2.0 STANDARDS
AND REQUIREMENTS
The contractor
shall maintain the below record types in one of the following allowable
formats; Portable Document Format (PDF), Tagged Imaged File Format
(TIFF), or searchable data file formats such as Microsoft (MS) Excel.
2.1 TRICARE Claims including supporting
documentation and any documentation that either supports or denies
payment of a claim.
2.1.1 The claim record data set shall
be in usable, searchable, and retrievable formats. It is not required
to recreate the claim images from the data set.
2.1.2 Only if the hard copy claim
is scanned and Optical Character Recognition (OCR) technology is
used to create the claim record data should the claim image be considered
the source of the claim record and used as the record copy.
2.2 Adjustment Records including
supporting documentation and any documentation that either supports or
denies payment of the adjustment.
2.3 Checks.
2.4 Explanation of Benefits (EOB)
Forms and Summary Payment Vouchers (Remittances).
2.5 The contractor shall digitize
records in accordance with 36 CFR 1236, Subpart D - “Digitizing
Temporary Federal Records” to include:
• Ensuring that Defense Health
Agency (DHA) can use the digitized versions for all the purposes
the original source records serve, including the ability to attest
to transactions and activities. Mainframe and system screenshots
are not acceptable.
• Ensuring the digitized copy
is searchable.
• Digitizing records in PDF TIFF
formats.
• Digitizing records at a minimum
of 300 dots per inch (DPI).
• Ensuring digitized copies of
DHA records shall be legible and reproducible.
2.6 The contractor shall use image
capture and storage systems that produce legible copies from the
storage medium.
2.7 The contractor
shall recover and re-image original documents if it produces illegible
copies of records or set of records and ensure that the newly stored
image (i.e., the re-image) is a legible and reproducible document.
2.8 The contractor shall provide
an automated indexing system to be used independently of the contractor’s data
system. An automated indexing system must not be subject to proprietary
hardware or software constraints.
2.8.1 The contractor
shall make the index available for DHA on-site reviews.
2.8.2 The contractor shall ensure
that the automated indexing system can identify the retrieval location
of all records related to a TRICARE beneficiary including enrollments,
original claim and all related documentation, adjustment claims
(including documentation on which the decision to adjust was based),
benefit checks, EOBs, provider remits and all related supporting
documentation.
Example 1: If back-end
imaging is done, the back-end document number assigned shall be
cross-referenced to the original claim number on the index.
Example 2: If the Internal Control Number
(ICN) assigned to the adjustment claim is different than the original claim
number, the contractor shall cross reference the adjustment claim
ICN to the ICN of the original claim being adjusted on the index.
2.9 The following requirement is
applicable to digital images (scanned), electronic records (born-digital),
and electronic data or records output in PDF format.
2.9.1 The contractor
shall ensure that the following security requirement is met for
all PDF records.
2.9.1.1 The media utilized to transfer
records to the Government shall be encrypted.
2.10 The PDF records shall not contain
security settings (e.g., self-sign security, user passwords or permissions) that
prevent DHA or National Archives and Records Administration (NARA)
from opening, viewing, or printing the record.
2.11 All PDF records shall have
all security settings deactivated (e.g., encryption, master passwords
or permissions) prior to transfer to DHA, NARA, or for transit reasons.
The deactivating security settings from PDFs ensures DHA has the
ability to support long term migration and preservation efforts,
especially records affected by legal holds. The electronic media
device containing PDF records with Personally Identifiable Information
(PII)/Protected Health Information (PHI) for transfer shall be encrypted
in accordance with guidance provided by the DHA Records Management
Officer (RMO).
2.12 The contractor
shall provide the DHA RMO with PDF functional specifications for
authorization prior to enabling any special feature(s). Examples
of special features include but are not limited to: digital signatures,
links to other documents, files or sites, embedded files (including
multimedia objects), form data, comments and annotations.
2.13 The contractor shall ensure
that the following requirements for scanned paper or image formats converted
To PDF are met:
2.13.1 Paper records scanned and converted
into PDF format shall adhere to the required minimum of 300 DPI or
higher as requirements identified in
paragraph 2.0. Contractors
with digitized records that do not meet the minimum image quality
standard shall contact the DHA RMO for further guidance.
2.13.2 For OCR, PDF records can contain
embedded searchable text based on OCR. DHA recognizes uncorrected
OCR’d text can assist with full text search capabilities. Contractors
shall be permitted to provide DHA with PDF records having been OCR’d
using processes that do not alter the original bit-mapped image.
An acceptable searchable PDF file output process is Searchable Image
(Exact). Unacceptable searchable PDF file output processes include:
Searchable PDF file output as Formatted Text and Graphics, PDF Normal,
or Searchable Image-Compact.
2.14 The contractor
shall, for digital-to-digital conversion, ensure that records converted
are searchable PDF files or is a searchable data file in Excel format.
This includes records converted from their native electronic formats (e.g.,
office automation products) and electronic data output (e.g., electronic
information systems). For other data file formats, contact DHA RMO
for further guidance and approval.
2.15 The contractor
shall ensure that electronic records having been converted to searchable
PDF files from their native electronic formats include embedded
fonts to guarantee the visual reproduction of all text as created. All
fonts embedded in searchable PDF files shall be publicly identified
as legally embeddable (i.e., font license permits embedding) in
a file for unlimited, universal viewing, and printing.
2.16 The contractor shall ensure
that PDF records have all fonts referenced in the record, and embedded within
the PDF file (i.e., all subsets of all referenced fonts must be
embedded within the PDF file). This includes the “base 14 fonts”
and all fonts other than the “base 14 fonts.”
4.0 DIGITIZING TEMPORARY FEDERAL
RECORDS
4.1 The contractor shall develop
and follow a system for imaging one or two-sided documentation (records) and
the output to electronic formats as required, to include written
procedures that detail the entire process and are available for
Government inspection. Written procedures shall include the following:
4.1.1 The ongoing functionality of
system components.
4.1.2 How records
stored on optical discs are monitored and how the deterioration
of records stored on optical discs and digital data disc storage
is limited.
4.1.3 A flowchart or other graphical
depiction of the imaging process -from start to finish that fully
depicts the digitization and conversion process.
4.1.4 A description of the process
for indexing, retrieval, and cross-referencing to include method
of indexing all records related to a claim (e.g., original claim,
adjustments, related correspondence, any documentation substantiating
the settlement of the claim, EOB, checks); and how claims retrieval
software is Structured Query Language (SQL) compliant.
4.1.5 A description of the quality
control process that addresses how the contractor ensures 100% accuracy of
readability of all imaged documents, how each original will be imaged,
how errors are identified and corrected, how equipment failures
are addressed, how skewed margins are handled and how loss of data
is addressed.
4.1.6 Related
index and metadata files that provide the ability to search for
a specific image.
4.1.7 A description
of Disaster Recovery (e.g., how to ensure 100% recovery capability,
how content and media will be protected, the protection of the vital
records, and the location of the duplicate copies of the images, indexes,
and PDF records).
4.1.8 A description
of the disposition of original records and how it meets current
DHA Records Disposition Schedule (RDS), the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), and the Privacy Act of 1974.
4.1.9 A description of the imaging
and output storage requirements.
4.1.10 Planning for future technological
developments and obsolescence in accordance with 36 CFR 1236.14.