The Department of Defense (DOD), Defense Health Agency (DHA), has a continuing requirement for TRICARE Medicare Eligible Program Second Generation (TMEP2).

N/A

• Objective 1 – Claims Processing: Provide timely and accurate claims processing while ensuring cost containment and alignment with industry best practices. Apply accurate deductible, co-pays/coinsurance, cost-shares and catastrophic cap in accordance with TRICARE manuals and TRICARE benefit policy.  Coordinate benefits with other health insurance companies and determine beneficiary eligibility and enrollment status based on information found in the Defense Enrollment Eligibility Reporting System (DEERS).
• Objective 2 – Customer Service: Deliver a claims processing system and customer friendly services which result in beneficiary and provider satisfaction. Establish 24-hour, seven (7) days a week customer service through a single, nationally accessible telephone number, without long distance charges.  Operate an Interactive Voice Response (IVR) unit that allows customers, at a minimum, access to information in a user-friendly and efficient manner related to the status of claims, eligibility and benefits.  Operate an IVR unit that allows callers the option of speaking to a customer service representative between the hours of 6:00 am and 11:00 pm EST (except weekends and federal holidays). Provide comprehensive, readily accessible customer services that include multiple, contemporary avenues of access (e.g., email, worldwide web, telephone, chat) for the beneficiary and provider.
• Objective 3 – Management Functions: Provide effective management approaches in the delivery of high-quality services.
• Objective 4 – Transition Activities: Ensure all services and systems are fully operational at the start of Option 1 and throughout the period of performance with minimal disruption of services to beneficiaries.