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.