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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Duplicate Claims System (DCS) - TRICARE Encounter Data (TED) Version
Chapter 4
Section 1.4
System Implementation And Operational Requirements
Revision:  C-68, June 12, 2023
This section describes implementation requirements for the Duplicate Claims System (DCS). It also defines policies and procedures for the operation of the system. For transition requirements related to this section, see the TRICARE Operations Manual (TOM), Chapter 2.
1.0  System Components
The DCS is a web-based application operating as a customized graphical user interface. The application runs under Microsoft® Internet Explorer (MSIE) in accordance with Chapter 1, Section 1.1.
2.0  Software Requirements
2.1  Optional Software
The contractor may, at it’s own option and expense, procure and utilize full version database management software packages such as Microsoft Access®, dBase®, Paradox For Windows®, etc., on the DCS PCs for the purpose of generating customized queries and reports utilizing optionally downloaded ASCII fixed length files that can be created by the DCS. Downloaded ASCII fixed length files may also be imported into Microsoft Excel®.
2.2  Security Requirements - Defense Health Agency (DHA) Form 834, Patient Encounter Processing and Reporting (PEPR) Account Activation Request Form
2.2.1  The contractor shall identify an Information Security Officer to oversee the DCS registration process. DCS registration requires the submission of one Defense Enrollment Eligibility Reporting System (DEERS), for each user through Enterprise Common Access Card (CAC) Registration Service (ECRS): 3&ecrs=true&goto= Each DCS user shall complete the electronic form and provide the required information, i.e., certification of completion of IA training.
2.2.2  In order to access the DCS and ECRS, users shall obtain a CAC from DHA, see Chapter 1, Section 1.1. CACs will be issued following receipt and processing of properly completed registration and security forms. Contractor users shall provide the required information, and submit the completed form to their DCS Information Security Officer for signature and transmittal to DHA.
2.2.3  DCS data shall be encrypted. Encryption specifications will be provided by DHA. See Chapter 1 for additional security and communications requirements.
2.3  Registration And Security
Each individual user must complete and sign Government provided security and access forms prior to be granted DCS access.
3.0  Connectivity
Connectivity will be through the Internet to the PEPR Portal via MSIE, Version 5.5, 6.0, or 7.0, or as directed by the Government.
4.0  System Support
For DCS support, contractors shall file a problem ticket with the DHA Global Service Center at 1-800-600-9332, then follow the prompts to the DCS.
5.0  Operating Procedures
5.1  For each regional contract for which a contractor is responsible, or for the TRICARE Medicare Eligible Program (TMEP), the contractor shall develop internal operating procedures for the DCS. These internal operating procedures shall designate the responsible areas for the various duplicate claims resolution functions and establish time lines. For example, one contractor may decide that the adjustment unit shall be responsible for scanning the DCS on a weekly basis for the appearance of adjustments submitted and for closing sets. Another contractor may decide that the unit responsible for researching potential duplicate claims should also be responsible for scanning for adjustments and closing the sets on a daily basis.
5.2  Contractor contract requirements for overpayment recovery, refunds and offsets, adjustments, etc., including timeliness requirements, apply to the operation of the DCS. As a result, operating procedures shall be developed which are consistent with all applicable contract requirements. Procedures must be established to ensure that recoupments are initiated in a timely manner following the research determination that a duplicate payment had been made. In other words, procedures must specify that after a decision has been made by the person responsible for determining that a duplicate payment was made, recoupment must be initiated in a timely manner and must be consistent with all overpayment recovery timeliness standards.
5.3  The contractor shall develop these procedures within 60 days of the date of system implementation and have them available for DHA review.
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