TRICARE Medicare Eligible Program Second Generation (TMEP2) Draft RFP

Quick Summary

The Defense Health Agency (DHA) has released a Draft Request for Proposal (RFP) for the TRICARE Medicare Eligible Program Second Generation (TMEP2). This Special Notice seeks industry feedback on the draft Section C (Performance Work Statement) and Section H (Special Contract Requirements) for a contract providing claims processing and customer support services for Medicare and TRICARE dual-eligible beneficiaries. Responses are due by January 7, 2026.

Purpose & Background

The TMEP2 contract aims to provide claims processing and associated customer support for active duty family members, retired members, and their families who are dual-eligible for Medicare and TRICARE benefits in the U.S. and its territories. Historically, this program processes 58-59 million claims annually. This draft RFP is for planning purposes and market research, not a solicitation for proposals.

Scope of Work (Draft Section C)

The anticipated scope includes:

• Claims Processing: Timely and accurate processing of 58-59 million claims annually, including coordination of benefits, deductibles, copayments, and preauthorization. Overseas claims are not processed by TMEP2.
• Customer Service: Comprehensive, 24/7 customer support via multiple channels, including HIPAA-compliant IVR and call center staff. Virtual call centers are allowed, with live agent availability expected 6:00 am to 11:00 pm EST.
• Provider Reimbursement: Verification of TRICARE authorized providers and processing reimbursements, including Medicare crossover claims and EFT.
• Data Management: Utilization of DEERS for beneficiary information and submission of TRICARE Encounter Data (TED) records.
• Management Functions: Experienced leadership, sufficient staffing, and a Quality Management/Improvement program.
• Transition Activities: Ensuring operational readiness and managing transition-in/transition-out activities over an expected 12-month transition period.

Special Contract Requirements (Draft Section H)

Key requirements include:

• Compliance: Adherence to 32 CFR Part 199, TRICARE Policy Manual, Reimbursement Manual, Systems Manual, and Operations Manual.
• Cybersecurity: CMMC Level 2 certification is a condition of contract award.
• Performance Incentives & Guarantees: Monetary incentives for meeting specified performance levels and 8 comprehensive performance guarantees covering areas like telephone service, claims processing timeliness and accuracy, and written correspondence accuracy. Multiple guarantees can be assessed concurrently with no aggregate cap.
• Organizational Conflicts of Interest (OCI): DHA has determined an actual or significant potential OCI exists or may be created, requiring contractor responsibilities to avoid, neutralize, or mitigate conflicts.
• Contract Structure: Intended to be fixed-price per claim and fixed monthly for administration, with healthcare being cost-reimbursable.

Submission Instructions & Timeline

Interested parties are encouraged to submit comments and questions on the draft Section C and H using the provided Microsoft Excel response template (no proprietary info). An "overall" assessment in narrative form (up to 5 pages, proprietary info allowed) is also accepted. Submissions must be electronic, emailed to Kristin Moore (kristin.m.moore13.civ@health.mil) and Addison Sexton (addison.t.sexton.civ@health.mil) by January 7, 2026, at 5:00 PM ET. An Industry Day is planned, and responding to this draft RFP is not a prerequisite for participation. Future updates will be posted on SAM.gov.

Set-Aside

None specified (this is a draft RFP/Special Notice).