TRICARE Dual-Eligible Contract Awarded to Wisconsin Physicians Service for $32.8M for Claims Processing
Contract Overview
Contract Amount: $32,783,233 ($32.8M)
Contractor: Wisconsin Physicians Service Insurance Corp.
Awarding Agency: Department of Defense
Start Date: 2020-12-08
End Date: 2022-04-30
Contract Duration: 508 days
Daily Burn Rate: $64.5K/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 $32.8 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 TDEFIC contract focuses on claims processing and customer support for TRICARE beneficiaries. 2. Wisconsin Physicians Service Insurance Corp. is the incumbent contractor. 3. The contract was awarded under full and open competition, suggesting a competitive bidding process. 4. The sector is Defense Health, a critical area for military healthcare services.
Value Assessment
Rating: good
The contract value of $32.8 million over approximately 17 months appears reasonable for complex claims processing and customer support services. Benchmarking against similar TRICARE contracts would provide a more precise assessment.
Cost Per Unit: N/A
Competition Analysis
Competition Level: full-and-open
The contract was awarded through full and open competition, indicating that multiple vendors had the opportunity to bid. This method generally promotes competitive pricing and ensures the government receives the best value.
Taxpayer Impact: The competitive nature of the award suggests that taxpayer funds are being used efficiently through a process designed to secure favorable pricing for essential healthcare support services.
Public Impact
Ensures continued claims processing for dual-eligible TRICARE beneficiaries, maintaining access to healthcare benefits. Supports customer service operations, assisting beneficiaries with inquiries and issues related to their healthcare coverage. Maintains the operational integrity of the TRICARE program, a vital component of military healthcare.
Waste & Efficiency Indicators
Waste Risk Score: 64 / 10
Warning Flags
- Contract duration is relatively short (508 days), potentially leading to frequent re-competition and transition costs.
- Limited data on performance metrics makes it difficult to assess the contractor's effectiveness beyond price.
Positive Signals
- Awarded under full and open competition, indicating a robust market and competitive pricing.
- Contract value is clearly defined, providing budget certainty for the period.
- Incumbent contractor has existing infrastructure and expertise, potentially leading to smoother service delivery.
Sector Analysis
This contract falls within the Defense Health sector, specifically related to third-party administration of insurance. Spending in this area is substantial, driven by the need to manage complex healthcare claims for military personnel and their families.
Small Business Impact
The data does not indicate any specific set-asides for small businesses. The contract was awarded through full and open competition, suggesting that large businesses were likely the primary bidders.
Oversight & Accountability
The Department of Defense, through the Defense Health Agency, is responsible for overseeing this contract. Standard oversight mechanisms for contract performance 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 service disruption during contract transitions due to short duration.
- Risk of reduced innovation if incumbent performance is not actively managed.
- Limited visibility into specific performance metrics and contractor value proposition.
- Dependence on a single contractor for critical claims processing functions.
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 $32.8 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 $32.8 million.
What is the period of performance?
Start: 2020-12-08. End: 2022-04-30.
What is the specific value proposition of Wisconsin Physicians Service Insurance Corp. that led to their selection in this competitive bid?
While the data confirms Wisconsin Physicians Service Insurance Corp. as the awardee, it does not detail their specific value proposition. Typically, in full and open competition, the winning offer demonstrates a balance of technical capability, past performance, and cost-effectiveness that best meets the government's requirements. Further analysis of the source selection decision document would be needed to identify the precise factors.
What are the potential risks associated with the short contract duration and the reliance on an incumbent contractor for critical claims processing?
A short contract duration (508 days) can lead to increased administrative burden for re-competition and potential disruption during contractor transitions. Relying on an incumbent, while offering continuity, might also reduce pressure for innovation and potentially lead to complacency if performance is not rigorously monitored. The government must ensure robust performance management to mitigate these risks.
How effectively does this contract ensure the efficient processing of claims and customer support for dual-eligible TRICARE beneficiaries?
The effectiveness hinges on the contractor's performance against contract requirements, which are not detailed here. The award under full and open competition suggests a belief that the chosen contractor can meet these needs efficiently. Ongoing monitoring of key performance indicators, such as claims processing times, accuracy rates, and customer satisfaction, is crucial to validate effectiveness.
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
Solicitation ID: HT940212R0005
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: $32,783,233
Exercised Options: $32,783,233
Current Obligation: $32,783,233
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: 2020-12-08
Current End Date: 2022-04-30
Potential End Date: 2022-04-30 00:00:00
Last Modified: 2025-01-10
More Contracts from Wisconsin Physicians Service Insurance Corp.
- Federal Contract — $512.0M (Department of Defense)
- Federal Contract — $462.9M (Department of Health and Human Services)
- Medicare Administrative Contractor Jurisdiction 5 — $369.2M (Department of Health and Human Services)
- Part a and Part B Medicare Administrative Contract Jurisdiction 8 — $324.6M (Department of Health and Human Services)
- J8 A/B MAC — $318.9M (Department of Health and Human Services)
View all Wisconsin Physicians Service Insurance Corp. federal contracts →
Other Department of Defense Contracts
- Federal Contract — $51.3B (Humana Government Business Inc)
- Lrip LOT 12 Advance Acquisition Contract — $35.1B (Lockheed Martin Corporation)
- SSN 802 and 803 Long Lead Time Material — $34.7B (Electric Boat Corporation)
- 200204!008532!1700!AF600 !naval AIR Systems Command !N0001902C3002 !A!N! !N! !20011026!20120430!008016958!008016958!834951691!n!lockheed Martin Corporation !lockheed Blvd !fort Worth !tx!76108!27000!439!48!fort Worth !tarrant !texas !+000026000000!n!n!018981928201!ac15!rdte/Aircraft-Eng/Manuf Develop !a1a!airframes and Spares !2ama!jast/Jsf !336411!E! !3! ! ! ! ! !99990909!B! ! !A! !a!n!r!2!002!n!1a!a!n!z! ! !N!C!N! ! ! !a!a!a!a!000!a!c!n! ! ! !Y! !N00019!0001! — $34.2B (Lockheed Martin Corporation)
- KC-X Modernization Program — $32.0B (THE Boeing Company)