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.
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 (LDT
s) DEMONSTRATION PROJECT
The outgoing contractor shall
provide a list of all beneficiaries under demonstration approved
LDT care to the incoming contractor.