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.