3M Outpatient Prospective Payment System Pricer Software License and Maintenance
Synopsis:
DHA-SS-18-3M Outpatient Prospective Payment System (OPPS) PRICER
software licenses and maintenance
A. Background
DHA is statutorily mandated to follow Centers for Medicare and Medicaid
Services (CMS) reimbursement methodologies where practicable. As a result,
DHA has worked in conjunction with 3M to develop and implement a
prospective payment system for processing hospital outpatient claims. OPPS
is comprised of two software programs:
1. The first program is the OCE designed for editing and processing hospital
outpatient claims. There is a Letter of Agreement between 3M and DHA (then
TRICARE Management Activity (TMA)) for the development and
maintenance of a TRICARE-specific OCE at no cost to the Government.
Since 3M maintains CMS' OCE, they agreed to develop and maintain a similar
TRICARE OCE with the understanding that they would retain proprietary
rights to the software.
2. The second program is the Pricer that determines how to price claims
based on the output from the OCE. Due to the complexity of TRICARE's
OPPS, DHA decided to license a commercial mainframe TRICARE Pricer to
include quarterly updates that coincide with those of CMS.
(a) TRICARE is statutorily mandated to follow CMS' OPPS reimbursement
methodology where practicable. It is critical the contractor have access to
advance copies of CMS' OCE changes in order to meet quarterly updates. In
accordance with 32 C.F.R. 199.1 (c)(2)(ii), CMS has agreed to allow 3M to
provide TRICARE with advance copies of OCE changes due to the delegated
authority given to the Assistant Secretary for Health, Department of Health
and Human Services (DHHS), to consult with the Secretary of Defense, or a
designee and to approve and issue joint regulations implementing 10. U.S.C.
chapter 55.
(b) TMA requires a license for a mainframe version of the TRICARE Pricer
software in order to ensure:
i. Uniformity of pricing among regions
ii. Programmatic control to ensure consistent and timely updates (requires
quarterly updating of pricing files)
iii. Consistency with CMS (Centers for Medicare and Medicaid Services)
pricing methodologies
iv. Integration between TRICARE specific OCE and Pricer software
v. Portability of Pricer software for future contract transitions
B. Purpose of this Sources Sought
The purpose of this Sources Sought is to conduct market research to determine if there
are vendors offering DHA's requirements for licensing a commercial
mainframe version of a TRICARE-specific OPPS Pricer that can be fully
integrated with the 3M OCE, and licensing PC versions that includes both the
OCE and Pricer software for auditing and verification of accuracy of payment
for hospital outpatient claims. This effort will provide for the licensing,
maintenance and updating of both the mainframe and PC software versions.
The maintenance, to include quarterly updates and any revisions to those
updates, this will have a 12 month period of performance.
C. Deliverables
Description:
TRICARE Mainframe Pricer Software License-includes maintenance, such as,
technical support, debugging and upgrades.
PC Version, 3M Core Grouping Software with TRICARE OPPS Grouping and
Reimbursement License -includes maintenance, such as technical support,
debugging, and upgrades.
Installation/User Manuals for Mainframe and PC Software -Included with
Consists of manuals support the mainframe software, quarterly licenses
updates that include software, coding, and prices.
3M Outpatient Pricer Tables for PC Version Software Consists of Included
with Pricer Tables for the PC software including quarterly updates.
D. How to Respond
THIS IS A SOURCES SOUGHT ONLY. Please do not submit
a quote or specific dollar amounts.
This RFI is issued solely for information and acquisition planning purposes. It
does not constitute a solicitation nor does it restrict the Government as to the
ultimate acquisition approach. In accordance with FAR 15.201(e), responses
to this notice are not offers and cannot be accepted by the Government to
form a binding contract. Any contract that might be awarded based on
information received or derived from this market research will be the outcome
of a competitive process. Responders are advised that the U.S. Government
will not pay for any information or administrative costs incurred in response to
this RFI. All costs associated with responding to this RFI will be solely at the
interested vendor's expense. Not responding to this RFI does not preclude
participation in any future Request for Quotation (RFQ), if any is issued. The
Government may issue a formal solicitation on the Federal Business
Opportunities (fbo.gov) website at a future date. If the Government issues a
solicitation, the Government will conduct any source selection in accordance
with the Federal Acquisition Regulation (FAR), as supplemented. Any future
information on this acquisition (statement of work, specifications, solicitation,
etc.) will be posted on www.fbo.gov. It is the responsibility of the prospective
offeror to review this site regularly for updates and/or changes. DHA will not
respond to questions about the policy issues raised in this notice. The formal
closing date for this RFI and for the submission of responses is October 27,
2017, 1:00pm MT. All responses shall be submitted electronically using PDF,
HTML, MS Word or PowerPoint formats with subject "DHA-SS-18-3M OPPS
PRICER Response" to the following Email address:
thomas.e.poplin3.ctr@mail.com and sherril.s.light.civ@mail.mil.
Please provide the following information:
Company name, mailing address; and the name, phone number, fax number, and email
of the designated point of contact. Please identify any available GSA contracts
which DHA may use to place an order, including NAICS codes and SINs.
Include any applicable small business categories.
Thomas E. Poplin, Phone 3036763694, Email thomas.e.poplin3.ctr@mail.mil - Sherril S Light, Contract Specialist, Phone 3036763890, Email sherril.s.light.civ@mail.mil
