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TRICARE Operations Manual 6010.62-M, April 2021
Communications and Customer Service (C&CS)
Chapter 11
Section 4
Inquiry Services Department - General
The contractor shall implement an inquiry processing system which tracks and reports on telephonic and written inquiries standards in accordance with Chapter 1, Section 3. For reporting requirements, see DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract.
2.0  Military Health System (MHS) Staff Inquiry Processing
2.1  The contractor shall designate staff with Government issued Common Access Cards (CACs) to respond to MHS staff customer service inquiries via a Government-designated, bi-directional, encrypted system.
2.2  Inquiries from designated staff shall be processed as priority for all cases.
2.3  The Government-designated, encrypted system shall be utilized by the prime contractor and all subcontractors.
The contractor shall provide trained personnel to answer all TRICARE inquiries in accordance with Chapter 1, Section 3.
4.1  The contractor shall provide documented training to its Customer Service Representatives (CSR) to include, but not limited to, TRICARE plans and programs; Privacy Act and Freedom of Information Act (FOIA) requirements; Health Insurance Portability and Accountability Act (HIPAA); fraud and abuse; medical terminology; effective listening; familiarity with military traditions and culture, courteous customer service and dealing with difficult customers.
4.2  The contractor shall measure and assess CSR knowledge and performance to effectively communicate and answer inquiries accurately and completely in accordance with call center quality assurance standards.
4.3  The contractor shall provide a monthly results report of call center quality monitoring. For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract.
4.4  The contractor shall identify training opportunities for CSRs through the use of customer service calls to continuously improve processes, scripts and work instructions.
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