The TOP contractor shall support
the best value in the coordination and delivery of health care services
in overseas locations for Service member, ADFMs, and other TRICARE-eligible
beneficiaries. This includes all health care services provided in
an overseas location, regardless of the beneficiary’s enrollment
location or residence address. Contractor responsibilities under
this contract include (but are not limited to) enrollment processing,
purchased care sector provider certification, network development
and maintenance, Beneficiary and Provider Services (BPS) (including
education and marketing), MTF optimization, medical management,
fraud and abuse prevention and detection, medically-necessary patient
evacuations and transfers, active duty dental care in remote overseas locations
(except for US territories), and claims processing. The contractor
shall provide a designated Point of Contact (POC) to assist the
TAO
Executive Directors or designee(s). Additionally,
every stateside contractor shall offer traveling TOP beneficiaries
use of existing toll free Health Care Finders (HCFs) numbers/services
to locate a stateside TRICARE network provider. Specific contractor
responsibilities are addressed in the TRICARE Manuals and in the
TRICARE Overseas health care support contract. Refer to the TOM,
Chapter
24 for additional TOP program instructions.