TRICARE Manuals - Display Chap 24 Sect 15 (Change 91, Jun 25, 2021)

TRICARE Overseas Program (TOP)

Chapter 24

Section 15

Audits, Inspections, Reports, And Plans

Revision: C-72, September 10, 2020

1.0 General

All TRICARE requirements regarding audits, inspections, reports, and plans shall apply to the TRICARE Overseas Program (TOP) unless specifically changed, waived, or superseded by the provisions of this section; the TRICARE Policy Manual (TPM), Chapter 12; or the TRICARE contract for health care support services outside the 50 United States (U.S.) and the District of Columbia (hereinafter referred to as the “TOP contract”). See Chapter 14 for additional instructions.

2.0 Audits And Inspections

2.1 The TRICARE Overseas Currency reports, and the claims supporting them, are subject to audit by Defense Health Agency (DHA) or other authorized Government auditors as part of any financial audit.

2.2 The claims auditing software requirements outlined in the TRICARE Reimbursement Manual (TRM), Chapter 1, Section 3 do not apply to TOP claims.

3.0 Reports And Plans

3.1 All TOP reports and plans shall be submitted to DHA in accordance with Chapter 14, unless a different method of submission is identified by the DD Forms 1423, Contract Data Requirement Lists (CDRLs), located in Section J of the applicable contract.

3.2 Reports must be sortable by all fields and by TOP Region/TRICARE Area Office (TAO) unless a different format is specified by the Government.

3.3 All reports and plans shall be titled as identified in DD Forms 1423, CDRLs, located in Section J of the TOP contract.

3.4 All reports and plans shall contain the contact information for contractor personnel who were involved in preparation of the report/plan, and who can be contacted if questions arise.

3.5 All reports and plans shall contain a legend for abbreviations or other terms used in the report.

3.6 All TRICARE requirements regarding Health Insurance Portability and Accountability Act of 1996 (HIPAA) and privacy of Individually Identifiable Health Information (IIHI) shall apply to TOP reports and plans.

3.7 Chapter 14, Section 2, paragraph 1.0 does not apply to the TOP contract.

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