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TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Medicare Eligible Program (TMEP)
Chapter 20
Section 1
Administration
Revision:  
All TRICARE requirements noted in Chapter 1 regarding administration shall apply to the TMEP unless specifically changed, waived, or superseded by this section (as indicated below), the TRICARE Policy Manual (TPM), TRICARE Reimbursement Manual (TRM), TRICARE Systems Manual (TSM), or TMEP contract.
1.0  Organization Of The Defense Health Agency (DHA)
The provisions of Chapter 1, Section 1 are applicable to TMEP.
2.0  Contract Administration and Instructions
2.1  The provisions of Chapter 1, Section 2 are applicable to TMEP.
2.2  In addition to the provisions of Chapter 1, Section 2, paragraph 2.0, the TMEP shall submit, in accordance with DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract a quarterly report outlining the modifications and implementation dates.
2.3  The provisions of Chapter 1, Section 2, paragraph 4.0 are superseded by the following: Generally, a 14 calendar notice will be provided by the Contracting Officer (CO) for all meetings hosted by DHA. The contractor shall provide up to four contractor representatives at up to four meetings at the direction of the CO per contract year.
3.0  TRICARE Processing Standards
3.1  The provisions of Chapter 1, Section 3, are applicable to TMEP, except for paragraphs 5.2 through 5.2.2.3, 4.0 through 4.2, 3.2.1, 3.2.5, and 7.1.
3.2  In addition to the provisions of Chapter 1, Section 3, paragraph 5.1, the TMEP shall track and report preauthorizations for Skilled Nursing Facilities (SNFs) separate from other preauthorizations noted in Chapter 7, Section 2 and TPM, Chapter 1, Section 7.1. The timeliness standards apply to the total volume of preauthorizations. See DD Form 1423, CDRL, located in Section J of the applicable contract.
3.3  The telephone inquiry requirements for the TMEP are as follows:
Note:  The below levels of service shall be available at all times-daily, weekly, monthly, etc. Averages are not acceptable.
•  Blockage rates shall not exceed 5%.
•  Ninety-five percent (95%) of all call received shall be answered within two rings by the Interactive Voice Response (IVR).
•  Ninety percent (90%) of all calls shall not exceed 60 seconds of time in queue (waiting for an agent or the next IVR queue).
•  Ninety-five percent (95%) of all calls answered by an agent shall not exceed a 30 second “hold-time” during the call.
•  Eighty-five percent (85%) of all calls answered by an agent shall achieve resolution in one call.
•  One hundred percent (100%) of all calls answered by an agent not fully and completely resolved on the initial call shall be fully and completely resolved within 10 business days.
4.0  Management
The provisions of Chapter 1, Section 4 are applicable to TMEP, except for Chapter 1, Section 4, paragraph 2.3.
5.0  Compliance with Federal Statutes
The provisions of Chapter 1, Section 5 are applicable to TMEP.
6.0  Legal Matters
The provisions of Chapter 1, Section 6 are applicable to TMEP.
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