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waived, or superseded by this section (as indicated below), the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.
2.0 Contract
Administration and Instructions
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Chapter 1, Section 2, paragraph 4.0 are superseded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
3.2 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.