2.0 The MCSCs,
DPs, and TDEFIC contractor shall transmit 95% of the requested records
to the TQMC contractor within 45 calendar days and 98% within 60
calendar days from the date the
MCSCs, DPs,
and TDEFIC contractor receive the request for records from the TQMC
contractor. Records to be transmitted shall include the complete
medical record, the MCSC’s, DP’s, and TDEFIC’s utilization review decision,
rationale for that decision, and quality of care determinations.
The MCSC’s, DPs, and TDEFIC contractor shall forward a monthly Contractors
Records Accountability Report. Details for
reporting are
identified
by DD Form 1423, Contract Data Requirements List
(CDRL)
, located in Section J of the applicable contract.
Both paper and electronic record transfer and storage are acceptable
to Defense Health Agency (DHA). Records may be transmitted through
secure electronic means and stored with the TQMC contractor for
review in adherence with the requirements specified in
Chapter 9, Records Management. Adherence to
these procedures is essential for compliance with the Privacy Act
of 1974 (5 USC 552a), the Department of Defense (DoD) Privacy Program
(DoD 5400.11-R), the Health Insurance Portability and Accountability
Act (HIPAA) Privacy and Security Rules (45 CFR Parts 160 and 164),
the DoD Health Information Privacy Regulation (DoD 6025.18-R), the
DoD Health Information Security Regulation (DoD 8580.02-R), and
other federal laws protecting the privacy and security of Personally Identifiable
Information (PII), including health information. Receipt of electronic
records shall be acknowledged by return e-mail from the TQMC contractor.
If the acknowledgment e-mail is not received within one business
day after the electronic records were transmitted, or if it is determined that
the records were not transmitted with the required security safeguards,
then the contractor (MCSC, DP, TDEFIC) shall immediately follow-up
to determine the status and whether a possible breach may have occurred.
Unless it is determined that no possible breach occurred, then,
within 24 hours, the contractor shall notify the DHA Privacy Office
and carry out the other breach response requirements of
Chapter 1, Section 5.
2.1 Transfer of paper records shall
adhere to procedures specified in
paragraphs 2.1.1 through
2.5.
2.1.1 The
records shall be packaged in boxes containing a single month of
records and a Box Inventory Document (see
Figure 7.3-1) stating the number
of patient records contained therein and identifying each record
by patient name and DHA Internal Control Number (ICN), which should
be clearly shown on each patient’s record. Because the Box Inventory
Document contains PII, that document (in both its paper and electronic
versions) shall be protected from unauthorized use and disclosure
in the same manner as the patient records themselves.
2.1.2 The MCSCs,
DPs, or TDEFIC shall notify the designated Point Of Contact (POC)
at the TQMC contractor, via e-mail, each day that a box or boxes
have shipped, stating the number of boxes (with tracking numbers)
in that day’s shipment (see
Figure 7.3-2). The MCSCs, DPs, or TDEFIC shall
track the shipment, including delivery, using the shipping vendor’s
tracking method and retain documentation of such.
2.2 Within
one business day of receipt of a shipment from a contractor (MCSC,
DP, or TDEFIC), the TQMC contractor, using the MCSC, DP, or TDEFIC
Box Inventory Document(s), the TQMC shall match the number of boxes
received with the corresponding e-mail shipment notification. If
any boxes are missing, the contractor and the TQMC shall immediately
investigate and, no later than 24 hours after finding that a box
is missing, initiate breach response in accordance with
Chapter 1, Section 5. If no boxes are missing
and for all boxes received, then the TQMC contractor shall confirm
the number of records in each box, and a match between each patient
record and ICN for the patient names listed on the Box Inventory
Document no later than the Close of Business (COB) on the fifth
business day after receipt of the shipment. By that date, the TQMC
contractor shall send an e-mail back to the MCSC/DP/TDEFIC confirming
the number of boxes, number of records in each box and match of
all ICNs. Upon receipt of the TQMC contractor’s confirmation e-mail,
no further action is required by the MCSC, DP, or TDEFIC.
2.3 Using
the Box Inventory Document, if the TQMC contractor identifies:
• A count discrepancy in either the number
of boxes or number of charts in each box;
• Absence of a record; or
• A mismatch of the record with the ICN;
and
• If the
TQMC contractor concludes that records are or may be missing, the
TQMC contractor shall notify by e-mail the MCSC, DP, or TDEFIC of
the discrepancy including details of the discrepancy by COB of the
fifth business day from receipt of shipment. Upon notification of the
count discrepancy, the MCSC, DP, or TDEFIC shall investigate the
discrepancy, take appropriate steps and notifications, and be in
telephone, fax and e-mail communication to resolve the potential
violations of applicable law as soon as possible. If the missing
records are not promptly located, then, within 24 hours of receiving
the notice from the TQMC, the contractor shall initiate breach response
in accordance with
Chapter 1, Section 5.
2.4 The TQMC
contractor shall send a “non-receipt” e-mail to the MCSC, Uniformed
Services Family Health Plan (USFHP) Designated Providers (DP) and
Program Office (PO), or TDEFIC POC by COB of the fifth
business day if no shipment was received from the MCSC, USFHP DP and
PO, or TDEFIC following notification that a shipment
was sent. Upon receipt of a “non-receipt of a shipment” e-mail from
the TQMC contractor POC, the MCSC, USFHP PO,
or TDEFIC shall immediately track the shipment and notify the TQMC
contractor POC, by e-mail, of the status of the shipment. The MCSC, USFHP DP and
PO, or TDEFIC shall be in telephone, fax or e-mail
communication with the TQMC contractor POC to determine the appropriate
steps and notifications, based upon the investigation to resolve
the potential HIPAA violation.
2.5 If
the MCSC,
USFHP DP
and
PO, or TDEFIC do not receive an e-mail from the TQMC
contractor indicating either confirmation of receipt, confirmation
of receipt with discrepancy, or a non-receipt of shipment, by the
morning of the sixth business day after shipment, the MCSC,
USFHP DP
and
PO, or TDEFIC shall notify, by COB on the same day,
all parties required to receive notice under the breach notification
provisions of
Chapter 1, Section 5 and applicable law. These
parties include the
DHA Clinical Operations Division
(COD), USFHP PO, and the DHA Privacy Office. The
notifications shall provide available details about the shipment
and the circumstances. The TQMC contractor shall verify that these
notifications are sent, and shall provide the notifications itself
if the sender of the records fails to do so. Thereafter, the MCSC,
USFHP DP,
or TDEFIC shall comply with breach response requirements of
Chapter 1, Section 5 and applicable law.