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TRICARE Operations Manual 6010.59-M, April 1, 2015
Transitions
Chapter 2
Section 1
Management and Administration
Revision:  C-26, May 30, 2018
1.0  Contract Transition
1.1  Transition Specifications Meeting
1.1.1  The incoming and outgoing contractors shall attend a two to four day meeting with the Defense Health Agency (DHA) within 15 calendar days following contract award. This meeting is for the purpose of developing a schedule for phase-in and phase-out activities. DHA will notify the contractor(s) as to the exact date and location of the meeting. Contractor representatives attending this meeting shall have the experience, expertise, and authority to provide approvals and establish project commitments on behalf of their organization.
1.1.2  The outgoing contractor shall provide a proposed phase-out plan at the Transition Specifications Meeting.
1.2  Interface Meetings
Within 30 calendar days from contract award, the incoming contractor shall arrange meetings with Government and external agencies to establish all systems interfaces necessary to meet the requirements of this contract. DHA representatives shall be included in these meetings.
2.0  Integrated Master Plan (Imp) And Integrated Master Schedule (IMS)1
2.1  The contractor shall submit an IMP and IMS as identified by DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract, to allow Government oversight of transition progress. The contractor’s IMP shall demonstrate that the contract transition is structured to provide a balanced technical approach, to minimize and control risk, to accomplish up-front summary planning and commitment, and to provide a basis for subsequent detailed planning. The IMP shall include milestones and measurable indicators that can be used to evaluate the contractor’s satisfactory progress toward being fully capable of delivering health care services at the start of health care delivery (SHCD).
2.2  The IMP/IMS shall address all processes and interdependencies associated with the provision of services to TRICARE beneficiaries. Interdependencies may include data such as exchanges, interfaces, and documents from the outgoing contractor and other entities, e.g., Defense Manpower Data Center (DMDC) and Military Treatment Facilities (MTFs)/Enhanced Multi-Service Markets (eMSMs).
2.3  The contractor shall identify an individual responsible for transition management who will serve as the single point of contact for the Government for all transition activities. This individual will be the overall coordination point for the management of the IMP and IMS and coordinate and integrate interdependencies with the outgoing contractor and other entities associated with the transition of the contract.
2.4  The IMP shall include the contractor’s in-process verification approaches. The IMP shall provide the Government the ability to validate progress in order to make informed decisions. If multiple tasks are combined and identified in the IMP as a single event, sufficient detail shall be provided to clearly identify all subtasks related to the single action.
2.5  The contractor’s IMP/IMS shall address the contractor’s plan to mitigate identified risks. The IMP shall be supported by a Risk Management Plan (RMP) that identifies risks to the successful execution of the contractor’s IMP, to include risks resulting from interdependencies on activities by other parties associated with the transition. The IMP shall include a Risk Management Strategy that clearly demonstrates how the contractor plans to mitigate risks identified in the RMP.
2.6  The IMP/IMS shall include a subsection specific to Information Systems (IS). The IS subsection shall identify the management process and schedule to be used to develop and implement all IS, technical interfaces and security protocols. At a minimum, the subsection shall include contractor developed systems/applications, contractor and Government security, connectivity with all Government interfaces and applications and testing. The IS subsection shall be maintained and updated as appropriate to reflect changes to development and implementation of IS.
2.7  The contractor shall coordinate data conversion and testing activities with the Government and submit required documents within the timeframes established during integration/testing meetings, i.e. Test Plan, and Test Scenarios as indicated in the IMP/IMS, but no later than 30 days following the Systems Integration Interface Meeting.
2.8  The IMP/IMS shall include a subsection that provides a staffing plan that delineates the hiring and training schedule of employees relevant to the stand-up of the contractor’s responsibilities. The Plan and Schedule should be incorporated into the contractor’s IMP/IMS. The training schedule shall be developed in order to ensure staff is trained with the requisite knowledge to perform the responsibilities of their position.
2.9  The contractor shall develop processing guidelines, desk instructions/user’s manuals and reference materials for internal use, at least 10 calendar days prior to the SHCD. Desk instructions shall be available to each employee in the immediate work area. Reference materials such as procedure codes, diagnostic codes, and special processing guidelines, shall be available to each work station with a need for frequent referral. Other reference materials shall be provided in each unit with a reasonable need and in such quantity as to ensure the ease of availability needed to facilitate work flow. Electronic versions may be used.
2.10  Contractor Weekly Status Reporting
The contractor shall provide a weekly status report of IMP/IMS providing transition schedule progress, identifying schedule modifications and impacts, as identified in DD Form 1423, CDRL, located in Section J of the applicable contract. The contractor shall document meetings with formal minutes and submit them as identified in DD Form 1423, the CDRL, located in Section J of the applicable contract.
2.11  Outgoing Contractor Weekly Status Reporting
Until all claims inventories have been processed, the outgoing contractor shall submit a weekly status report of inventories and phase-out activities to DHA beginning the 20th calendar day following the Specifications Meeting until otherwise notified by the Procuring Contracting Officer (PCO) to discontinue. This shall be done in accordance with specifications of the official transition schedule.
3.0  Performance Readiness Validation (PRV) And Performance Readiness Assessment And Verification (PRAV)
3.1  During contract transition, the contractor shall conduct validation reviews to assess their performance readiness in seven critical performance areas. This self-assessment process is called PRV. The seven critical performance areas that are subject to PRV reviews are:
•  Provider networks;
•  Enrollment;
•  Customer service;
•  Management;
•  Referral management;
•  Claims processing; and
•  Medical management.
PRV activities and milestones shall be identified in the IMP/IMS and shall be reported to the Government via the Weekly Status Report.
3.2  Following the completion of PRV activities, the contractor shall provide the Government transition team(s) with a comprehensive briefing on the processes, results, and findings of all PRV reviews. The briefing shall include a description of specific performance issues and/or risks identified by the contractor, lessons learned, and a comprehensive discussion of the steps contemplated or taken by the contractor to ensure full performance readiness at the SHCD. A revised IMP/IMS will be submitted if the contractor anticipates any significant deviation from any stated activities and milestones.
3.3  Following the completion of the PRV briefing, the Government will conduct PRAV activities to assess and verify the contractor’s readiness to perform in the seven critical performance areas identified in paragraph 3.1. PRAV activities will be conducted by one or more Government transition teams utilizing a variety of methods, including, but not limited to: on-site testing/inspection at one or more contractor and/or subcontractor locations; remote assessment via telephone or other method; random sampling of contractor’s work products; direct observation of contractor performance and systems operability; and evaluation of transition deliverables and data as required by the contract. Projected PRAV dates, location(s), transition team structure, and specific assessment/verification methods will be identified by the Government during the transition specification meeting.
3.4  Following the completion of all PRAV activities, the Government shall provide a summary out brief to the contractor on the processes, results, and findings of all PRAV activities. Results will be briefed as assessed or verified performance against PRAV acceptable quality levels in each critical performance area.
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Department of Defense, Integrated Master Plan and Integrated Master Schedule Preparation and User Guide, Version 9, October 21, 2005 Defense Acquisition University (http://www.DAU.mil).

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