DoD's TRICARE Dual-Eligible Contract Awarded to Wisconsin Physicians Service for $69M
Contract Overview
Contract Amount: $69,148,086 ($69.1M)
Contractor: Wisconsin Physicians Service Insurance Corp.
Awarding Agency: Department of Defense
Start Date: 2018-12-31
End Date: 2021-06-30
Contract Duration: 912 days
Daily Burn Rate: $75.8K/day
Competition Type: FULL AND OPEN COMPETITION
Pricing Type: FIRM FIXED PRICE
Sector: Healthcare
Official Description: 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 $69.1 million to WISCONSIN PHYSICIANS SERVICE INSURANCE CORP. for work described as: TRICARE DUAL-ELIGIBLE FISCAL INTERMEDIARY CONTRACT (TDEFIC) PROVIDES CLAIMS PROCESSING AND ASSOCIATED CUSTOMER SUPPORT SERVICES Key points: 1. Contract covers 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 contract value is $69.15 million over its period of performance. 5. The sector is primarily IT and healthcare administration.
Value Assessment
Rating: good
The contract value of $69.15 million appears reasonable for a multi-year contract providing complex claims processing and customer support services for a specialized beneficiary group. Benchmarking against similar TRICARE contracts or other 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 soliciting bids and ensuring fair pricing. This method typically leads to competitive pricing as multiple vendors vie for the contract, driving down costs for the government.
Taxpayer Impact: Full and open competition generally benefits taxpayers by ensuring the government receives the best value and competitive pricing for services rendered.
Public Impact
Ensures continued healthcare claims processing for TRICARE dual-eligible beneficiaries. Supports customer service operations for a vulnerable population. Maintains continuity of essential health services administration. Potential impact on healthcare access and efficiency for beneficiaries. The contract's performance directly affects the administrative efficiency of the TRICARE program.
Waste & Efficiency Indicators
Waste Risk Score: 75 / 10
Positive Signals
- Full and open competition utilized.
- Clear statement of work for claims processing and support.
- Incumbent contractor likely brings institutional knowledge.
Sector Analysis
This contract falls within the IT and Healthcare Administration sector, specifically focusing on third-party administration of insurance and pension funds. Spending in this area is significant as government agencies outsource complex administrative functions to specialized contractors to ensure efficiency and expertise.
Small Business Impact
The provided data does not indicate any specific set-asides for small businesses for this contract. Analysis of subcontracting opportunities for small businesses would be necessary to assess their participation.
Oversight & Accountability
The Department of Defense, through the Defense Health Agency, is responsible for overseeing this contract. Standard oversight mechanisms for contract performance, quality assurance, and financial management are expected to be in place.
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 scope creep if requirements are not clearly defined.
- Reliance on incumbent contractor may limit future innovation.
- Complexity of dual-eligibility claims processing.
- Ensuring consistent customer support quality over contract duration.
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 $69.1 million to WISCONSIN PHYSICIANS SERVICE INSURANCE CORP.. 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 $69.1 million.
What is the period of performance?
Start: 2018-12-31. End: 2021-06-30.
What is the specific definition of 'dual-eligible' within the TRICARE program, and how does this contract cater to their unique needs?
Dual-eligibles in TRICARE are typically beneficiaries who are eligible for both Medicare and TRICARE. This contract likely addresses the complex coordination of benefits and claims processing required when healthcare services are covered by multiple payers. The specific needs involve ensuring seamless transitions between TRICARE and Medicare coverage, accurate adjudication of claims, and specialized customer support to navigate these dual entitlements.
How does the firm fixed-price contract type mitigate risks associated with fluctuating costs for claims processing and customer support?
A firm fixed-price (FFP) contract shifts the risk of cost overruns to the contractor. For claims processing and customer support, where volumes and complexity can vary, FFP provides budget certainty for the government. The contractor is incentivized to manage their costs efficiently to maintain profitability, as they bear the responsibility for any expenses exceeding the agreed-upon price.
What performance metrics are used to evaluate the effectiveness of Wisconsin Physicians Service Insurance Corp. in fulfilling the TDEFIC contract requirements?
Effectiveness is typically measured through key performance indicators (KPIs) related to claims processing timeliness, accuracy rates, customer satisfaction scores, and adherence to service level agreements. The Defense Health Agency would monitor these metrics to ensure the contractor is meeting its obligations and providing high-quality services to TRICARE dual-eligible beneficiaries.
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: FIRM FIXED PRICE (J)
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: $69,148,086
Exercised Options: $69,148,086
Current Obligation: $69,148,086
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: 2018-12-31
Current End Date: 2021-06-30
Potential End Date: 2021-06-30 00:00:00
Last Modified: 2024-08-27
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