Sources Sought -Outpatient Prospective Payment System (OPPS) Pricer Software

The Defense Health Agency (DHA), Ft Sam Houston, TX intends to issue a sole source contract award to 3M for Software (SW) with a base period of performance beginning 22 December 2024 – 21 December 2025, and Two (2) one (1) year options. The 3M Outpatient Code Editor (OCE) Software, edits and processes hospital outpatient claims and the TRICARE Pricer Software, determines how to price claims based on the output from the TRICARE OCE which coincides with that of the Centers for Medicare and Medicaid Services (CMS).

TRICARE Health Plan (THP) is responsible for editing and processing hospital outpatient claims for TRICARE eligible beneficiaries. The fundamental functionality required by THP is for the licensing of a mainframe version of a TRICARE specific Outpatient Prospective Payment System (OPPS) Pricer. Both, 3M’s OCE and Pricer, are compatible with the 3M mainframe and licensing PC software currently used by THP which sanctions the auditing and verification of accuracy of payment for hospital outpatient claims.

Additionally, THP is statutorily mandated to follow CMS’ reimbursement rules, and 3M’s OCE and Pricer software have been authorized by CMS. All interested sources may submit a capability statement that identifies business size, along with authorized letter from the manufacturer with detailed information and convincing evidence that clearly demonstrates the authority to provide the software as outlined above.