3.1 Research
Assistance
The contractor shall provide immediate
assistance to the Government in support of the debt collection assistance
function. In addition to identifying specific underpayments, the
contractor shall also:
3.1.1 Designate specific individuals
and provide resources to work collection issues with Government
representatives during normal weekday business hours.
3.1.2 Provide
Web-site access and/or e-mail addresses, mailing addresses, fax
numbers and direct phone number(s) of specialized collections research
and support staff to the Government.
3.1.3 Maintain records and processing
statistics on collection activity. The records to be maintained
shall include a detailed chronological record of all actions taken,
including names and telephone numbers of all parties contacted in
the course of the actions taken, as well as copies of all correspondence
sent and received.
3.1.4 When violation of the participation
agreement or balance billing is not at issue, issue letters to providers
and conduct provider education when the provider was at fault.
3.1.5 The
contractor shall furnish reports of all completed collection cases.
3.1.6 In newsletters
and other materials, publicize and educate beneficiaries and providers
on the Debt Collection Assistance Program. This shall include informing
providers of the availability of the contractor’s support services
to assist in resolution of claims problems, and encourage providers
to contact the contractor’s priority unit for assistance prior to
initiating any collection action. If the contractor is asked to
participate in beneficiary, sponsor or provider training, workshops
or briefings at Military Treatment Facilities (MTFs)/Enhanced Multi-Service
Markets (eMSMs) or elsewhere in the Region in accordance with specific
regional requirements, the contractor shall ensure the Debt Collection
Assistance Program is a topic.
All requests for expedited payment will be
coordinated through the TRICARE contractor for the region. When
research reveals a processing error by the contractor or subcontractor,
any additional payment due shall be processed on an expedited basis,
and the contractor’s response to the Government shall reflect an
expected date of payment.
3.3 Referrals
to Program Integrity, Defense Health Agency (DHA)
When
it has been determined that balance billing or violation of the
participation agreement is at issue, the matter will continue to
be handled in accordance with the existing program integrity guidelines
contained in
Chapter 13, Section 2.