All The
TMEP contractor shall comply with all TRICARE requirements
noted in
Chapter 11 regarding Communications
and Customer Service (C&CS)
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TMEP unless specifically changed, waived, or superseded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 Education Requirements
The
provisions
of requirements in Chapter 11, Section 1, are superseded by the
following:
1.1 A collaborative effort between
Defense Health Agency (DHA) Communications and the contractor shall address
the communication and education requirement of TMEP beneficiaries
and associated providers. The intent is to make sure TRICARE benefit
information is effectively communicated. TMEP educational activities
include targeted beneficiary and provider education related to specific
issues. Issues may be identified by the Government or the contractor.
1.2 The contractor
shall participate in various work group meeting(s) to be held in
the Washington, DC area. The contractor shall also participate in
other meetings to address communication and education activities
in support of the TRICARE benefit, to include print and web content.
Meetings may be attended via teleconference, video telecommunications
or in person (for up to four meetings/year), as directed by the
Government. The purpose of these meetings are to develop, review,
or revised core educational materials for the following calendar
year, discuss observations from the previous year and discuss possible
changes in education and communication activities.
1.3 The contractor
shall coordinate with DHA communications on development of content
that addresses how individuals may identify and report fraudulent
practices and to develop messaging and content for use in beneficiary
and provider education products.
1.4 The contractor
shall work with DHA to ensure beneficiaries receive unified, timely,
accurate, consistent, and effective products and tools.
1.5 The Government shall furnish
the TMEP contractor printed TMEP, beneficiary-focused educational materials.
The Government shall will develop
materials based on recommendations by contractors, program managers,
the Uniformed Services, DHA leadership and
others with interests and concerns about information shared with
TRICARE beneficiaries and other stakeholders. DHA Communications
shall review all recommendations and prioritize products in accordance
with funding availability. DHA Communications shall have final approval authority
for TMEP products. Ordering The
contractor shall discuss ordering of initial and subsequent
educational materials shall be discussed with the Government. and
outlined in The contractor shall ensure the
Memorandum of Understanding (MOU) with DHA Communications Division outlines
the procedures.
1.6 The contractor
shall provide staff to perform timely reviews and provide input
to content developed by DHA Communications on a regular basis. Reviews
shall include printed products, web content, responses to query for
media requests, customer service scripts, senior leader talking
points, briefings, and other products identified by the DHA.
1.7 The contractor
shall be responsible for distribution of distribute TRICARE
information using industry best practices (for example, email, telephone,
media, social media, text messaging, chat and other contemporary methods)
to ensure timely delivery and receipt to TMEP beneficiaries.
1.8 Upon request,
the contractor shall furnish claim forms, claim completion instructions,
the TRICARE materials, Defense Enrollment Eligibility Reporting
System (DEERS) information and other TMEP related materials to beneficiary,
provider and Congressional offices. The contractor will shall establish
and maintain effective communications with all TRICARE/Medicare
dual eligible beneficiaries.
1.9 The contractor
shall submit an education plan, outlining how it intends to conduct
targeted-TMEP education for beneficiaries and providers. The Program
Office and DHA Communications will review the plan and provide appropriate
feedback for recommended changes. Details for submission of the
Education Plan are identified by DD Form 1423, Contract Data Requirements
List (CDRL), located in Section J of the applicable contract. If
the contractor intends to exhibit at conferences, a yearly exhibition
plan should be submitted for approval as well.
1.10 The contractor
shall provide a quarterly report outlining provided and planned
targeted beneficiary and provider education in accordance with DD
Form 1423, CDRL, located in Section J of the applicable contract.
1.11 DHA Communications
shall review and approve education or communication materials developed
by the contractor (for example; facts sheets, news releases, talking
points, and public affairs guidance). The contractor’s timeline
for submission shall include sufficient time, as determined by the
Government, for Government review for audience appropriateness,
accuracy, timeliness, use of plain language, 508 compliance, and any
other criteria identified by the Government. DHA Communications
and the TMEP contractor shall work closely to address completion
of items with a short suspense. DHA Communications requires
a two business day minimum to review and approve materials.
2.0 Government Staff and Beneficiary
Education
The provisions
of
Chapter 11, Section 2, are superseded by the
following:
2.1 The contractor shall not maintain
public web content about TRICARE benefits. They may have a secure portal
that contains transactional content (e.g., explanation of benefits,
referrals, bill pay, provider education, and other online business
items), but unsecured portions of their site shall contain simply
the login page and a series of links to TRICARE.mil for the informational
content (e.g., costs, eligibility, covered services, qualifying
life events, etc.).
2.2 The contractor shall
ensure the public login page and secure portal portions
of web presence shall follow the TRICARE.mil look and feel as closely
as possible. DHA will provide Cascading Style Sheets (CSS) files
on request to make the adoption of the TRICARE.mil look and feel
easier.
2.3 The contractor shall adopt
a DHA approved TRICARE Uniform Resource Locator (URL) for proposed websites.
DHA will own and manage the domain and license its use to the contractor.
TRICARE URL examples are
www.TRICARE-West.com,
www.TRICARE-East.com,
www.TRICARE-overseas.com.
The contractor shall not use corporate URLs for TRICARE customer
websites.
2.4 The contractor shall follow
Department of Defense (DoD) and Federal Government website rules, including
guidance on 508 compliance, mobile responsiveness, National Institute
of Standards and Technology (NIST)-compliance, and plain language
writing.
2.5 InformationThe
Government will not accept information contained on
the contractor’s website will not as
a substitute for written or telephonic communication
with the beneficiary if those communication tools are in the best
interest of the beneficiary.
2.6 The contractor
shall recommend messages and placement on government Government managed platforms
to reach the target audience. Examples include social media posts,
additional web content, recommendations for articles, and information
for inclusion in press releases or media pitching.
2.7 Use
of theThe contractor shall not use TRICARE
trademarks, logo, brand, name, or any aggregate Government or personal
TRICARE data collected as a TRICARE contractor to explicitly promote
non-TRICARE related products and services to TRICARE beneficiaries
is prohibited. The contractor may state their TRICARE contractor status
in company marketing/promotional activities as long as Unites States (US) Government,
Military Health System (MHS), or DHA endorsement of the contractor
is not implied.
2.8 The contractor shall monitor
and report on customer access assistance, customer support hour
usage and web analytics in accordance with DD Form 1423, CDRL, located
in Section J of the applicable contract.
3.0 Beneficiary, Congressional,
Media, Beneficiary Counseling and Assistance Coordinator (BCAC),
and Debt Collection Assistance Officer (DCAO) Relations
3.1 The
provisions
of requirements in Chapter 11, Section 3, paragraph 2.03.0,
specific to Market/Military Medical Treatment Facilities (MTFs)
Prime Service Areas (PSAs)
are do not
applicable apply to
TMEP except the contractor
will shall provide
sufficient telephone lines addressed in this paragraph to meet the
requirements in
Section 1.
3.2 Media
The provisions of
Chapter 11, Section 6, paragraph 9.0 are superseded
by the following:
3.2.1 DHA Communications and the TMEP
contractor will shall work
together to support media-related activities. Media relations programs
implemented by the Government and the contractor on behalf of the Government
will have three objectives: educate beneficiaries about changes
to their TRICARE benefit, respond to media queries quickly and accurately
and inform the American public about Government activities related
to the TRICARE program. The contractor will shall conduct
a media-relations program in accordance with the DoD guidelines
and guidance provided by DHA Communications. The contractor shall
provide regular feedback to DHA Communications regarding their media
activities, including coordination of proposed responses to media
queries for sensitive and controversial issues. The contractor will shall keep
DHA Communications, the Contracting Officer (CO), and the Program
Office aware of public and beneficiary perceptions regarding TRICARE
policies and procedures, and advise DHA on proposed communication
strategies for responding to these issues.
3.2.2 All published materials will
communicate consistent TRICARE program messages with one voice and tone.
Contractors
will The contractor shall perform
the following in their media relations program, with approval from
the Government, unless otherwise directed:
3.2.2.1 Respond to media questions
about contractor roles, responsibilities and actions on behalf of
the Government in support of the TRICARE program.
3.2.2.2 Follow-up media contacts by
sending copies of information provided to the media and a summary
of any discussions to DHA Communications when immediate action was
required.
3.2.3 The TMEP contractor will shall speak
only on issues for which it has direct responsibility and will not speculate
on issues beyond the scope of the support they are providing to
the Government.
3.2.4 The TMEP contractor will shall alert
the Contracting Officer Representative (COR), Program Office, and DHA
Communications on any situations that have or may be likely to result
in heightened or public media visibility. The contract will shall identify
one point of contact to support timely awareness and interaction. Items
to be The contractor shall obtain DHA
Communications approval for items posted in a public
forum have to be approved by DHA Communications.
3.3 Social Media
The following additional provisions
are applicable to TMEP.
3.3.1 The contractor
will shall
solely rely on DHA Communications social media
to platforms
and leverage those means of education and communication.
The contractor
will shall provide
appropriate content for posting in response to identified educational
opportunities on an ad hoc basis or as requested by the Government.
3.3.1.1 The contractor
will shall identify
a primary and an alternate contact in support of
paragraph 3.3.13.2.1 to
create written input for social media messaging and craft responses
to social media inquiries within a defined period of time (usually
not to exceed one business day).
3.3.1.2 The contractor will shall identify
a primary and at least one alternate customer service support staff
to contact beneficiaries and providers identifying specific issues/concerns
on the social media platform to assist with resolution. The Government
will provide the inquiry to the contractor via the Government designated
web-based customer relations management system.
3.3.2 The contractor will shall assist
DHA Communications in planning, designing, and implementing a comprehensive
communications program that incorporates diverse functions and issues,
serves numerous distinct and specialized audiences and responds
rapidly, in crisis conditions to changing
demands.
3.3.3 The contractor will shall submit
information, including news releases, fact sheets, talking points, communications
plans, and public affairs guidance to DHA Communications for approval.
The contractor’s timeline for submission of ongoing materials will shall include
sufficient time for government Government review
for accuracy, timeliness, use of plain language, 508 compliance
and any other criteria as determined by the government Government. DHA
Communications and the The contractor will shall work
closely with DHA Communications to address
completion of items with a short suspense.
5.0 Telephone
Inquiries
5.1 The
provisions
of TMEP contractor shall comply with the
requirements in Chapter 11, Section 7,
are applicable
to TMEP with the
below noted changes
noted
below.
5.2 The
provisions
of requirements in Chapter 11, Section 7, paragraphs 1.1 through
1.5,
are superseded by the following: The TMEP contractor shall provide
a toll-free telephone inquiry system
. The toll-free
telephone inquiry system shall provide with 24-hour,
seven days a week, nationally accessible service.
The
system shall be fully staffed, continuous with callers having The
contractor shall fully and continuously staff the system and provide the option
of to speak
ing with
a customer service representative between the hours of 6:00 am and
11:00 pm EST (except weekends and federal holidays).
Telephone The
contractor may use Interactive Voice Response (IVR) unit meet the
telephone access outside of these hours
may
be accomplished through an IVR unit.
Responses The contractor shall
be furnish
ed within
the time frames noted in
Section 1.
5.3 The
provisions
of requirements in Chapter 11, Section 7, paragraph 1.6, are
superseded by the following:
The contractor shall ensure
that after hours, the telephone system
shall indicate
s the
hours customer service representatives are available.
Calls The
contractor shall
be handle
d calls in
the order they are received. The contractor shall advertise the
toll-free service using available media including the Explanation
of Benefits (EOB) and other appropriate sources.
5.5 The
provisions
of TMEP contractor shall comply with the
requirements in Chapter 11, Section 7, paragraph 3.0 paragraphs
2.0 through 2.2,
are applicable to
TMEP with the exception that the contractor shall
meet the telephone requirements and standards in
Section 1.
5.6 The
provisions
of TMEP contractor shall comply with the
requirements in Chapter 11, Section 7, paragraph 3.0,
are
applicable to TMEP with the exception of the noted
normal business hours
and the requirement to be staffed
and operation on Federal holidays which fall during open season.
Business hours for TMEP are noted in
paragraph 5.2 3.1.1.
5.7 The
provisions
of TMEP contractor shall comply with the
requirements in Chapter 11, Section 7, paragraph 3.2.1.3.2paragraphs
3.2.1.2.2 through 3.2.1.2.4,
are applicable
to TMEP with the exception of providing network provider
availability/assistance.
5.10 The
provisions
of requirements in Chapter 11, Section 7, paragraph 6.0, are
superseded by the following: the contractor shall collect and report
customer support data, operational data and analytics in accordance
with DD Form 1423, CDRL, located in Section J of the applicable
contract.
5.11 The
provisions
of TMEP contractor shall comply with the
requirements in Chapter 11, Section 7, paragraph 6.07.0,
are
applicable to TMEP with the exception of providing
access to information for staff outside the Market/MTF.