TRICARE Dual-Eligible Contract Awarded to Wisconsin Physicians Service for $77.9M for Claims Processing
Contract Overview
Contract Amount: $77,931,725 ($77.9M)
Contractor: Wisconsin Physicians Service Insurance Corp.
Awarding Agency: Department of Defense
Start Date: 2019-12-19
End Date: 2022-04-30
Contract Duration: 863 days
Daily Burn Rate: $90.3K/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 $77.9 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. The contract supports critical healthcare claims processing for dual-eligible beneficiaries. 2. Wisconsin Physicians Service Insurance Corp. is the incumbent contractor. 3. The contract value is substantial, requiring careful oversight. 4. The sector is Defense Healthcare, a high-priority area for the DoD.
Value Assessment
Rating: good
The contract value of $77.9M over approximately 2.4 years appears reasonable for comprehensive claims processing and customer support services. Benchmarking against similar large-scale healthcare administration contracts would provide a more precise assessment.
Cost Per Unit: N/A
Competition Analysis
Competition Level: full-and-open
The contract was awarded under full and open competition, suggesting a robust price discovery process. This method typically leads to more competitive pricing for the government.
Taxpayer Impact: The competitive award process is expected to ensure taxpayer funds are used efficiently for essential healthcare services.
Public Impact
Ensures continued healthcare claims processing for TRICARE beneficiaries. Supports customer service operations for eligible individuals. Maintains continuity of essential health services for military families and retirees.
Waste & Efficiency Indicators
Waste Risk Score: 78 / 10
Warning Flags
- Potential for cost overruns if scope expands.
- Dependence on a single contractor for critical services.
Positive Signals
- Awarded through full and open competition.
- Clear contract performance period.
- Firm fixed price contract type limits cost uncertainty.
Sector Analysis
This contract falls within the Defense Healthcare sector, specifically focusing on third-party administration of insurance. Spending in this area is significant due to the large number of beneficiaries and complexity of healthcare services provided.
Small Business Impact
The provided data does not indicate any specific set-asides for small businesses. Further analysis would be needed to determine if small businesses were involved as subcontractors or if opportunities were missed.
Oversight & Accountability
The Department of Defense, through the Defense Health Agency, is responsible for oversight. The firm fixed price contract type provides some cost control, but performance monitoring is crucial to ensure service quality and value.
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
- Contract duration is relatively short (approx. 2.4 years).
- Incumbent contractor may have pricing advantages.
- Potential for scope creep in claims processing.
- Reliance on a single vendor for critical function.
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 $77.9 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 $77.9 million.
What is the period of performance?
Start: 2019-12-19. End: 2022-04-30.
What is the historical performance of Wisconsin Physicians Service Insurance Corp. in managing TRICARE contracts?
Historical performance data for Wisconsin Physicians Service Insurance Corp. on TRICARE contracts is essential for a comprehensive risk assessment. Reviewing past performance metrics, such as on-time claims processing, customer satisfaction ratings, and adherence to service level agreements, will provide insight into their reliability and capability to meet the current contract's requirements. This information can inform future contract negotiations and performance expectations.
Are there any identified risks associated with the transition or continuity of claims processing services under this contract?
Potential risks include service disruptions during transition periods, data security breaches, or failure to meet performance standards. Given the critical nature of healthcare claims, robust contingency plans and continuous monitoring by the Defense Health Agency are necessary to mitigate these risks. Understanding the contractor's disaster recovery and business continuity plans is also vital.
How does the pricing structure compare to industry benchmarks for similar third-party administration services?
A detailed pricing analysis comparing the per-claim cost, administrative overhead, and customer support expenses to industry benchmarks is crucial. While the contract is firm fixed price, understanding the underlying cost structure ensures fair pricing and prevents potential overpayment. Benchmarking against contracts with similar scope and complexity within the healthcare administration sector will validate the value received.
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: $85,001,199
Exercised Options: $85,001,199
Current Obligation: $77,931,725
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: 2019-12-19
Current End Date: 2022-04-30
Potential End Date: 2022-04-30 00:00:00
Last Modified: 2022-09-16
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