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TRICARE Operations Manual 6010.59-M, April 1, 2015
TRICARE Prime Remote (TPR) Program
Chapter 16
Section 3
Enrollment, Beneficiary Education, And Support Services
Revision:  C-1, March 10, 2017
1.0  Enrollment
1.1  The TRICARE Regional Offices (TROs) will, on an as needed basis, but at least semi-annually, provide the contractor with an update to the TRICARE Prime Remote (TPR) directory of units whose members are eligible for enrollment in the program according to Section 1, paragraph 3.0.
1.2  An enrollment request must be submitted by either the Service member or the Service member’s unit commander for each Service member enrolling in the TPR Program. The effective date for TPR Program enrollment is the date the Service member or the Service member’ s unit commander submitted the enrollment request. An official enrollment request includes those with:
•  An original signature;
•  An electronic signature offered by and collected by the contractor;
•  A verbal consent provided vial telephone and documented in the contractor’s call notes; or
•  A self-attestation by the beneficiary when using the Government furnished web-based self-service enrollment system/application.
A Service member signature is not required to make enrollment changes using the Enrollment Portability process outlined in Chapter 6, Section 2, paragraph 1.4. A signature in not required to complete the enrollment.
1.3  Service member enrollment in the TPR Program will be for the tour of duty. Enrollment transfers or disenrollments will occur upon change of duty location out of the region, transfer into an Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM)/clinic Prime Service Area (PSA), retirement, or separation from the service. The Service member is responsible for notifying the contractor when an enrollment transfer is needed. The contractor shall follow enrollment portability and transfer procedures in Chapter 6, Section 2.
1.3.1  If at any point during the enrollment period the contractor determines or is advised that a Service member is no longer eligible for TPR, the contractor shall notify (letter, telephone call, or e-mail) the Service member of the discrepant enrollment immediately.
1.3.2  If the discrepant enrollment is not corrected within 30-days of the notification date, the contractor shall disenroll the Service member from TPR effective the first of the month after the 30-day notification period. The contractor shall use the address in Defense Enrollment Eligibility Reporting System (DEERS) to reassign the Service member to TRICARE Prime at an MTF/eMSM utilizing the MTF/eMSM enrollment guidelines.
1.4  The contractor shall record the Service member’s TPR enrollment in the DEERS via Government furnished web-based system/application. The TPR enrollment card is provided by Defense Manpower Data Center (DMDC). When processing TPR enrollment requests from Service member astronauts, the contractor shall not assign the astronauts to a network or other TRICARE authorized Primary Care Manager (PCM). The National Aeronautics and Space Administration (NASA) providers shall provide primary care for the Service member astronauts and the contractor shall use the PCM (unassigned) procedure when enrolling Service member astronauts into the TPR program. The contractor shall coordinate referrals and authorizations from the NASA providers for TPR enrolled Service member astronauts in accordance with Section 2, paragraph 5.2 and its subordinate paragraphs.
2.0  Primary Care Manager (PCM) Assignment
At the time of enrollment, a Service member will select (or will be assigned) a PCM in the local community, if available. A Service member without an assigned PCM may use a local TRICARE-authorized provider for primary care.
3.0  Beneficiary Education
3.1  Enrollment in the TPR Program is mandatory for Service members who qualify for the program (see Section 1, paragraph 2.0); therefore, the contractor shall limit educational activities for TPR-enrollees to distributing the informational materials provided by the Government. The TROs will determine the initial supply (if hard copies are used) of materials required and the contractor shall forward materials to the TPR Program Units. The contractor shall include enrollment request options (enrollment forms, the Government furnished web-based self-service enrollment system/application transactions, and telephonic requests documented in the contractor’s call center notes), for the TPR Program in the Service member informational materials.
3.2  Educational issues include the PCM concept (and what procedures to follow when a network PCM is not assigned), how to access care in and out of the area using the contractor, how to access specialty care through the contractor and Specified Authorization Staff (SAS), and information on filing medical claims.
3.3  The Government will provide all TPR enrollees with information about how to obtain self-care manuals (hard or electronic versions). The contractor shall give TPR-enrolled Service members and their family members the option of participating in health promotion and wellness programs offered by the contractor in MTF/eMSM PSAs.
3.4  Educational activities in the TPR Program areas shall involve the joint efforts of the service unit of the Service member, the SASs, the Service Medical Departments, the TROs, and the contractor. The contractor shall distribute Defense Health Agency (DHA)-supplied educational materials unique to the TPR Program. Contractor shall consider multiple, contemporary avenues of access (for example, e-mail, World Wide Web (WWW), telephone, texting, smart phone applications, and other social media) to distribute these educational materials to the Service member and their beneficiaries. If the contractor uses traditional mail, the contractor is responsible for postage, envelopes, and mailing costs for distributing educational material.
4.0  The contractor shall include TPR Program information and updates as part of all TRICARE briefings. The contractor may propose alternative methods for supplying educational information to Service members eligible to enroll in the TPR Program.
5.0  Support Services
5.1  General
The requirements and standards in Chapters 1 and 11, apply to the TPR Program unless otherwise stated in this chapter.
5.2  Inquiries
The contractor shall designate a point of contact for Government inquiries related to the TPR Program. The contractor may establish a dedicated unit for responding to inquiries about the TPR Program and the Supplemental Health Care Program (SHCP). The contractor shall respond to all inquiries--written, telephone, walk-in (overseas only), etc.-- that are not related to dental care or to SAS reviews of medical care. The contractor shall forward all inquiries that specifically address dental care or SAS review of medical care to the active duty dental claims processor or the TPR enrollee’s SAS for response. The requirements and standards in Chapter 1, Section 3, apply to TPR inquiries.
5.3  Toll-Free Telephone Service
The contractor shall provide toll-free telephone access for TPR Program beneficiary inquiries. This toll-free access may also serve the SHCP beneficiaries. See Chapter 1, Section 3 for telephone standards. The contractor shall handle provider inquiries through the contractor’s provider inquiry system.
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