TRICARE Claims Review Services (TCRS)

Description: Government’s Notice of Intent (NOI) to extend the TRICARE Claims Review Services (TCRS) contract performed by Concept Plus for up to 12 months. The work includes evaluating the accuracy of claims payment and payment record coding under the terms of the TRICARE Claims Review Services contract. A solicitation document will not be issued, nor will quotations be requested.

The Defense Health Agency (DHA), DHA Contracting Activity (DHACA), Managed Care Contracting Division (MC-CD), is issuing this NOI pursuant to Federal Acquisition Regulation (FAR) 5.2. The DHA intends to issue a sole-source bridge action to continue the provision of services provided under the existing TCRS contract, HT9402-17-D-0001, to Concept Plus in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 206.302-1, only one responsible source and no other supplies or services will satisfy agency requirements. This contract modification to extend performance is necessary to continue to meet mission critical requirements and to support the transition to a competitively awarded follow-on TCRS contract. A new contractor would require a minimum of 6 months to complete the transition-in requirements given the startup requirements associated with staff recruiting and training, meeting the Personnel Security, and System Security and connectivity requirements. The current TCRS contractor, Concept Plus, is the only known contractor that can provide these services within the needed time frame.

The base period of performance will be from March 01, 2025 – August 31, 2025, with an option to extend for up to an additional 6 months. The total potential period of performance is March 01, 2025 - February 28, 2026. The extension is necessary to prevent a gap in support to critical DHA requirements after the end of the current TCRS contract on February 28, 2025, until a competitive follow-on contract is awarded, and the awardee completes transition-in.

Interested Parties: Interested parties capable of providing the same or similar services described in this notice may submit a capability statement outlining their capability to perform the described work.  Capability Statements must be received within the time set forth in this synopsis to be considered by the Government. The determination to compete this proposed contract based on responses to this notice is solely within the discretion of the Government. Information received will normally be considered solely for the purpose of determining whether to conduct a competitive procurement.

The Defense Health Agency (DHA) supports health services for more than 9.4 million beneficiaries of the Military Health System (MHS). The purpose of the TCRS contract is to assist the DHA Improper Payment Evaluation Branch (IPEB) in identifying and reporting improper payments and discrepancies in payment recording for the MHS. TCRS support provides an independent impartial review of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors and assesses purchased-care contractor compliance with TRICARE policies and directives by evaluating the accuracy of claims payment and payment record coding for the MCSC, TMEP, TPharm, TOP, and ADDP contracts. TCRS helps support IBEP’s requirement to assess the potential risk of improper payments and to 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 Laws 107-300, and the Payment Integrity Act of 2019 (PIIA), Public Laws 116-117.

PRIMARY POINT OF CONTACT: Please respond or submit inquiries (via email) to the Defense Health Agency, Managed Care - Contracting Division, TRICARE Support Branch, support contractor Gregory Stephens at gregory.r.stephens3.civ@health.mil. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted.