4.1 Incoming
And Outgoing Contractor Requirements
4.1.1 The incoming contractor shall
access the web-based DCS via the Patient Encounter Processing and
Reporting (PEPR) Portal in accordance with the TSM,
Chapter 4 and ensure the connection has been
tested and is accessible.
4.1.2 Contractors shall participate in Government
furnished DCS training. Training will be scheduled as part of the
IMP/IMS.
4.1.3 The date
when an incoming contractor will assume full responsibility for
resolving all existing potential duplicate claim sets from the outgoing
contractor (including completing existing recoupments), and for
all new potential duplicate claim sets, shall be determined during
transition meetings and be established in the transition plan/schedule.
4.1.4 During transition the Government will provide
DCS training to the incoming contractor. Training may occur 120
days prior to the SHCD, but not later than 60 days following the
SHCD. The incoming contractor shall coordinate training needs in
accordance with the transition plan/schedule. All user access requirements
shall be met prior to the initiation of training.
4.1.5 The incoming contractor shall begin using the
DCS to resolve identified potential duplicate claim sets “owned”
by the incoming contractor 120 days following the SHCD.
4.1.6 The incoming contractor shall begin processing
potential duplicate claim sets transferred from the outgoing contractor
150 days following the SHCD.
4.1.7 For each regional contract for which a contractor
is responsible, the contractor is required to identify at least
one individual to serve as the DCS Point of Contact (POC). Contractor
DCS POCs must be individuals who are, or will be, trained in the
use of the DCS, and who are able to perform the required research
and determine whether a particular claim is within their processing
jurisdiction. Contractors shall provide the name(s), title(s), business
address(es), and business telephone number(s) of their DCS POCs
to the Procuring Contracting Officer (PCO), with courtesy copies
to the Contracting Officer Representatives (CORs) and to the DHA
DCS Program Representative. The DCS POCs shall be provided to the
PCO no later than two weeks prior to implementation of the DCS.
4.1.8 DHA will provide each contractor with the list
of all DCS POCs. Whenever a new contract is awarded, DHA will notify
all contractors of the new contractor’s DCS POC. Once the initial
listing is provided to the contractors, it is the responsibility
of each contractor to maintain the listing and keep DHA and the
other contractors informed of any changes.
4.1.9 In accordance with the Financial Procedures
in the Transition Plan, the contract, and the TOM, the outgoing
contractor shall package and forward to the incoming contractor,
refund checks received and offsets taken for recoupments associated
with duplicate claims payments and recoupment files associated with
in progress duplicate claim recoupment 120 days following SHCD.
4.1.10 On the last day of the fourth month following
the start of SHCD, or upon direction of the Government, the outgoing
contractor shall cease researching Open claim sets
and initiating new recoupments associated with duplicate claim payments.
The outgoing contractor shall also cease entering refund data and
linking adjustment data in the DCS for Pending and Validate claim
sets.
4.1.11 The outgoing
contractor shall move all Open DCS claim sets to
a Pending, Validate, or Closed status
by the last day of TED submissions (as defined by the transition
plan).
4.1.12 When the
outgoing contractor has ceased entering refund and adjustment data
on the DCS, refunds may be received and/or TED adjustments may still
be submitted for claims in Open and Pending sets.
In this case, the incoming contractor may be required to resolve
the set without knowing the amount of the refund received by the
outgoing contractor.
4.1.13 If the actual recoupment amount was zero when
the set was transferred from the outgoing contractor, the incoming
contractor may apply the adjustment to the set while leaving the
actual recoupment amount as zero dollars. Resolution would result
in a Validate status, requiring an explanation
by the incoming contractor that the outgoing contractor did not
enter the actual recoupment amount.
4.1.14 Following the SHCD, the DCS will begin displaying
identified potential duplicate claim sets for which the incoming
contractor has responsibility for resolving. The incoming contractor
shall begin using the DCS to resolve potential duplicate claim sets
in accordance with the TSM,
Chapter 4 and
the IMP/IMS requirements.
4.1.15 The incoming contractor shall assume full responsibility
for resolving all existing potential duplicate claim sets from the
outgoing contractor (including completing existing recoupments)
and for all new potential duplicate claims sets as agreed upon during
the transition meeting.