3.1 Research
Assistance
The contractor shall provide immediate
assistance to the Government in support of the debt collection assistance
function. In addition to identifying specific underpayments, the
contractor shall also:
3.1.1 Designate specific individuals and provide
resources to work collection issues with Government representatives
during normal weekday business hours.
3.1.2 Provide Web-site access and/or e-mail addresses,
mailing addresses, fax numbers and direct phone number(s) of specialized
collections research and support staff to the Government.
3.1.3 Maintain
records and processing statistics on collection activity. The records
to be maintained shall include a detailed chronological record of
all actions taken, including names and telephone numbers of all
parties contacted in the course of the actions taken, as well as
copies of all correspondence sent and received.
3.1.4 When violation
of the participation agreement or balance billing is not at issue,
issue letters to providers and conduct provider education when the
provider was at fault.
3.1.5 The
contractor shall furnish reports of all completed collection cases.
3.1.6 In newsletters
and other materials, publicize and educate beneficiaries and providers
on the Debt Collection Assistance Program. This shall include informing
providers of the availability of the contractor’s support services
to assist in resolution of claims problems, and encourage providers
to contact the contractor’s priority unit for assistance prior to
initiating any collection action. If the contractor is asked to
participate in beneficiary, sponsor or provider training, workshops
or briefings at Military Treatment Facilities (MTFs)/Enhanced Multi-Service
Markets (eMSMs) or elsewhere in the Region in accordance with specific
regional requirements, the contractor shall ensure the Debt Collection
Assistance Program is a topic.
All requests for expedited payment
will be coordinated through the TRICARE contractor for the region.
When research reveals a processing error by the contractor or subcontractor,
any additional payment due shall be processed on an expedited basis,
and the contractor’s response to the Government shall reflect an
expected date of payment.
3.3 Referrals
to Program Integrity, Defense Health Agency (DHA)
When it
has been determined that balance billing or violation of the participation
agreement is at issue, the matter will continue to be handled in
accordance with the existing program integrity guidelines contained
in
Chapter 13, Section 2.