Combined Synopsis/Solicitation
TRICARE Medicare Eligible Program Second Generation (TMEP2)
Department of Defense · Defense Health Agency (DHA)
AI summaryThe Defense Health Agency wants a contractor to process health care claims and run customer service for military beneficiaries who have both Medicare and TRICARE, covering care in the U.S., Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands. It is a full and open, best value, firm-fixed-price competition with a one-year transition-in base period, seven one-year periods of service, and a possible 6-month extension, for up to 8.5 years. The work is very large (about 2.6 million beneficiaries and roughly 62 million claims a year), so it favors firms that already run federal-scale claims and call center operations. More in the summary
AI summary Beta
Summary of the version posted Sep 28, 2026. The notice was amended Oct 28, 2026. The due date moved from Nov 5, 2026 to Dec 3, 2026. Check what else changed on SAM.gov. This summary may miss requirements: 5 of 17 attachments weren't read (Exhibit L-9 - TMEP CY24_25_26 Manual Changes Modification Log.xlsx, Exhibit L-3 - RFP-Cross-reference Matrix.xlsx and 3 more). Check the attachments on SAM.gov.
The Defense Health Agency wants a contractor to process health care claims and run customer service for military beneficiaries who have both Medicare and TRICARE, covering care in the U.S., Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands. It is a full and open, best value, firm-fixed-price competition with a one-year transition-in base period, seven one-year periods of service, and a possible 6-month extension, for up to 8.5 years. The work is very large (about 2.6 million beneficiaries and roughly 62 million claims a year), so it favors firms that already run federal-scale claims and call center operations.
Who can bid (7)
- Open to all businesses (no set-aside), but every offeror, large or small, must show at least 3 percent of total contract value going to small businesses as prime or subcontractors, with a credible good-faith strategy
- Recent past performance: work must have been ongoing for at least six months and performed within three years of the solicitation date, and is judged against the size of this program (beneficiaries, claims, calls, authorizations)
- Adequate financial resources to perform, reviewed as part of the contracting officer's responsibility determination
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- Security certifications (physical, personnel and NIST) are part of the transition-in work before services start
- Contractor acts as a Peer Review Organization (PRO) under 32 CFR Part 199.15 on claims where TRICARE is the primary payer
- Hire an independent auditing firm with SSAE audit experience for an annual SOC 1 Type 2 report (and bridge letters)
- Call center must operate around the clock, every day of the year
How to submit: due Nov 5, 2026 17:00 (UTC-07:00), as given in the SAM.gov response deadline field. What to include is under Full summary below. Check the solicitation's instructions on SAM.gov.
Things to watch (8)
- Serious: Very large scale. The program covers over 2.6 million dual-eligible beneficiaries and about 62 million net claims received in 2025, which few small businesses can staff or fund without a large teaming partner.
- Serious: Past performance must match the size of the program. Relevance is judged on beneficiaries, claims, calls and authorizations, and unrelated or too-small experience is rated Not Relevant, which leaves a new firm with a neutral rating at best.
- Serious: Must integrate with government systems and pass security checks. Work depends on DEERS eligibility files, TED reporting to DHA and Medicare's recovery contractor, plus security certifications during transition-in, which is costly to build and test.
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- Worth checking: Strict performance standards and financial incentives. The surveillance plan says the contract has positive and negative incentives and performance guarantees, and TED accuracy must climb to 97 percent, so missed targets can cost money.
- Worth checking: Fixed prices on estimated volumes over many years. Unit prices are fixed while claim counts are only estimates, and pricing is checked for unbalanced pricing across about eight years.
- Worth checking: Small business participation floor. A proposal that does not show at least 3 percent small business participation is rated Unacceptable, even for large primes.
- Minor: Schedule dates and labels look inconsistent. Several admin CLINs for later option periods list the FY30 dates and one transition-out CLIN is mislabeled, so questions to the contracting officer may be needed before pricing.
- Minor: Several documents are drafts or were not readable. The QASP and CDRLs are marked draft and the pricing template and other spreadsheets were not available, so final terms could change.
Read from the notice and 12 attachments. 5 of 17 not read. Show which files.
- HT940226R0001-20260923.pdf (read)
- HT940226R0001 Amd 0001 20260924.pdf (read)
- Attachment J-1 DMDC Eligibility File Layout TMEP.pdf (read)
- Attachment J-3 CDRLs.pdf (read)
- Attachment J-4 TMEP 2 Chapter 20 Clean Draft Copy 20260730.pdf (read)
- Attachment J-5a QASP TMEP2 DRAFT.pdf (read)
- Exhibit L-1 - Beneficiary Data.pdf (read)
- Exhibit L-2 - Historical Data.pdf (read)
- Exhibit L-5 - Sample Client Authorization Letter.pdf (read)
- Exhibit L-6 - Subcontractor Consent Letter.pdf (read)
- Exhibit L-8 - Small Business Participation Commitment.docx (read)
- Attachment J-2 Beneficiary Satisfaction Survey.pdf (read)
- Exhibit L-9 - TMEP CY24_25_26 Manual Changes Modification Log.xlsx: not read (the AI doesn't read this file type yet): open it on SAM.gov
- Exhibit L-3 - RFP-Cross-reference Matrix.xlsx: not read (the AI doesn't read this file type yet): open it on SAM.gov
- Attachment J-5b QASP Matrix TMEP2 DRAFT.xlsx: not read (the AI doesn't read this file type yet): open it on SAM.gov
- Exhibit L-7 - TMEP2 Pricing Template.xlsx: not read (the AI doesn't read this file type yet): open it on SAM.gov
- Exhibit L-4 - Past Performance Questionnaire.pdf: not summarized: open it on SAM.gov
Full summary
What they want
- Process Medicare crossover claims (electronic and paper) for TRICARE and Medicare dual-eligible beneficiaries under the TRICARE manuals, applying deductibles, copayments, cost shares and catastrophic caps and coordinating other insurance
- Submit TRICARE Encounter Data (TED) to DHA and meet strict timeliness and accuracy standards
- Handle pre-authorizations (including skilled nursing facility care), check medical necessity and honor authorizations from the managed care support contractors
- Run customer service: 24/7 call center, IVR phone system, beneficiary and provider web portal, explanations of benefits, appeals and correspondence
- Verify providers, pay them by electronic funds transfer, and prevent duplicate payments
- Provide management, quality, program integrity and anti-fraud functions, required reports (CDRLs) and an annual SOC 1 Type 2 audit
- Complete a transition-in (security certifications, agreements with other TRICARE contractors and Medicare's recovery contractor) before services start, and a transition-out at the end
- Earn a beneficiary satisfaction incentive based on telephone survey scores
- Contract type
- Firm-fixed-price, with fixed unit prices on estimated quantities (per electronic and paper claim, monthly admin fees) and a beneficiary-satisfaction incentive
- Period of performance
- One 12-month base period of transition-in (10/01/2028 to 09/30/2029), seven 1-year option periods for health care delivery (10/01/2029 through 09/30/2036), transition-out, and a possible 6-month extension under FAR 52.217-8; potential total of 8.5 years
- Place of performance
- USA per the notice. Beneficiaries are in the U.S., Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands; the contractor provides its own facilities and the evaluation mentions remote personnel. No specific site is required in the text provided.
- Estimated value
- Not stated
- How they'll choose
- Best value trade-off in a full and open competition (technical/risk, past performance, price, and small business participation scored acceptable or unacceptable)
- Offers due
- Nov 5, 2026 17:00 (UTC-07:00), as given in the SAM.gov response deadline field (from the version posted Sep 28, 2026; amended since)
What they'll judge offers on
- Technical (Volume II): Subfactor 1 Claims processing, Subfactor 2 Customer service, Subfactor 3 Management functions, Subfactor 4 Transition management
- Past performance (Volume III): up to 3 recent and relevant references for the prime and 1 per major subcontractor
- Price (Total Evaluated Price across the base, seven option periods and the 6-month extension plus the highest Transition-Out CLIN; checked for reasonableness and unbalanced pricing)
- Small business participation (Volume V): acceptable or unacceptable, minimum 3 percent of total contract value
- Financial viability (Volume VI): checked as part of the contracting officer's responsibility determination
What to include when you submit
- Section L (proposal instructions) was mostly left out of the text provided, so the submission method and page limits are not confirmed; the solicitation contact on the form is Addison Sexton, 303-676-3594, and the amendment lists David Smith at david.c.smith139.civ@health.mil
- Proposal is organized in volumes: Volume II Technical, Volume III Past Performance, Volume V Small Business Participation, Volume VI Financial Viability (Volume I and IV contents are not shown)
- Acknowledge Amendment 0001 before the due date (return signed copies, or send a letter or electronic message that cites the solicitation and amendment numbers)
- Complete the pricing template (Exhibit L-7) and the Small Business Participation Commitment (Exhibit L-8, which must total 100 percent between large and small business)
- Past performance: include client authorization letters (Exhibit L-5) and subcontractor consent letters (Exhibit L-6), which are exempt from the page count, and Past Performance Questionnaires (Exhibit L-4)
- Fill in the SF 1449 offer blocks 12, 17, 23, 24 and 30 and sign
Current contractor
Not named. The notice calls this the continuing requirement and the name TMEP2 (Second Generation) and the transition-in and outgoing contractor language show a current contractor exists, but no company or contract number is given in the text provided.
Not in the notice text
- Total contract value and the actual unit prices (the pricing template, Exhibit L-7, is a spreadsheet that was not read)
- Relative importance of the evaluation factors and subfactors (that part of Section M was left out)
- Proposal submission method, volume contents and page limits (most of Section L was left out)
- Section G, H and K details such as the incentive formulas, performance guarantees, claims audit review and required certifications (the middle of the main RFP was left out)
- Offer due time zone as stated in Block 8 of the SF 1449 (SAM.gov field shows 17:00 at UTC-07:00)
- Expected award date and how long prices must be held, since performance starts in October 2028
- Identity of the current contractor
- Contractor facility location rules, staffing and key personnel requirements
- Content of Exhibit L-4 Past Performance Questionnaire, Exhibit L-3 cross-reference matrix, Exhibit L-9 manual changes log and QASP matrix J-5b (not read)
- Middle sections of the CDRLs and TRICARE Operations Manual Chapter 20 that were left out
Eligibility and how to respond
- No set-aside: any business, large or small, can bid unless the notice says otherwise.
- How and where to submit is in the notice text and its attachments on SAM.gov.
- Service contracts usually set minimum pay rates (the Service Contract Act). Price the labor with the SCA price calculator.
Notice details
- Posted
- Oct 28, 2026
- Notice type
- Combined Synopsis/Solicitation
- Office
- Defense Health Agency, Aurora, CO
- Product/service code
- Q201 · Medical – Managed Healthcare
- Business type
- Consulting & professional services (FedReady's grouping, from NAICS 524292)
- Versions
4 versions have been posted, newest first.
- Oct 28, 2026 · Amendment 0001 (this version)Due Dec 3, 2026 (changed)
- Sep 28, 2026 · AmendmentDue Nov 5, 2026
- Sep 25, 2026 · AmendmentDue Nov 5, 2026
- Sep 23, 2026 · Combined Synopsis/SolicitationDue Nov 5, 2026
- Attachments
Past awards and competition
Who has won work like this before, the likely incumbent, and what similar contracts paid, from USAspending.gov.
Before you respond
- How to respond to a solicitation (8 steps)
- How to read a government solicitation
- How to price a government contract
Terms on this notice: Solicitation
Full notice text from SAM.gov
28 Oct 2026: The TRICARE Medicare Eligible Program Second Generation SAM.gov posting is being updated to reflect a change in proposal due date. The new due date for TMEP2 RFP Proposals is December 03, 2026, at 5.p.m. MST.The DHA anticipates to have responses to questions before receipt of proposals out within the next few weeks. An RFP amendment will follow the Q&A posting to SAM.gov to address questions raised on the Q&A. 25 Sep 2026: Uploaded signed version of the basic RFP and Amendment 0001 that updates the sensitivity labels of Section J, Attachment J-5b and Exhibits L-7, L-8, L-9. This acquisition is for the continuing requirement for health care claims processing, customer support and other associated administrative services (e.g. submission of TRICARE encounter data and provider certification) of dual-eligible Medicare and TRICARE beneficiaries who receive medical services within the United States, Puerto Rico, Guam, US Virgin Islands, American Samoa, and Northern Mariana Islands. USC Title 10, Chapter 55, and USC Title 32, National Defense, Code of Federal Regulations (CFR) Part 199, outline the benefit structure, administrative functions and the various health care programs, including TMEP2. This is a full and open competitive source selection, using best value trade-off procedures in accordance with RFO Federal Acquisition Regulation (RFO FAR) 15.2, Evaluation and Award, as supplemented with Defense FAR Supplement and the DoD Source Selection Procedures (August 2022). The contract awarded will be a Firm Fixed-Price contract. The contract will have a one 12-month base period of transiotion-in activiteis, seven 1-year periods for healthcare delivery, a one 12-month contract period for transition-out activities, and a potential 6-month extension of services permitted per RFO FAR Clause 52.217-8, Option to Extend Services, for a potential total period of performance of 8.5 years.
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