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TRICARE Operations Manual 6010.62-M, April 2021, Change 5002 (Jul 29, 2021)
Published Change
Revisions As A Result of Industry Questions
Published Date: July 29, 2021
CONREQ:None
Implementation Date:July 29, 2021
This change is made in conjunction with TRICARE Systems Manual 7950.4-M, April 2021, Change 5002.
Summary of Changes:
CHAPTER 1
  1. Section 3. Paragraph 3.2.1. Deleted “Averages are not acceptable” from the first line. Added as the third bullet: “If transferred to an individual, 90% of all calls shall be answered by an individual (not an answering machine) within 30 seconds.” Add as the last bullet: “Ninety-nine and one-half percent (99.5%) of all inquiries not fully and completely resolved on the initial call shall be fully and completely resolved to the customer’s satisfaction within 10 business days.” EFFECTIVE DATE: July 29, 2021
CHAPTER 2
  1. Section 5. Paragraph 5.1.1.1. Second bullet, changed the “45” to “20.” EFFECTIVE DATE: July 29, 2021
CHAPTER 2
  1. Section 6. Paragraph 2.3. Deleted “Section 1.” Paragraphs 2.4 and 3.4. Added the following as the first bullet: Thirty (30) calendar days after the Transition Specification (TRANSPEC) meeting, a cross-section representation of DHA records shall be transferred to include the record layouts with specifications, formats, definitions of fields and data elements, access keys, and sort orders, for the following, but not limited to: Beneficiary History Files; Claims History Files, TRICARE Encounter Provider Files (TEPRVs); Enrolled Beneficiary and Primary Care Manager (PCM) Assignment Files; Automated Data Processing (ADP) files, such as the Provider and Pricing Files. Paragraphs 2.4 and 3.4. Changed the days: of the second bullet from one hundred eighty (180) days to two hundred ten (210), of the third bullet from one hundred twenty (120) to one hundred fifty (150) and the fourth bullet from sixty (60) to ninety (90). EFFECTIVE DATE: July 29, 2021
CHAPTER 2
  1. Section 8. Paragraph 4.1.7. Added new paragraph as follows: “4.1.7 The outgoing contractor shall retain sufficient resources to ensure correction (and reprocessing through DHA) of all TRICARE Encounter Data (TED) record edit errors no later than 210 calendar days following the start of the incoming contractor’s health care delivery.” EFFECTIVE DATE: July 29, 2021
CHAPTER 7
  1. Section 6. Paragraph 2.2. Delete the seventh bullet “Consumer Assessment of Healthcare Providers and Systems (CAHPS).” EFFECTIVE DATE: July 29, 2021
CHAPTER 11
  1. Section 4. Paragraph 2.2. Deleted and renumbered the subsequent paragraphs. EFFECTIVE DATE: July 29, 2021
CHAPTER 11
  1. Section 6. Paragraph 4.4.2 changed to read as follows: The contractor shall print and mail out a welcome packet to each new beneficiary or household when there is a change in eligibility status (active duty versus retiree) or when there is a change in TRICARE plan coverage (Prime to Select and vice versa). Welcome packets shall include a welcome letter, costs and fees sheet, wallet card, and the appropriate plan or program handbook. DHA communications develops the packet contents. Paragraph 10.6 added as follows: "10.6 The contractor shall analyze Government beneficiary satisfactory surveys. For survey results scoring below the national benchmark, the contractor shall develop an action plan to improve customer satisfaction. A quarterly after action executive summary report shall be provided to the TRICARE Health Plan (THP), Managed Care Support Branch Office (MCSBO) outlining the actions taken and the outcomes of those actions. For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract." EFFECTIVE DATE: July 29, 2021
CHAPTER 27
  1. Section 1. Paragraph 2.1.4 changed to read as follows: “The contractor shall obtain and maintain nationally recognized accrediting organization accreditation for its telehealth network of virtual-only telehealth providers. The offeror’s Health Network accreditation is sufficient for providers who deliver care via physical office locations and who have integrated a HIPAA-compliant virtual care delivery option into their practices. For reporting requirements, see DD Form 1423, CDRL, located in Section J of the applicable contract." EFFECTIVE DATE: July 29, 2021
CHAPTER 28
  1. Section 3. Paragraph 2.3.2.2. Changed the paragraph reference from 2.2.2.1 to 3.0. EFFECTIVE DATE: July 29, 2021
Affected Sections:

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