Third Party Collections Program

Summary (Newest Update)

Background The Defense Health Agency (DHA) is authorized under U.S. Code 1095 and 1079b, along with relevant regulations and directives, to recover costs for healthcare services provided to Department of War (DoW) beneficiaries from third-party payers through the Third-Party Collections Program (TPCP). This program involves billing for medical services rendered in DoW/DHA military treatment facilities (MTFs) as well as professional services provided by MTF personnel at civilian facilities. The DHA is seeking contract support for various medical billing and collection activities as outlined in the attached Performance Work Statement (PWS). This Request for Information (RFI) is intended to gather information on companies capable of fulfilling these requirements. Work Details The contractor will be responsible for a range of tasks including: 1. Claims Generation and Submission: Ensure 95% of claims are generated and submitted within specified timeframes, resolving errors within 10 business days. 2. Other Health Insurance (OHI) Verification: Enter OHI data into the Government Billing Solution (GBS) within 5 business days of discovery and re-verify annually. 3. Payment Posting and Refund Management: Post payments in GBS within 24 hours of receipt and process refund requests within 30 days. 4. Follow-Up/Denials Management: Conduct follow-ups on unpaid or denied claims every 30 days, transferring delinquent claims to the Office of General Counsel after 120 days. 5. Unpaid Claims Management: Close all valid bills by the 120th day of delinquency. 6. Training Requirement: Market the TPC program to patients and train MTF staff quarterly on their responsibilities regarding TPC. Period of Performance The anticipated period of performance will begin in March 2027 and will not exceed five years. Place of Performance Services will be performed at various Military Treatment Facilities (MTFs) as specified in the contract.