TRICARE Medicare Claims Processing and Support

The Defense Health Agency is seeking a contractor to process Medicare and TRICARE claims and provide customer support, encounter-data administration, provider certification, and related program-management services for dual-eligible beneficiaries across the United States and specified U.S. territories under an 8.5-year potential contract.

United States of America > DEPT OF DEFENSE > DEFENSE HEALTH AGENCY (DHA) > DEFENSE HEALTH AGENCY (MANAGED CARE CONTRACT DIRECTORATE)

General

Status:Open

Solicitation Identifier:HT940226R0001

Due Date:Nov 06, 2026 12:00 AM

Posted Date:Sep 28, 2026 05:57 PM

Contract Period:1 year base + options: 1 year, 1 year, 1 year, 1 year, 1 year, 1 year, 1 year, 1 year, 6 months

Type:Request for Proposal (RFP)

Level:Federal

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Original Solicitation Links

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HT940226R0001

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tricare medicare eligible program second generation (tmep2)

Contact

Name:David Smith

Email:david.c.smith139.civ@health.mil

Address:16401 East Centretech Parkway, Aurora District, CO, USA

Submission Instructions

Method:Online

Portal:https://safe.apps.mil

Items via this method:Request a DoD SAFE drop-off code from the Contract Specialist by email no later than seven days before the proposal due date., Submit one zip file for each proposal volume using the required volume-specific naming convention.

Description

The Defense Health Agency is soliciting a full-and-open, best-value procurement for the second-generation TRICARE Medicare Eligible Program. The contractor will process claims for beneficiaries who are eligible for both Medicare and TRICARE, including claims adjudication, application of TRICARE benefit and cost-sharing rules, Medicare crossover processing, provider certification, authorization and preauthorization processing, TRICARE Encounter Data submission, payment administration, appeals and reconsiderations, records management, program integrity, and related reporting. The requirement covers services rendered in the United States, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. Historical workload includes approximately 58–59 million claims annually, more than 7 million annual telephone calls, and approximately 2.6 million dual-eligible beneficiaries. The contractor must provide comprehensive beneficiary and provider customer service through a 24-hour, seven-day telephone system, staffed representative access from 6:00 a.m. to 11:00 p.m. Eastern Time except weekends and federal holidays, interactive voice response, portals, correspondence, and a beneficiary-facing website. The solicitation requires an automated claims-processing capability, cybersecurity and personnel-security compliance, CMMC Level 2 (Self), quality-management and anti-fraud programs, transition-in and transition-out support, and coordination with Medicare, Defense Manpower Data Center, Managed Care Support Contractors, and other TRICARE contractors. The contract is firm-fixed-price, with a 12-month transition-in period, seven one-year healthcare-delivery option periods, a 12-month transition-out period, and a potential six-month extension under the applicable option clause, for a potential total period of performance of 8.5 years.

Title	Date Posted
TMEP2 Draft RFP Response.xlsx	Nov 25, 2025 12:00 PM
TMEP2 Section C Draft Performance Work Statement.pdf	Nov 25, 2025 12:00 PM
TMEP2 Section H Draft Special Contract Requirements.pdf	Nov 25, 2025 12:00 PM
Exhibit L-5 - Sample Client Authorization Letter.pdf	Sep 23, 2026 12:00 PM
Exhibit L-9 - TMEP CY24_25_26 Manual Changes Modification Log.xlsx	Sep 23, 2026 12:00 PM
HT940226R0001-20260923.pdf	Sep 23, 2026 12:00 PM
Exhibit L-8 - Small Business Participation Comittment.docx	Sep 23, 2026 12:00 PM
Attachment J-1 DMDC Eligibility File Layout TMEP.pdf	Sep 23, 2026 12:00 PM
Attachment J-5b QASP Matrix TMEP2 DRAFT.xlsx	Sep 23, 2026 12:00 PM
Attachment J-3 CDRLs.pdf	Sep 23, 2026 12:00 PM
Exhibit L-3 - RFP-Cross-reference Matrix.xlsx	Sep 23, 2026 12:00 PM
Exhibit L-4 - Past Performance Questionnaire.pdf	Sep 23, 2026 12:00 PM
Attachment J-4 TMEP 2 Chapter 20 Clean Draft Copy 20260730.pdf	Sep 23, 2026 12:00 PM
Exhibit L-2 - Historical Data.pdf	Sep 23, 2026 12:00 PM
Exhibit L-7 - TMEP2 Pricing Template.xlsx	Sep 23, 2026 12:00 PM
HT940226R0001-20260923.pdf	Sep 25, 2026 12:00 PM
Exhibit L-1 - Beneficiary Data.pdf	Sep 23, 2026 12:00 PM
Attachment J-5a QASP TMEP2 DRAFT.pdf	Sep 23, 2026 12:00 PM
Attachment J-2 Beneficiary Satisfaction Survey.pdf	Sep 23, 2026 12:00 PM
Exhibit L-6 - Subcontractor Consent Letter.pdf	Sep 23, 2026 12:00 PM
HT940226R0001-20260923.pdf	Sep 28, 2026 12:00 PM
HT940226R0001 Amd 0001 20260924.pdf	Sep 25, 2026 12:00 PM
Exhibit L-7 - TMEP2 Pricing Template.xlsx	Sep 25, 2026 12:00 PM
Attachment J-5b QASP Matrix TMEP2 DRAFT.xlsx	Sep 25, 2026 12:00 PM
Exhibit L-9 - TMEP CY24_25_26 Manual Changes Modification Log.xlsx	Sep 25, 2026 12:00 PM
Exhibit L-8 - Small Business Participation Commitment.docx	Sep 25, 2026 12:00 PM