TRICARE Medicare Eligible Program Second Generation (TMEP2)

INTRODUCTION: 

1. This announcement constitutes a Request for Information (RFI). This announcement does not constitute a commitment, implied or otherwise that a solicitation will be issued. This is not a request for proposal (RFP) or an invitation for bids (IFB).
2. Please note that the collection of this requested information does not obligate the U.S. Government to incorporate any solicited comments, nor does it obligate the Government to procure the services. Responses to this RFI will not be returned. The Government is not liable to pay any costs associated with companies responding to this RFI.
3. All information received resulting from this RFI will be used by the Defense Health Agency (DHA) for acquisition planning and market research purposes only. However, your response may be releasable to the public under the Freedom of Information Act (FOIA). If you wish the DHA to consider any portion of your response as “confidential commercial information,” you should clearly mark the portion as “confidential commercial information.”
4. The DHA, at its discretion, may request respondents to this RFI to elaborate on information in their written response.  Respondents to this RFI will not be notified of any results derived from a review of the information provided.
5. The DHA invites all interested parties to submit a written response to this RFI. This RFI is issued for the sole purpose of conducting market research in accordance with the Federal Acquisition Regulation (FAR) Part 10.
6. The DHA Contracting Activity, Managed Care Contracting Division is seeking industry’s feedback on capabilities currently available to meet the Military Health System (MHS) TRICARE Medicare Eligible Program (TMEP) requirement and to gather information from potential offerors to be utilized by the DHA TRICARE Program as support in its continuous market research for upcoming contract requirements.  The DHA will use the information collected to determine small business capability and to inform its selection of an appropriate acquisition strategy and contract type, all to the end of achieving the overall objectives of the TMEP.

CONTRACT PURPOSE:

1. The Department of Defense, through the DHA, is required to offer coverage to active duty family members, retired 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 services rendered in the United States and the U.S. Territories.  The purpose of the contract is to provide claims processing and associated customer support services for claims submitted by and on behalf of MHS beneficiaries eligible for both Medicare and TRICARE benefits.  The contractor provides the expertise of health care claims processing and its support services by incorporating and delivering the best practices of the private sector in support of TRICARE. Historically, the number of total claims processed per year ranges from 58,000,000 – 59,000,000, and the number of paper claims averages about 3% of that total.
2. Of critical importance to effective delivery of services under the TMEP is the contractor’s ability to effectively collaborate and reach 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.
3. Transition in for TMEP2 is anticipated to begin on 1 May 2027, with award occurring prior to the start of transition in.

Contract Objectives:

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.

RESPONSES:

To this end, DHA seeks responses that include your company’s capability statement, inclusive of relevant current experience in the commercial and non-commercial marketplace.  The Government requests that interested parties respond to this notice including details of your company’s ability to perform as a prime contractor or a subcontractor.  Additionally, please provide the following information:

1. Company Name and Address
2. Cage Code
3. Unique Entity Identifier
4. Company business size by NAICS code 524292 (and any other applicable)
5. Small Business Type(s), if applicable
6. Point of Contact for questions and/or clarifications (include telephone number and email address)
7. Web Page URL (if applicable)
8. Teaming Partners (if applicable)
9. Provide any recommendations and/or concerns.
10. Describe your overall capabilities as it relates to the TMEP requirements and objectives (most notably, the capability to accurately process millions of electronic and paper TRICARE claims per month) and include the following.

Management:

1. Ability to provide operational management of all human and capital resources for all TMEP operations such as: customer service call staff, systems, system components, and databases at contractor operational sites.
2. Ability to manage, maintain and provide support service for configuration, access control and basic Troubleshooting.
3. Ability to provide management reports that monitor and measure key performance requirements and management indicators with the goal of continuous improvement in all facets of the company’s operations

Transition-in and Out Capability:

1. Ability to transition all systems, process, and beneficiary information from or to a losing or gaining contractor with no impact on beneficiaries’ customer service, or customer satisfaction.
2. Ability to timely and accurately receive or transfer all required beneficiary records and information from or to a losing or gaining contractor with no impact to TMEP beneficiaries.

1. The current contract is a Firm Fixed Price Contract with a 1-year base period plus six 1-year options.  Transition-In activities occur during the base period with claims processing and customer services beginning with Option Period 1. What would you recommend in terms of length and type of contract?  Why?  Would less or more time change whether your company proposes on this effort as a Prime or seeks an arrangement as a subcontractor?
2. Historically, the DHA has conducted the TMEP acquisition on a non-commercial basis. If DHA determines that the TMEP services are commercial services and conducts the acquisition under the umbrella of Federal Acquisition Regulation (FAR) Part 12, would this impact your company’s decision to propose as a Prime or seek subcontracting opportunities.  If so, please explain the rationale behind the decision.
3. Describe any commercial or industry best practices that your company could bring to support the TMEP requirement.
4. The TMEP contractor, in delivering services to TRICARE beneficiaries, must comply with the requirements of the TRICARE Manuals.  Among many other things, this means the contractor must meet all TRICARE Encounter Data (TED) requirements (which are unique to TRICARE) outlined in Chapter 2 of the TRICARE Systems Manual (TSM), at the site below:

https://manuals.health.mil/pages/DisplayManualHtmlFile/2025-01-08/AsOf/TST5/C2TOC.html, Describe your company or team’s background, technical expertise, experience, staffing, ability to meet/comply with the TRICARE requirements addressed in the manuals listed above.

1. Describe your capability and approach to interoperability (i.e., communicating and interacting with other systems).
2. Does your company have a federal supply schedule contract with the scope and labor categories able to meet the requirements of this effort?

CONCLUSION:

1. Both large and small businesses with interest in this future requirement are requested to submit its capability statement and responses to this notice.  Please indicate if the company interest is as a prime contractor or subcontractor.
2. Do not submit pricing information in response to this RFI notice. All responses should be submitted using PDF, MS Word or PowerPoint formats with subject “TMEP Response.” Responses to this notice should not exceed 15 pages in length.  The information in this notice is current as of the publication date but is subject to change and is not binding to the Government.  Oral submissions of information are not acceptable.
3. Responses to this RFI are due no later than 6/5/2025 at 1600 ET.
4. Information gathered will not be posted to industry and is for market research purposes only (see Introduction paragraph 3 regarding FOIA).  Include a brief summary of the email’s content, the vendor’s name, point of contact, vendor size, and socioeconomic status (if any) and contact information including email and mailing address.
5. Provide responses to both Ms. Jamie A. Ford, Contracting Officer, and Mr. Addison Sexton, Contract Specialist at: [email protected], and [email protected].