TRICARE Manuals - Display Chap 11 Sect 4 (RFP Baseline, Apr 6, 2021)

Communications and Customer Service (C&CS)

Chapter 11

Section 4

Inquiry Services Department - General

Revision:

1.0 INQUIRY SERVICE DEPARTMENT OBJECTIVES

The contractor shall implement an inquiry processing system which tracks and reports on telephonic and written inquiries standards in accordance with Chapter 1, Section 3. For reporting requirements, see DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract.

2.0 TELEPHONES

The contractor shall provide trained personnel to answer all TRICARE inquiries in accordance with Chapter 1, Section 3.

3.0 TRAINING OF SERVICE REPRESENTATIVES

3.1 The contractor shall provide documented training to its Customer Service Representatives (CSR) to include, but not limited to, TRICARE plans and programs; Privacy Act and Freedom of Information Act (FOIA) requirements; Health Insurance Portability and Accountability Act (HIPAA); fraud and abuse; medical terminology; effective listening; familiarity with military traditions and culture, courteous customer service and dealing with difficult customers.

3.2 The contractor shall measure and assess CSR knowledge and performance to effectively communicate and answer inquiries accurately and completely in accordance with call center quality assurance standards.

3.3 The contractor shall provide a monthly results report of call center quality monitoring. For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract

3.4 The contractor shall identify training opportunities for CSRs through the use of customer service calls to continuously improve processes, scripts and work instructions.

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