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TRICARE Operations Manual 6010.59-M, April 1, 2015
TRICARE Medicare Eligible Program (TMEP)
Chapter 20
Section 11
Communications And Customer Service (C&CS)
Revision:  C-108, May 18, 2022
TMEP contractor shall comply with all TRICARE requirements noted in Chapter 11 regarding Communications and Customer Service unless specifically changed, waived, or superseded by this section (as indicated below), the TRICARE Policy Manual (TPM), TRICARE Reimbursement Manual (TRM), TRICARE Systems Manual (TSM) or TMEP contract.
1.0  Education Requirements
1.1  The requirements in Chapter 11, Section 1, are superseded by the following:
1.2  A collaborative effort between Defense Health Agency (DHA) Communications and the contractor shall address the communication and education requirement of TMEP beneficiaries and associated providers. The intent is to make sure TRICARE benefit information is effectively communicated. TMEP educational activities include targeted beneficiary and provider education related to specific issues. Issues may be identified by the Government or the contractor.
1.3  The contractor shall participate in various work group meeting(s) to be held in the Washington, DC area. The contractor shall also participate in other meetings to address communication and education activities in support of the TRICARE Benefit, to include print and web content. Meetings may be attended via teleconference, video telecommunications or in person (for up to 4 meetings/year), as directed by the Government. The purpose of these meetings are to develop, review, or revised core educational materials for the following calendar year, discuss observations from the previous year and discuss possible changes in education and communication activities.
1.4  The contractor shall coordinate with DHA communications on development of content that addresses how individuals may identify and report fraudulent practices and to develop messaging and content for use in beneficiary and provider education products.
1.5  The contractor shall work with DHA to ensure beneficiaries receive unified, timely, accurate, consistent, and effective products and tools.
1.6  The Government will furnish the TMEP contractor printed TMEP, beneficiary- focused educational materials. The Government will develop materials based on recommendations by contractors, program managers, the Uniformed Services, DHA leadership and others with interests and concerns about information shared with TRICARE beneficiaries and other stakeholders. DHA Communications will review all recommendations and prioritize products in accordance with funding availability. DHA Communications will have final approval authority for TMEP products. The contractor shall discuss ordering of initial and subsequent educational materials with the Government. The contractor shall ensure the Memorandum of Understanding (MOU) with DHA Communications Division outlines the procedures.
1.7  The contractor shall provide staff to perform timely reviews and provide input to content developed by DHA Communications on a regular basis. Reviews shall include printed products, web content, responses to query for media requests, customer service scripts, senior leader talking points, briefings, and other products identified by the DHA.
1.8  The contractor shall distribute TRICARE information using industry best practices (for example, email, telephone, media, social media, text messaging, chat and other contemporary methods) to ensure timely delivery and receipt to TMEP beneficiaries.
1.9  Upon request, the contractor shall furnish claim forms, claim completion instructions, the TRICARE materials, Defense Enrollment Eligibility Reporting System (DEERS) information and other TMEP related materials to beneficiary, provider and Congressional offices. The contractor will establish and maintain effective communications with all TRICARE/Medicare dual eligible beneficiaries.
1.10  The contractor shall submit an education plan, outlining how it intends to conduct targeted-TMEP education for beneficiaries and providers. The Program Office and DHA Communications will review the plan and provide appropriate feedback for recommended changes. Details for submission of the Education Plan are identified by DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract. If the contractor intends to exhibit at conferences, the contractor shall submit a yearly exhibition plan for approval as well.
1.11  The contractor shall provide a quarterly report outlining provided and planned targeted beneficiary and provider education in accordance with DD Form 1423, CDRL, located in Section J of the contract.
1.12  DHA Communications will review and approve education or communication materials developed by the contractor (for example; facts sheets, news releases, talking points, and public affairs guidance). The contractor’s timeline for submission shall include sufficient time, as determined by the Government, for Government review for audience appropriateness, accuracy, timeliness, use of plain language, 508 compliance, and any other criteria identified by the Government. DHA Communications and the TMEP contractor shall work closely to address completion of items with a short suspense. DHA Communications requires a two business day minimum to review and approve materials.
2.0  Government Staff And Beneficiary Education
2.1  The requirements in Chapter 11, Section 2, are superseded by the following:
2.2  The contractor shall not maintain public web content about TRICARE benefits. The contractor may have a secure portal that contains transactional content (e.g., explanation of benefits, referrals, bill pay, provider education, and other online business items), but unsecured portions of their site shall contain simply the login page and a series of links to TRICARE.mil for the informational content (e.g., costs, eligibility, covered services, qualifying life events, etc.).
2.3  The contractor shall ensure the public login page and secure portal portions of web presence follow the TRICARE.mil look and feel as closely as possible. DHA will provide Cascading Style Sheets (CSS) files on request to make the adoption of the TRICARE.mil look and feel easier.
2.4  The contractor shall adopt a DHA approved TRICARE Uniform Resource Locator (URL) for proposed websites. DHA will own and manage the domain and license its use to the contractor. TRICARE URL examples are www.TRICARE-West.com, www.TRICARE-East.com, www.TRICARE-overseas.com. The contractor shall not use corporate URLs for TRICARE customer websites.
2.5  The contractor shall follow Department of Defense (DoD) and Federal Government website rules, including guidance on 508 compliance, mobile responsiveness, NIST-compliance, and plain language writing.
2.6  The Government will not accept information contained on the contractor’s web site as a substitute for written or telephonic communication with the beneficiary if those communication tools are in the best interest of the beneficiary.
2.7  The contractor shall recommend messages and placement on Government managed platforms to reach the target audience. Examples include social media posts, additional web content, recommendations for articles, and information for inclusion in press releases or media pitching.
2.8  The contractor shall not use TRICARE trademarks, logo, brand, name, or any aggregate Government or personal TRICARE data collected as a TRICARE contractor to explicitly promote non- TRICARE related products and services to TRICARE beneficiaries. The contractor may state their TRICARE contractor status in company marketing/promotional activities as long as U.S. Government, MHS, or DHA endorsement of the contractor is not implied.
2.9  The contractor shall monitor and report on customer access assistance, customer support hour usage and web analytics in accordance with DD form 1423, CDRL, located in Section J of the applicable contract.
3.0  Beneficiary, Congressional, Media, Beneficiary Counseling And Assistance Coordinator (BCAC), And Debt Collection Assistance Officer (DCAO) Relations
3.1  The requirements in Chapter 11, Section 3, paragraph 3.1.2, specific to Market/Military Treatment Facility (MTF) Prime Service Areas (PSAs) do not apply to TMEP except the contractor shall provide sufficient telephone lines addressed in that paragraph to meet the requirements in Chapter 20, Section 1.
3.2  Media
The requirements in Chapter 11, Section 3, paragraphs 5.0 through 5.4, are superseded by the following:
3.2.1  DHA Communications and the TMEP contractor will work together to support media-related activities. Media relations programs implemented by the Government and the contractor on behalf of the Government will have three objectives: educate beneficiaries about changes to their TRICARE benefit, respond to media queries quickly and accurately and inform the American public about Government activities related to the TRICARE program. The contractor shall conduct a media-relations program in accordance with the DoD guidelines and guidance provided by DHA Communications. The contractor shall provide regular feedback to DHA Communications regarding their media activities, including coordination of proposed responses to media queries for sensitive and controversial issues. The contractor shall keep DHA Communications, the Contracting Officer, and the Program Office aware of public and beneficiary perceptions regarding TRICARE policies and procedures, and advise DHA on proposed communication strategies for responding to these issues.
3.2.2  All published materials will communicate consistent TRICARE program messages with one voice and tone. The contractor shall perform the following in their media relations program, with approval from the Government, unless otherwise directed:
3.2.2.1  Respond to media questions about contractor roles, responsibilities and actions on behalf of the Government in support of the TRICARE program.
3.2.2.2  Follow-up media contacts by sending copies of information provided to the media and a summary of any discussions to DHA Communications when immediate action was required.
3.2.3  The TMEP contractor shall speak only on issues for which it has direct responsibility and shall not speculate on issues beyond the scope of the support they are providing to the Government.
3.2.4  The TMEP contractor shall alert the Contracting Officer Representative (COR), Program Office, and DHA Communications on any situations that have or may be likely to result in heightened or public media visibility. The contractor shall identify one point of contact to support timely awareness and interaction. The contractor shall obtain DHA Communications approval for items posted in a public forum.
3.3  Social Media
3.3.1  The contractor shall solely rely on DHA Communications social media platforms and leverage those mediums of education and communication. The contractor shall provide appropriate content for posting in response to identified educational opportunities on an ad hoc basis or as requested by the Government.
3.3.1.1  The contractor shall identify a primary and an alternate contact in support of paragraph 3.3.1 to create written input for social media messaging and craft responses to social media inquiries within a defined period of time (usually not to exceed one business day).
3.3.1.2  The contractor shall identify a primary and at least one alternate customer service support staff to contact beneficiaries and providers identifying specific issues/concerns on the social media platform to assist with resolution. The Government will provide the inquiry to the contractor via the Government designated web-based customer relations management system.
3.3.2  The contractor shall assist DHA Communications in planning, designing, and implementing a comprehensive communications program that incorporates diverse functions and issues, serves numerous distinct and specialized audiences and responds rapidly in crisis conditions to changing demands.
3.3.3  The contractor shall submit information, including news releases, fact sheets, talking points, communications plans, and public affairs guidance to DHA Communications for approval. The contractor’s timeline for submission of ongoing materials shall include sufficient time for government review for accuracy, timeliness, use of plain language, 508 compliance and any other criteria as determined by the government. The contractor shall work closely with DHA Communications to address completion of items with a short suspense.
4.0  Inquiry Service Department-General
4.1  The TMEP contractor shall comply with the requirements in Chapter 11, Section 4, related to an Inquiry Service Department with the exception of paragraph 3.0. Instead, the contractor shall provide trained personnel to answer all TRICARE inquiries in accordance with Chapter 20, Section 1.
4.2  The requirements in Chapter 11, Section 4, paragraph 5.0 do not apply to the TMEP contractor.
5.0  Correspondence Control, Processing And Appraisal
The requirements in Chapter 11, Section 5, paragraph 5.3 regarding copies of congressional inquiries and the contractor’s response being sent to DHA do not apply to the TMEP contractor.
6.0  Telephone Inquiries
6.1  The TMEP contractor shall comply with the requirements in Chapter 11, Section 6, with the changes noted below.
6.2  The requirements in Chapter 11, Section 6, paragraph 1.1, are superseded by the following: The TMEP contractor shall provide a toll-free telephone inquiry system with 24-hour, seven days a week, nationally accessible service. The contractor shall fully and continuously staff the system and provide callers with the option to speak with a customer service representative between the hours of 6:00 am and 11:00 pm EST (except weekends and federal holidays). The contractor may use an IVR unit to meet telephone access standards outside of these hours. The contractor shall furnish responses within the time frames noted in Chapter 20, Section 1.
6.3  The requirements in Chapter 11, Section 6, paragraph 1.2, are superseded by the following: The contractor shall ensure that after hours, the telephone system indicates the hours customer service representatives are available. The contractor shall handle calls in the order they are received. The contractor shall advertise the toll-free service using available media including the Explanation of Benefits (EOB) and other appropriate sources.
6.4  The TMEP contractor shall comply with the requirements in Chapter 11, Section 6, paragraph 2.0 with the exception that the contractor shall meet the telephone requirements and standards in Chapter 20, Section 1.
6.5  The TMEP contractor shall comply with the requirements in Chapter 11, Section 6, paragraph 3.0, with the exception of the noted normal business hours and the requirement to be staffed and operational on Federal Holidays which fall during open season. Business hours for TMEP are noted in paragraph 6.2.
6.6  The TMEP contractor shall comply with the requirements in Chapter 11, Section 6, paragraph 3.2, with the exception of providing network provider availability/assistance.
6.7  The contractor shall refer to Chapter 20, Section 1, for the Telephone Standards instead of the requirements in Chapter 11, Section 6, paragraphs 3.10 and 3.12.
6.8  The contractor shall follow Chapter 20, Section 1 and CDRL M010 instead of the requirements in Chapter 11, Section 6, paragraphs 3.12.1 and 3.12.2.
6.9  The requirements in Chapter 11, Section 6, paragraph 6.0, are superseded by the following: the contractor shall collect and report customer support data, operational data and analytics in accordance with DD Form 1423, CDRL, in section J of the contract.
6.10  The TMEP contractor shall comply with the requirements in Chapter 11, Section 6, paragraph 7.0, with the exception of providing access to information for staff outside the Market/MTF.
7.0  Allowable Charge Reviews
The TMEP contractor shall comply with the requirements in requirements in Chapter 11, Section 7, in relation to Allowable Charge Reviews.
8.0  Grievances And Grievances Processing
8.1  The TMEP contractor shall comply with the requirements in Chapter 11, Section 8, in relation to grievances and grievances processing.
8.2  The TMEP contractor shall comply with the requirements in Chapter 11, Section 8, paragraph 2.0, except that the contractor shall report quality of care issues to CMS when CMS is the primary payer.
9.0  Collection Actions Against Beneficiaries
The TMEP contractor shall comply with the requirements in Chapter 11, Section 9, in relation to collection actions against beneficiaries.
10.0  TRICARE Logo
The TMEP contractor shall comply with the requirements in Chapter 11, Addendum A. The link to the TRICARE Logo Style Guide is https://tricare.mil/trademark.
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