TAOP TRICARE Advanced Course 2010

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MiscellaneousObjectives

TRICARE Prime: OCONUS vs CONUS

Medicare & TRICARE

TRICARE Manuals

HIPAA [not the animal…]

EFMP & ECHO

TOP POC Program

TAOP & You

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TRICARE Prime: CONUS vs OCONUS

CONUS: Prime & Prime Remote– Command sponsorship not required for ADFMs

• Prime Remote: ADFMs eligible only if residing with sponsor– Prime: ADSMs - MTF PCMs only; ADFMs - MTF or civilian PCMs– Prime Remote - Civilian PCMs only

• MCSC assigns network and/or non-network PCMs – Prime network coverage areas: Most care received at an MTF;

Civilian care coordinated through the PCM, MTF and the MCSC– Non-network areas: Most care received by civilian providers

• MCSC handles HCF, authorizations and referrals – Prime Travel Benefit: Reimburses for travel expenses incurred

• Medical attendant, lodging, gas, etc. – Retirees and family members are eligible (Prime only)

TRICARE Prime: CONUS vs OCONUS

OCONUS: TOP Prime/TOP Prime Remote (TGRO)– Command sponsorship required for ADFMs– TOP Prime: MTF PCMs only - No civilian PCMs– TOP Prime Remote: ISOS (TOPC) acts as the PCM

• HCF, case management, authorizations, referrals and GOPs– MTF locations: Civilian care facilitated through MOUs with HNPs

• MOUs vary by MTF– Remote locations: Most care received through a network of providers

established by ISOS (TOPC)• Non-network providers utilized in out-reach locations and to compensate

for network inadequacies– Medical TAD/TDY travel not reimbursed by TRICARE - Funded by

command/unit or service fund cite– Retirees and their family members are not eligible

Miscellaneous

Medicare & TRICARE

MiscellaneousMedicare & TRICARE

TRICARE beneficiaries who are eligible for Medicare Part A and enrolled into Medicare Part B are called TRICARE for Life (TFL) beneficiaries.

– Can be eligible based on age, disability and/or end stage renal disease.

Open enrollment: 3 months prior & 3 months after month of 65th birthday– Enrollment effective the month of their 65th birthday.

Yearly enrollment period is January 1st – March 31st. – Enrollment effective from July 1st of the enrollment year.

Beneficiaries who fail to enroll or disenroll at any time from Medicare Part B, remain eligible for direct care on a space available basis at MTFs.

Medicare cannot be backdated.– 10% premium increase each year a beneficiary was eligible but didn’t enroll

Beneficiaries not eligible for Medicare still need to formally apply for benefits and take their “Letter of Disallowance” to DEERS to be updated; they will continue to have TRICARE benefits.

– Social Security Administration 1-800-772-1213, www.ssa.gov; www.medicare.gov

Miscellaneous

TRICARE Manuals

MiscellaneousTRICARE Manuals

http://manuals.tricare.osd.mil/

To search:– Click “Search” in the top left-hand corner– Put a check mark next to the manuals to be searched– Type the term(s) to be searched in the field below “Search For”

To review a manual in full, scroll down and click the manual of choice on the previous screen

MiscellaneousTRICARE Manuals

Miscellaneous

Health Insurance Portability & Accountability Act (HIPAA)

MiscellaneousHIPAA

Authorization to Disclose is required before providing anyone--other than the beneficiary or a dependent minor child—health information

Authorization to Disclose is required when:– Sponsor inquires about his adult spouse/dependent child;– Spouse inquires about the sponsor/adult child;– Anyone other than MHS personnel or providers inquire about a beneficiary– Authorization to Disclose form can be found here:

https://www.tricare4u.com/apps-portal/tricareapps-app/static/pdf/paauth.pdf

If HIPAA protected information must be sent by email, be sure to use a password protected document and ensure the information is sent to authorized personnel only

Miscellaneous

Exceptional Family Member Program &

Extended Care Health Option

EFMP & ECHO

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MiscellaneousEFMP & ECHO

Family support program for military families with special needs. EFMP managers are located at family centers.

Includes enrollment in EFMP for purposes of assignment coordination. EFMP enrollment points of contact – MTFs.

Special needs – – Chronic medical condition – Child in special education/early intervention

Briefed at C&CS Conference 2010

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MiscellaneousEFMP & ECHO

Provide community support at the installation level

Provide case managers and individual service plans (ISPs)

Expand assignment coordination to/within the US

Stabilization of assignment for a minimum of four years.

Applies to service members regardless of location

Communicate w/ Service members & families

Briefed at C&CS Conference 2010

SCOR for Children

Tracks/organizes med info/ special education

Available on CD

3 ring binder

Inserts for business cards, records & receipts

AVAILABLE THROUGH MILITARYONESOURCE.COM/1-800-342-9647

Briefed at C&CS Conference 2010

MiscellaneousEFMP & ECHO

www.militaryonesource.com/specialneeds

Specialty consultations – up to 12 per year– Consultants w/ professional training & background in special needs– Consultants who also have a family member w/ a special need

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MiscellaneousEFMP & ECHO

ECHO is a TRICARE program for qualifying family members of AD sponsors that provides additional financial assistance for services not covered under the TRICARE Basic program.

ECHO is available to all FMs of AD sponsors regardless of location, command sponsorship status or TRICARE enrollment category

ECHO provides up to $3K per month or $36K per year for covered services for each qualifying FM.

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MiscellaneousEFMP & ECHO

ECHO can provide financial assistance for– training– rehabilitation– special education– assistive technology devices*– institutional care in private nonprofit, public, and State institutions

and facilities; and, if appropriate, – transportation to and from such institutions and facilities

* Rule of thumb: if the device in question has uses unrelated to the treatment of the qualifying medical condition, it typically will not be covered under ECHO.

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MiscellaneousEFMP & ECHO

Enrolling into ECHO:– Registering in the EFMP is a requirement for enrollment into ECHO.

Contact the local EFMP Coordinator for assistance with the registration process. EFMP registration requirement can be waived if• the AD sponsor’s branch of service does not provide EFMP• the Beneficiary seeks ECHO eligibility based on “deceased

sponsor” provisions• when enrollment into EFMP would be unnecessary or

inappropriate, such as when the child lives with the custodial parent who is not the AD sponsor

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MiscellaneousEFMP & ECHO

Once a family member has been enrolled into EFMP, a request for enrollment into ECHO can be made directly to the TRICARE Area Office Pacific (TAOP)

Provide the “Exceptional Family Member Medical Summary” DD Form 2792 & copies of any medical records documenting the qualifying medical condition

The documentation can be scanned & sent by email to the TAOP customer service email at tpao.csc@med.navy.mil or faxed to DSN 315-643-2037 Comm +81-611-743-2037

Once approved, the FM will be enrolled into ECHO & an informational welcome package will be sent to the family

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MiscellaneousEFMP & ECHO

To find out more about ECHO, visit www.tricare.mil. The TRICARE Policy Manual 6010.57-M and the 32 CFR 199 are two other resources available for researching ECHO related topics such as eligibility, enrollment requirements, covered services, etc. Both can be accessed electronically online at http://manuals.tricare.osd.mil.

As with all things TRICARE, if you can’t seem to find the information you are looking for in the resources available, a TAOP BCAC is just a phone call or email away.

Miscellaneous

TOP POC Program

MiscellaneousTOP POC Program

Why should I be designated as a TOP POC?– You get direct assistance from the best in the TRICARE business,

the TAO-P staff – You will be able to contact TMA, WPS and UCCI directly regarding

TRICARE beneficiaries; no Authorization to Disclose required.– You are provided with educational materials and training

opportunities not available with any other offer. Like this advanced course and on-site training

– You help Beneficiaries & Providers get paid! By being the G2G (Go 2 Gal/Guy) for solving those pesky denied claims issues

$$$

MiscellaneousTOP POC Program

I’ve decided I want to be a part of this exclusive program. How do I join?– Step1: Submit a designation letter on official letter head signed by

your OIC, section head, etc to the TAOP.– Step 2: Register for an ART account and have your info included on

the online BCAC/DCAO Directory.– Step 3: Register for a TRICARE4U account.– Step 4: Register for a TRICARE Online account.– Step 5: Thank the TAOP for this wonderful opportunity

This sounds to good to be true…What’s the catch?– There is no catch; Just some fine print

• You must notify the TAOP of your departure and replacement.• You should prepare/maintain a continuity binder to help-out your replacement.• Ensure your replacement knows how prestigious this program is and that this is a once in a

lifetime (or tour) opportunity.

Miscellaneous

TAOP & You

MiscellaneousTAOP & You

We’re here to assist you– Policy interpretation– Education & training– Assessments– POC appointments– Townhalls, briefings, – Lunches, – Etcetera

Just a click or ring away

And we’re friendly…

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MiscellaneousQuestions