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TRICARE Operations Manual 6010.59-M, April 1, 2015
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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