TRICARE Manuals - Display Chap 3 Sect 1.1 (Change 26, Jun 28, 2019)

Defense Enrollment Eligibility Reporting System (DEERS)

Chapter 3

Section 1.1

General

Revision:

1.0 Introduction

1.1 The Defense Manpower Data Center (DMDC) maintains the largest, most comprehensive central repository of personnel, manpower, casualty, pay, entitlement, personnel security, person identity and attributes, survey, testing, training, and financial data in the Department of Defense (DoD). DMDC is the central source to identify, authenticate, authorize, and provide information on personnel during and after their affiliation with DoD. DMDC is the one central access point for; information and assistance on DoD entitlements, benefits, and medical readiness for Uniformed Service members, veterans, and their families.

1.2 The Defense Enrollment Eligibility Reporting System (DEERS) is a vital component of DMDC and is a person-centric centralized data repository of DoD personnel and medical data, and the National Enrollment Database (NED) for the portability of the Military Health System’s (MHS) worldwide TRICARE program.

1.2.1 DEERS is a computerized database for United States (U.S.) Service members, retirees, dependents, DoD civil servants, DoD contractors, and others worldwide who are entitled to DoD benefits or are entitled to DoD-issued Public Key Infrastructure (PKI).

1.2.2 DEERS is used by the Real-Time Automated Personnel Identification System (RAPIDS). RAPIDS is the DoD system used to issue the DoD Common Access Card (CAC) and Uniformed/Military Identification (ID) cards.

1.2.3 DEERS is also used to support the business execution of TRICARE Program support contractors. This chapter describes and defines that support.

2.0 Application

2.1 This chapter provides all TRICARE Program support contractors operational guidance for interacting with DMDC systems:

• Beneficiary identification/authentication; and

• DoD entitlements/TRICARE benefits information.

2.2 When required by specific contract requirements:

• Enrollment processing;

• Enrollment premiums/fees maintenance (includes fee exclusion);

• Claims processing (with associated address updates);

• Catastrophic Cap And Deductible (CC&D) information;

• Other Health Insurance (OHI) Program; and

• Standard Insurance Table (SIT) Program.

3.0 Contractor Responsibility

This chapter is applicable to all contractors that provide health care support to the TRICARE Program and require interactions with DEERS to execute the business requirements of their contract(s).

3.1 Technical Requirements

3.1.1 DMDC/DEERS provides contractors with detailed technical information and guidance on system to system interfaces and required web-based interactions through tables, figures, guides, user manuals, etc., to ensure contractors meet their business obligations within their respective contracts.

3.1.2 Contractors will be provided the appropriate technical guidance documents by the Defense Health Agency (DHA). These DMDC/DEERS technical guidance documents may be updated as needed with proper notice and coordination with DHA and the contractors.

3.1.3 Deviation from the intended technical concept of operations between contractors and DEERS described in this chapter and materials/documents on the DMDC/DEERS web site is at contractors’ technical and financial risk.

3.2 DMDC Authentication Service

Contractors shall use and support the DMDC Authentication service. The DMDC Authentication service supports the DoD approved enterprise self-service credential called the DoD Self-Service Logon (DS Logon) account (see Chapter 1).

3.3 Site Security Manager(s)

Contractors are responsible for designating a primary Site Security Manager (SSM) and one backup to manage all contractor users and their access to DEERS applications. The appointed SSM and alternate are required to complete an on-line training certification at initial appointment and yearly thereafter. SSMs will use Security application(s) provided by DEERS to establish users and grant access to applications and other privileges. All SSMs are required to remove access to all DEERS systems immediately upon departure of an employee from performing the function.

3.4 Process Deviations and Unscheduled System Down Time

Unless authorized by the Contracting Officer (CO) or Contracting Officer’s Representative (COR), contractors may not bypass or deviate from the DEERS specified query/response process. If either DEERS or a contractor is down for 24 hours or any other extended period of time, contractors shall work directly with DEERS and the DHA to develop a mutually agreeable method and schedule for processing the backlog or implementing their disaster recovery processes.

4.0 DEERS System Description

4.1 DEERS major system components include:

• Person repository provides identification and lists DoD benefits for individuals that are listed in DEERS.

• NED identifies enrollment status and supports enrollment maintenance for benefit delivery.

• Primary Care Manager (PCM) repository is a central repository that contains both Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM) and Network PCMs used to support the Prime enrollment process.

• Centralized Catastrophic Cap and Deductible Data (CCDD) repository contains all CC&D data that applies to TRICARE programs.

• OHI repository contains a listing of OHI policies reported to DEERS.

• SIT Database contains health insurance carrier information used in support of OHI.

4.2 Major communities that DEERS interfaces with include:

• DoD service personnel systems.

• Centers For Medicare and Medicaid Services (CMS) and the State Medicaid agencies.

• Person Data Repository (PDR), or equivalent repository under evolving DoD/MHS Information Technology (IT) systems development/acquisition.

• Clinical Data Repository (CDR), or equivalent repository under evolving DoD/MHS IT systems development/acquisition.

• MHS and MTF/eMSM for clinical, patient appointing, and Referral Management (RM) programs.

• TRICARE pharmacy support contractors/claims processors, including Pharmacy Data Transaction Service (PDTS).

• TRICARE dental support contractors/claims processors.

• TRICARE medical support contractors/claims processors.

• Uniformed Services Family Health Plan (USFHP) Providers, as required by statute or policy.

• TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC) contractor/claims processors.

• Nurse Advice Lines (NALs).

• Beneficiary Services Officers.

• Continued Health Care Benefits Program (CHCBP) administrator/claims processor.

• Department of Veterans Affairs (DVA).

• Other organizations as required.

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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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