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WEEKEND MAINTENANCE: The maintenance outage is scheduled for April 20th at 6:00am EST ending NLT Sunday, April 21st at 11:59pm Eastern EST. The TRICARE Manuals web site may be available intermittently during this period but it's usage is not recommended.

TRICARE Operations Manual 6010.62-M, April 2021
Records Management (RM)
Chapter 9
Section 3
Digital Imaging (Scanned) And Electronic (Born-Digital) Records Process And Formats
The contractor shall, if it intends to digitally reproduce (digitize) temporary records in order to designate the digitized version as the recordkeeping copy:
•  Digitize the record according to the standards in 36 Code of Federal Regulations (CFR) 1236.32.
•  Validate the digitization according to 36 CFR 1236.34.
1.1  When the contractor designates the digitized version as the recordkeeping copy, the original source record becomes an intermediary record.
1.2  The contractor shall dispose of intermediary records according to 36 CFR 1236.36.
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.  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.”
3.1  Metadata is a critical element of DHA records in electronic format. All DHA electronic records require metadata to be associated or linked to them throughout their active and inactive records management life cycle. Metadata enables DHA to meet the federally mandated life cycle and recordkeeping requirements while ensuring electronic records remain authentic, reliable, usable, accessible and searchable to DHA business owners and authorized users.
3.2  The contractor shall capture or generate metadata throughout and as part of its RM process. For specific metadata required, see Section 2.
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.
5.0  The contractor shall design and implement migration strategies to counteract hardware and software dependencies of electronic records whenever the records must be maintained and used beyond the life of the information system in which the records are originally created or captured.
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