Q -- PROPOSED TRICARE ACTIVE DUTY DENTAL PROGRAM (RFI)

The Department of Defense is interested in contracting for processing and payment of Dental claims for Active Duty Service Members (ADSMs) residing within the United States and its territories. A potential offeror must tender its current nation-wide dental network of credentialed providers to the Program and its most favorable network fee schedule. However, in remote locations, claims from non-network providers will be submitted for payment. All claims will be preauthorized by Government personnel prior to payment who, it is anticipated, will also determine each ADSM’s eligibility. The dental benefit structure will be a full-spectrum of possible dental procedures; however, the contractor will pay claims based solely on the specified procedures in the authorizations and will make no benefit determinations. The contractor must be able to pay for a wide range of benefits, both routine and specialty care. Authorizations may be received by fax or by other electronic means to be determined. The contractor must have the ability to accept both ADA the versions of the paper claim form and the electronic formats to include the dental ANSI X12N 837. Benefit payments will be drawn from an account established specifically for this program and the contractor will be given authority to draw funds into that bank account. The volume of dental claims paid for authorized civilian dental care in CY2004 was 158,866. Please direct any questions you may have to this RFI to the POC's e-mail addresses listed below.