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TRICARE Operations Manual 6010.62-M, April 2021
Transitions
Chapter 2
Section 10
Other Requirements
Revision:  
1.0  RECOUPMENTS
1.1  Installment Cases
The outgoing contractor shall transfer all installment cases by fax or encrypted email to the Defense Health Agency (DHA), Office of General Counsel (OGC), Claims Collection Section (CCS) no later than 30 calendar days after the start of health care delivery (SHCD) of the incoming contract.
1.2  Cases Less Than 12 Months
1.2.1  The outgoing contractor shall transfer cases greater or equal to $110 ($30 for pharmacy) and that are less than 12 months old to the incoming contractor, who shall assume management of the cases, in accordance with Chapter 10, Section 4.
1.2.2  The outgoing contractor shall write-off the above cases that do not meet the transfer criteria and report on line A5 of the Accounts Receivable Summary Report as identified by DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract.
1.3  Cases Greater Than 12 Months
1.3.1  The outgoing contractor shall write off cases less than $600 ($30 for pharmacy) that when combined with other cases do not equal $600 or more, and reported on line A5 of the Accounts Receivable Summary Report.
1.3.2  The outgoing contractor shall write off the above cases no later than 30 calendar days after the SHCD of the incoming contract as identified by DD Form 1423, CDRL, located in Section J of the applicable contract.
1.3.3  The outgoing contractor shall transfer cases greater or equal to $600 to CCS no later than 30 calendar days after the SHCD of the incoming contract.
1.3.4  The outgoing contractor shall transmit installment cases to be transferred by fax or encrypted email to CCS before the cases are transferred to the incoming contractor.
1.4  General
1.4.1  The outgoing contractor shall ensure receipt of designated cases, by incoming contractor and CCS, no later than 30 calendar days after the SHCD.
1.4.2  The incoming contractor shall reflect the number of cases and the amount of the outstanding debt received from the outgoing contractor on the next monthly Accounts Receivables Summary Report following the date of transition as identified by DD Form 1423, CDRL, located in Section J of the applicable contract.
1.4.3  The outgoing contractor shall submit a credit adjustment to include all amounts recouped up to the point of transition.
1.4.3.1  The outgoing contractor shall reflect the number of cases and the amount of the outstanding debt transferred to the incoming contractor in the final Accounts Receivable Summary Report as identified by DD Form 1423, CDRL, located in Section J of the applicable contract.
1.4.3.2  The outgoing contractor shall have complete documentation of recoupment cases ready for transfer to the incoming contractor.
1.4.3.3  The outgoing contractor shall send designated cases to the incoming contractor and the CCS, no later than 30 calendar days prior to from the SHCD.
1.4.3.4  The outgoing contractor shall transmit recoupment case files to DHA OGC with a return receipt requested.
1.4.3.5  The outgoing contractor shall send the Power of Attorney (POA) and Agreement forms, with copies of claims and Explanation of Benefits (EOBs) to DHA OGC for follow-up, if a transition occurs before the contractor determines that the bankruptcy case has been closed, with or without distribution of assets.
1.4.3.6  The outgoing contractor shall transfer to the Federal Records Center (FRC) recoupment case files not transferred to the DHA OGC or to an incoming contractor in accordance with Chapter 9.
2.0  THIRD PARTY RECOVERY
2.1  The outgoing contractor shall transfer court-ordered restitution cases to the incoming contractor no later than 30 calendar days after the SHCD for continued collection.
2.2  The incoming contractor shall continue to collect whatever payments are forthcoming and advise the probation officer or the court with jurisdiction, as applicable, when a payment is missed, in accordance with Chapter 10, Section 4.
3.0  ACCOUNTS RECEIVABLES SUMMARY REPORT
3.1  The incoming contractor shall reflect the number of cases and the amount of the outstanding debt received from the outgoing contractor on the next monthly Accounts Receivables Summary Report following the date of transition as identified by DD Form 1423, CDRL, located in Section J of the applicable contract.
3.2  The outgoing contractor shall submit a credit adjustment no later than 30 calendar days after the end of health care delivery (HCD) to include all amounts recouped up to the point of transition.
3.3  The outgoing contractor shall reflect the final number of cases and the amount of the outstanding debt transferred to the incoming contractor in the Accounts Receivable Summary Report as identified by DD Form 1423, CDRL, located in Section J of the applicable contract.
4.0  APPEALS AND HEARINGS
4.1  The incoming contractor shall develop and maintain appeals processing guidelines, desk instructions, and reference materials relevant to Chapter 11, Section 8 and Chapter 12. For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract.
4.2  Appeals for Claims Spanning Multiple Jurisdictions
4.2.1  The outgoing contractor shall provide the incoming contractor with copies of all files and documentation regarding all open appeals, appeals under development, and proactive action items no later than 90 calendar days prior to the SHCD of the incoming contract.
4.2.2  The outgoing contractor shall, after the initial transfer of files, provide weekly updates to the incoming contractor regarding any newly opened appeals, appeals under development, and proactive action items. The outgoing contractor shall provide these weekly updates, to include copies of all files and documentation, to the incoming contractor until the SHCD for the incoming contract.
4.2.3  The outgoing contractor shall transfer to the incoming contractor, upon request, individual cases completed during the transition period and not yet transferred to the incoming contractor.
4.2.4  The outgoing contractor shall provide the appeal case file to the incoming contractor no later than five business days following receipt of incoming contractor’s request.
5.0  The outgoing contractor shall transfer the listing of stale dated checks and all supporting documentation to the incoming contractor within 90 calendar days prior to the SHCD.
6.0  ASSISTANCE TO INCOMING CONTRACTOR, TRICARE QUALITY MONITORING CONTRACT (TQMC), AND DHA DURING TRANSITION
The outgoing contractor or the TQMC contractor shall make available, upon request, individual cases completed during the transition period and not yet transferred to the incoming contractor or the TQMC contractor. The outgoing contractor shall mail the appeal case file to the incoming contractor, the TQMC contractor, or DHA no later than five business days following request.
7.0  TELEHEALTH NETWORK
7.1  The incoming contractor shall establish a robust telehealth capability within the larger TRICARE Network in accordance with Chapter 27.
7.2  The incoming contractor shall develop a Telehealth Implementation Plan in accordance with DD Form 1423, CDRL, located in Section J of the applicable contract.
7.3  The incoming contractor shall include in its implementation plan all phases of telehealth implementation, such as schedule for telehealth mobile application Government certification for interoperability with DoD mobile applications, and the establishment of telehealth site locations, to include sites for physical exam encounters.
7.4  The incoming contractor shall ensure the telehealth network mobile application meets the requirements in Chapter 27, Section 1, paragraphs 3.1.1 and 3.1.16 no later than 120 calendar days prior to the SHCD.
8.0  DHA COMMUNICATIONS
8.1  The incoming contractor shall have a face to face meeting with DHA Communications within 30 calendar days following contractor award to review requirements in Chapter 11 and other DHA Communications associated activities.
8.2  The incoming contractor shall provide mockups and wireframes of their website for DHA Communications to review and approve 270 calendar days prior to the SHCD.
8.3  The incoming contractor shall build and implement a secure portal for beneficiaries, providers, and government staff at least 180 calendar days prior to the SHCD. Details of the portal landing page shall be addressed at the interface meeting.
8.4  The incoming contractor shall complete testing of its secure portal not later than 90 calendar days prior to the SHCD.
8.5  The incoming contractor shall provide DHA Communications with the storage facility address and information for deliveries 90 calendar days prior to the SHCD.
9.0  DHA EVALUATION OF NON-UNITED STATES (US) FOOD AND DRUG ADMINISTRATION (FDA) APPROVED LABORATORY DEVELOPED TESTS (LDTs) DEMONSTRATION PROJECT
The outgoing contractor shall provide a list of all beneficiaries under demonstration approved LDT care to the incoming contractor.
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