Updated February 8, 2024
Notice ID: HT940224TCRS2
On behalf of DOD, GSA is conducting market research for the TRICARE Claims Review Services (TCRS) Program, which provides support for Improper Payment Program-initiated focused studies which result from contract claims processing compliance reviews; healthcare data analysis and/or mining; the implementation of a new health benefit; or at the request of other DHA entities. The ultimate goal is to develop contract requirements that achieve the maximum impact and value for our taxpayers. In particular, the DHA seeks comments regarding which approaches it should consider to assess various aspects of identifying improper payments and/or developing requirements for focused studies.
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.
1.5 Scope: 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.
Posted December 19, 2023
Notice ID: HT940224TCRS
On behalf of DOD, GSA is conducting market research for the TRICARE Claims Review Services (TCRS) Program, which provides support for Improper Payment Program-initiated focused studies which result from contract claims processing compliance reviews; healthcare data analysis and/or mining; the implementation of a new health benefit; or at the request of other DHA entities. The ultimate goal is to develop contract requirements that achieve the maximum impact and value for our taxpayers. In particular, the DHA seeks comments regarding which approaches it should consider to assess various aspects of identifying improper payments and/or developing requirements for focused studies.
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