Reports
Chapter 14
Section 2
Special Reports
Revision: C-26,
May 30, 2018
1.0 General
1.1 The contractor shall provide special
programming reports to the Defense Health Agency (DHA) on an “as
needed” basis. The DHA Procuring Contracting Officer (PCO) will
not request a special programming report more than 10 times per
contract period. The PCO will tell the contractor what information
to include in the report. Examples of these reports include claims
history data (either limited or complete) by provider, including
one or more sub-identifiers; beneficiary; specific diagnosis(es);
specific procedure code(s); and/or geographic region delineated
by zip code(s). The contractor shall submit the reports by means
of electronic medium or a disc as specified by the PCO. The contractor
shall provide the completed reports to the PCO at DHA-Aurora within
60 calendar days of the date on the written request from the PCO.
1.2 If special
reports are requested by DHA, the contractor shall inform the PCO
of the cost, if any. Upon approval of the cost estimate, the contractor
shall complete the special report within the time requested by DHA
unless a different delivery date is approved.
2.0 Reports To
Military treatment facility (MTF) Commanders/Enhanced Multi-Service
Market (
eMSM) managers
The contractor
shall submit to MTF Commanders/eMSM Managers the following reports
with information specific to their MTF/eMSM or Prime Service Areas
(PSAs). Details for reporting are identified in
DD Form 1423, Contract Data Requirements List (CDRL),
located in Section J of the applicable contract.
• Network Adequacy Report.
• Enrollment Report
(Active Duty Enrollees to MTF/eMSM).
• Provider and
Beneficiary Satisfaction Surveys.
• Utilization
Management Report.
• Case Management
Report.
• Contingency
Program Plan.
• Referrals from
Right of First Refusals (ROFRs).
• Clinical Support
Agreement (CSA) Report.
3.0 Internal
Quality Management/Quality Improvement (QM/QI) Report
If problems are identified through
the contractor’s internal QM/QI Program, the contractor shall electronically
submit a QM/QI report to the Director, TRICARE Regional Offices
(TROs) and PCO within 10 days following the end of the month when
the problem was identified. The report shall include corrective
actions planned/initiated. A monthly update/status report shall
be submitted until all corrective actions have been achieved.
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