TDEFIC Contract: $70M for TRICARE Dual-Eligible Claims Processing by Wisconsin Physicians Service
Contract Overview
Contract Amount: $69,941,045 ($69.9M)
Contractor: Wisconsin Physicians Service Insurance Corp.
Awarding Agency: Department of Defense
Start Date: 2017-12-11
End Date: 2018-12-31
Contract Duration: 385 days
Daily Burn Rate: $181.7K/day
Competition Type: FULL AND OPEN COMPETITION
Pricing Type: FIXED PRICE LEVEL OF EFFORT
Sector: Healthcare
Official Description: IGF::OT::IGF TRICARE DUAL-ELIGIBLE FISCAL INTERMEDIARY CONTRACT (TDEFIC) PROVIDES CLAIMS PROCESSING AND ASSOCIATED CUSTOMER SUPPORT SERVICES.
Place of Performance
Location: MONONA, DANE County, WISCONSIN, 53713
Plain-Language Summary
Department of Defense obligated $69.9 million to WISCONSIN PHYSICIANS SERVICE INSURANCE CORP. for work described as: IGF::OT::IGF TRICARE DUAL-ELIGIBLE FISCAL INTERMEDIARY CONTRACT (TDEFIC) PROVIDES CLAIMS PROCESSING AND ASSOCIATED CUSTOMER SUPPORT SERVICES. Key points: 1. The contract focuses on claims processing and customer support for TRICARE dual-eligible beneficiaries. 2. Wisconsin Physicians Service Insurance Corp. is the incumbent contractor. 3. The contract was awarded under full and open competition. 4. The total value is approximately $70 million over its period of performance.
Value Assessment
Rating: good
The contract value of $70M appears reasonable for claims processing and support services for a specific beneficiary group. Benchmarking against similar large-scale health insurance administration contracts would provide further context.
Cost Per Unit: N/A
Competition Analysis
Competition Level: full-and-open
The contract was awarded through full and open competition, suggesting a robust process for price discovery and selection of the most advantageous offer. This method generally leads to competitive pricing.
Taxpayer Impact: Competitive bidding under full and open competition aims to secure fair pricing, maximizing taxpayer value for essential healthcare support services.
Public Impact
Ensures critical claims processing for TRICARE beneficiaries eligible for both Medicare and Medicaid. Supports a vital segment of the military healthcare system, impacting beneficiary access to services. The contract's performance directly affects the efficiency and accuracy of payments to healthcare providers.
Waste & Efficiency Indicators
Waste Risk Score: 50 / 10
Warning Flags
- Potential for vendor lock-in if performance is consistently good.
- Reliance on a single vendor for critical claims processing functions.
Positive Signals
- Awarded via full and open competition.
- Clear statement of work for claims processing and support.
Sector Analysis
This contract falls within the broader IT and healthcare administration sector, specifically focusing on third-party administration of insurance. Spending in this area is substantial, driven by the complexity of healthcare claims and the need for efficient processing systems.
Small Business Impact
The data does not indicate any specific set-asides for small businesses. The contract was awarded to Wisconsin Physicians Service Insurance Corp., a large entity, suggesting limited direct opportunities for small businesses as prime contractors on this specific award.
Oversight & Accountability
The contract was awarded by the Department of Defense through the Defense Health Agency, indicating established oversight mechanisms. Further review of IG reports or contract performance reviews would be needed to assess the effectiveness of oversight.
Related Government Programs
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
- Department of Defense Contracting
- Defense Health Agency Programs
Risk Flags
- Potential for single point of failure.
- Reliance on incumbent's system and processes.
- Contract duration and potential for price escalation in future renewals.
- Complexity of dual-eligible beneficiary claims processing.
Tags
pharmacy-benefit-management-and-other-th, department-of-defense, wi, delivery-order, 10m-plus
Frequently Asked Questions
What is this federal contract paying for?
Department of Defense awarded $69.9 million to WISCONSIN PHYSICIANS SERVICE INSURANCE CORP.. IGF::OT::IGF TRICARE DUAL-ELIGIBLE FISCAL INTERMEDIARY CONTRACT (TDEFIC) PROVIDES CLAIMS PROCESSING AND ASSOCIATED CUSTOMER SUPPORT SERVICES.
Who is the contractor on this award?
The obligated recipient is WISCONSIN PHYSICIANS SERVICE INSURANCE CORP..
Which agency awarded this contract?
Awarding agency: Department of Defense (Defense Health Agency).
What is the total obligated amount?
The obligated amount is $69.9 million.
What is the period of performance?
Start: 2017-12-11. End: 2018-12-31.
What is the specific performance metric for claims processing accuracy and timeliness under this contract?
The provided data does not detail specific performance metrics. However, for a contract of this nature, key performance indicators would typically include claims processing accuracy rates (e.g., percentage of claims processed correctly), timeliness of processing (e.g., average days to process claims), and customer satisfaction scores for support services. These metrics are crucial for ensuring efficient and effective healthcare benefit delivery.
What is the risk of service disruption if the incumbent contractor faces operational challenges?
There is a moderate risk of service disruption if the incumbent contractor, Wisconsin Physicians Service Insurance Corp., faces significant operational challenges. As the sole provider for these specific services under this contract, any major disruption could impact claims processing and beneficiary support. Mitigation strategies typically involve robust contingency planning by the contractor and close monitoring by the contracting agency.
How does the pricing structure (Fixed Price Level of Effort) ensure cost-effectiveness for the government?
A Fixed Price Level of Effort (FPLE) contract aims for cost-effectiveness by establishing a fixed price for a defined scope of work and a specified level of effort. This structure provides cost certainty for the government, as the contractor is obligated to complete the work within the agreed-upon budget and effort. However, it relies on accurate estimation of the effort required; if the effort significantly exceeds projections, the contractor may absorb the loss, or if it's less, the government may overpay for the actual effort expended.
Industry Classification
NAICS: Finance and Insurance › Agencies, Brokerages, and Other Insurance Related Activities › Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Product/Service Code: MEDICAL SERVICES › OTHER MEDICAL SERVICES
Competition & Pricing
Extent Competed: FULL AND OPEN COMPETITION
Solicitation Procedures: NEGOTIATED PROPOSAL/QUOTE
Pricing Type: FIXED PRICE LEVEL OF EFFORT (B)
Evaluated Preference: NONE
Contractor Details
Address: 1717 W BROADWAY, MADISON, WI, 53713
Business Categories: Category Business, Corporate Entity Not Tax Exempt, Nonprofit Organization, Not Designated a Small Business, Special Designations, U.S.-Owned Business
Financial Breakdown
Contract Ceiling: $69,941,045
Exercised Options: $69,941,045
Current Obligation: $69,941,045
Contract Characteristics
Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED
Cost or Pricing Data: NO
Parent Contract
Parent Award PIID: HT940214D0003
IDV Type: IDC
Timeline
Start Date: 2017-12-11
Current End Date: 2018-12-31
Potential End Date: 2018-12-31 00:00:00
Last Modified: 2025-04-26
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