TRICARE Claims Review Services (TCRS)

The Department of Defense (DoD), Defense Health Agency (DHA), has a requirement for TRICARE Claims Review Services.

Solicitation Summary

The Department of Defense (DoD), Defense Health Agency (DHA), has a requirement for TRICARE Claims Review Services.

Solicitation in a Nutshell

Item

Details
Agency The Department of Defense (DoD), Defense Health Agency (DHA)
Solicitation Number HT940224TCRS2
Status Pre-RFP
Solicitation Date 05/2024 (Estimate)
Award Date 08/2024 (Estimate)
Contract Ceiling Value $62,500,000.00
Solicitation Number HT940224TCRS2
Competition Type Undetermined
Type of Award Undetermined
Primary Requirement Professional Services
Duration 6 month(s) base plus 8 x 12 month(s) option(s)
Contract Type TBD
No. of Expected Awards N/A
NAICS Code(s):
518210
Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services
Size Standard: $40 million annual receipts
Place of Performance:
  • Aurora, Colorado, United States
Opportunity Website: https://sam.gov/opp/1ff9167de1284b43937b9586f66ece6b/view

Background

Requirements

  • The contractor shall provide services to meet the following:
    • The objectives of this contract are to support the missions of the MHS which enable the  National Defense Strategy by providing a Medically Ready Force, a Ready Medical Force, and improving the health of all those entrusted to its care. The objectives below represent the performance outcomes for this contract and are supported by technical requirements. The acceptable performance standards are explained further in the contract.
    • Objective 1, Compliance Reviews. Provide independent, impartial reviews (manual re-adjudication) of claims to include timely and accurate evaluations of each purchased care contractor’s healthcare claims processing and payment record coding procedures.
    • Objective 2, Focused Studies. Assist the IPEB in studying areas of the TRICARE health benefits program with the potential for incurring a higher than average risk of improper payments, including claims selected for an annual Payment Integrity Information Act of 2019 (PIIA) compliance review.
    • Objective 3, Medical Record Reviews. Validate healthcare services documented in a patient’s medical record is correctly invoiced to the Government for payment.
    • Objective 4, Continuity of Review Services. Maintain effective management solutions to provide the necessary claims review services, incorporating DHA and healthcare standards and best practices.
    • The purpose of this contract is to assist the Office of the Assistant Secretary of Defense for Health Affairs (OASD-HA), the Office of Management and Budget (OMB), and the DHA Improper Payment Evaluation Branch (IPEB), in identifying and reporting improper payments and discrepancies in payment record coding. This contract provides an independent, impartial review of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors, assesses purchased-care contractor compliance with TRICARE policies and directives, and monitors the claims processing performance of DHA TRICARE purchased-care support contractors. The contractor shall evaluate the accuracy of claims payment and payment record coding for the six purchased-care contractors.
    • This contract also supports IPEB’s requirement to assess the potential risk of improper payments, identify, and report improper payments to the Office of Management and Budget (OMB) for publication in the Department of Defense (DoD), Agency Financial Report (AFR) pursuant to Public Law (PL) 116-117 – Payment Integrity Information Act (PIIA) of 2019

How can GDIC Help?

As a consulting firm that specializes in helping companies prepare winning proposals for government contracts, GDIC can provide a wide range of services to help offerors prepare their C2E proposal, including capture management, proposal writing, proposal management, and proposal review. GDIC can also provide training and support to help offerors understand the technical and administrative requirements outlined in the solicitation, and can provide guidance on how to structure the proposal to maximize its chances of success.

Our business development and proposal professionals have several decades of experience and expertise in construction proposals and contracts for government. By working with GDIC, offerors can increase their chances of winning the C2E contract and can position themselves for long-term success in the federal marketplace.

Make an Appointment