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waived, or superseded by this section (as indicated below), the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 requirements
in Chapter 1, Section 2, paragraph 2.0, the TMEP
contractor 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of requirements in Chapter 1, Section 2, paragraph 4.0 are superseded
by the following: Generally,
the Contracting Officer
(CO) will provide a 14 calendar
day 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 requirements
in Chapter 1, Section 3, paragraph 5.1, the TMEP
contractor 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
telephoneTelephone inquiry
requirements
for the TMEP are as follows:
Note: The below levels
of service shall be available TMEP contractor
shall meet the service levels described below at all
times-daily, weekly, monthly, etc. Averages are not
acceptable. The Government will not accept averages.
• 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.