindy Dahlstrom, Contract Specialist, 303-676-3516/Laura L. Sells, Contracting Officer, 303-676-3420!! WEB: Survey is located in Contracting on/about March 31,, http://www.tricare.osd.mil. E-MAIL: CLICK HERE TO CONTACT THE CONTRACTING OFFICER BY E-MAIL, Cynthia.Dahlstrom@tma.osd.mil. The DoD is in the process of planning for the TRICARE Dental Program for family members of active duty members of the seven Uniformed Services (Army, Navy, Air Force, Marine Corps, Coast Guard, Public Health Service and National Oceanic and Atmospheric Administration). This is not a Request for Proposal (RFP). This is a Market Survey in accordance with Federal Acquisition Part 10. DoD does not intend to award a contract on the basis of the survey submitted in response to the market analysis nor pay for costs associated with responses received. Interested parties may submit a response by mail to Ms. Laura L. Sells, TRICARE Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043, or via facsimile to 303-676-3987, or an email response addressed to Cynthia.Dahlstrom@tma.osd.mil no later than 30 days from the date of release of this market survey. Feel free to answer any or all of the questions presented in this survey and provide a rationale for your comments. To aid in the Government's review of responses submitted, please indicate the specific issue you are addressing by utilizing the respective number in the "Specific Market Survey" portion of this document for each of your responses. Information received in response to this market survey will be considered confidential and will not be disclosed to anyone other than the personnel working on this project. POC: Cindy Dahlstrom, Contract Specialist, 303-676-3516/Laura L. Sells, Contracting Officer, 303-676-3420. CONTENT. The intent is for TRICARE to comply with the DoD Federal Acquisition Regulation (FAR) Part 12, Acquisition of Commercial Items, for a commercial line of business or to comply with FAR Part 15, Contracting by Negotiation, for source selection. Please respond to the following questions about your commercial line of business: (1) Do you (a) credential dentists and dental hygienists using a single, centralized and comprehensive certification process prior to inclusion of these providers in your network? (b) Recredential these providers in your network? (2) Do you have networks of dentists throughout the 50 United States, the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands? (3) Do you have the experience to accurately service claims and correspondence and provide a comprehensive customer service unit for an actual enrollment base of almost 2 million beneficiaries? (4) Do you process dental claims for services rendered in countries throughout the world? This includes translation of claims and correspondence and payment of claims in foreign currency. (5) Do you have separate payment policies for network versus non-network providers where network providers are paid a premium over non-network providers? (6) Do you administer a benefit program with over 200 dental procedures available to a single client? (7) Do you process multiple enrollment and disenrollment options depending on a client's location, their employment status and time remaining with their company and the residence of their family members? (8) Do you receive and send enrollment/premium rate information and premium payments directly to and from third parties and dually perform direct eligibility verification and billing of enrollees? (9) Do you have a comprehensive fraud, waste and utilization review program for provider and beneficiary-submitted claims? (10) Do you have a nationwide network of regional representatives who interface and address problems and concerns with providers and beneficiaries on a daily basis? (11) Do you have a comprehensive coordination of benefits, third party liability and workers compensation program? (12) Do you have a comprehensive auditable end of line quality assurance program for claims that ensures accurate input and correct payments are made to authorized providers and eligible enrollees? (13) Do you have a quality control program to include supervisory review of all appeals, correspondence, and telephone responses? (14) Do you have a comprehensive beneifit brochure written in common layman terminology which includes information on benefits, limitations, exclusions, and other rules for administering the benefits, to include the complete rules for adjudication and payment of claims, appealable issues and the appeals process? (15) Do you have a quarterly news bulletin to dentists and clients that cover such issues as program changes, processing procedures, and announcements? (16) Do you produce recurring management reports for customers listing utilization and cost data by locality as well as performance data for areas such as claims, correspondence, telephone services, provider network, appeals, grievances, adjustments and predeterminations? (17) Do you have a comprehensive provider grievance program that allows timely investigation and resolution of all grievances? (18) Do you have a comprehensive provider education and relations program which includes written information on terms and limits of practices, programs to assist with electronic claims processing, and assistance on filing appeals? (19) Do you have a comprehensive multi-tiered appeals program that offers appealing parties the opportunity to appeal adverse factual determinations? (a) Does this process ensure that higher levels in the appeals process are administered by staff not involved in the claim's initial determination? (20) Do you have a routine program where care can be "predetermined" in advance of actual treatment or the provider and enrollee can receive an estimate of what the insurer will pay? (21) Do you enroll prospective clients over the phone, by written application and through automated means, such as Web-based and electronic mail applications? (22) Do you transfer enrollment information and subscriber history between insured accounts? (23) Do you offer and manage a program in which clients pay premiums based on a premium schedule versus a single premium? (12) Do you Posted 03/29/99 (W-SN313710). (0088)

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