TNEX New DEERS Update Session 032

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TNEX New DEERS Update Session 032 Powered By Docstoc
					TNEX New DEERS Update
      Session 032
   Janine Groth, DEERS
     Pete Koste, TMA
           Agenda

•   What is complete
•   Performance Metrics
•   In Process
•   Planned TNEX Final Projects
•   Requested Futures



                                  2
               Goals
• Full Portability
• ONE TRICARE
  – One look to the beneficiary
  – One common set of processes and business rules
• Allow MTFs/CHCS to focus on patient care
• Establish MCSC accountability for enrollment
• Position the government to be able to implement
  changes more quickly at less cost
• Regain Government control of key data
• Improve data quality
• Improve person identification within the MHS
• Finish Legacy DEERS migration                      3
              Provide Portability

                   Eligibility
  TRICARE
Insurance Policy

                                    Civilian & Direct Care
                                      PCM Assignments

                                  Other Health Insurance/
                                 Standard Insurance Table
      •Catastrophic Cap
      •Deductible
      •Enrollment Fee                                    4
                   One TRICARE
                   One Look
• Consistent Correspondence
  – Enrollment Cards and Welcome Letters
  – Re-issuance of enrollment cards as each TNEX
    contract transitions
  – PCM Change Letters
  – Disenrollment Letters
• Beneficiary Self Service through TRICARE Online
  –   Enrollment & Transfers of Enrollment
  –   Disenrollment
  –   PCM Changes
  –   Address Changes                               5
               One TRICARE
               One Process
• Provide consistent eligibility verification
  through DEERS
• Perform all enrollments, civilian and direct
  PCM assignments for all enrollments for
  all programs worldwide in DOES
• Implement the Universal Enrollment
  Application
• Standardize the MCSC contract language
                                                 6
           Improve Data Quality
• Establish ownership of key data
• Eliminate redundant data stores
  across the MHS
• Monitor quality of data provided by
  the Services, MCSCs, and CHCS
• Provide monitoring reports for TMA
• Proactive identification and action to
  data trends
• Increase data sharing                    7
                                            New DEERS Projects
Project:                 Status:   Comments/Start Date:                  Project:                Status:   Comments/Start Date:
Buffer Existing MCSC               Completed 12/28/2003                  Accommodate                       Completed 4/22/2004
Claims Inquiries                                                         Monthly Fee                       (for pre-enrollment activity)
                            (G)                                                                     (G)
                                                                         Payments


Claims Interface for               Completed 4/1/04 - TDEFIC,            PCM Change Letters                5/1/04 – Initial release
T-NEX                       (G)    6/1/04 - West, 7/1/04 - North, and                               (G)
                                   8/1/04 - South

NAS Migration from                 Completed 12/28/2003                  Disenrollment Letters             5/1/2004 - released
DEERS to TOL                (G)                                                                     (G)

Cat Cap & Deductible               Completed 4/1/04 - TDEFIC,            Enrollment Reports                Basic reports - August 2004; Web
Interface for T-NEX         (G)    6/1/04 - West, 7/1/04 - North, and                               (G)    based reports - February 2005
                                   8/1/04 - South

IFMC Cat Cap &                     2/1/05                                Re-Issue Enrollment               Began 5/1/04 - West, 6/1/04 -
Deductible Interface        (G)                                          Cards                      (G)    North, and 7/1/04 - South

Buffer Existing                    Completed 12/28/2003                  OHI/SIT                           Summer 2005 for Direct Care
MCSC/PDTS Cat Cap           (G)                                                                     (G)    System. Implemented for MCSCs
                                                                                                           June 1, 2004.

Create Enrollment                  Gold Files Created for all Regions.   PCMBN Assignment                  1/19/04 - Latin America, 3/8/04 -
Gold File/Final Policy             Final Policy Consolidation will       for the Direct Care               Europe & Pacific, 6/1/04 - West,
Consolidation               (G)    occur 9/16/05-9/18/05.                System                     (Y)    7/1/04 - North, 8/1/04 – South
                                                                                                           1/24/05 – 12,292 unassigned


                                                                                                                                               8
                                            New DEERS Projects
Project:                 Status:   Comments/Start Date:       Project:               Status:   Comments/Start Date:
Address Change                     Implemented 4/22/2004      PCM Panel                        Started 1/19/04 - Latin America,
Notifications                                                 Reassignment (Batch)             3/8/04 -Europe & Pacific, 6/1/04 -
                            (G)                                                         (G)
                                                                                               West, 7/1/04 - North, 8/1/04 -
                                                                                               South
Address Validation in              Implemented 4/22/2004      Beneficiary Web                  Phased implementation beginning
DOES                        (G)                               Enrollment                (G)    October 1, 2005.

Alignment of EY to FY              Implemented 4/22/2004      Retroactive Elig /               Completed 6/6/2003
                            (G)                               Enrollment Maint          (G)

Display Fee Payment                Implemented 4/22/2004      Establish Test                   Completed Jan-04
History on DOES             (G)                               Environments              (G)

Accommodate ECHO                   Will implement after TRS   Comm Infrastructure:             Completed 12/29/03 - TDEFIC,
Registration                (G)                               B2B Gateway               (G)    1/22/04 - West, 2/5/04 - North,
                                                                                               2/12/04 - South, 2/24/04 - PDTS

Failure to Pay Fees                Implemented 4/22/2004      Comm Infrastructure:             Completed 12/29/03
Interface                   (G)                               Web DMZ                   (G)

Failure to Pay Fees                Implemented 4/22/2004      DOES/NED Cleanup                 Completed 8/25/03
Reports                     (G)                                                         (G)

Modifications to Batch             Implemented 4/22/2004      PCMBN for the                    On hold until DPs are ready to
Fee Interface               (G)                               USFHP                            load PCMs on DEERS



                                                                                                                                    9
             Applications Delivered

 TNEX DOES for Enrollment
 Civilian Panel Reassignment
 Web General Inquiry to DEERS (GIQD
 Replacement)
 Web PCM Research
 Web Research for Cat Cap/Deductible and Fees
 Web Other Health Insurance Collection &
 Standard Insurance Table updates
 Web Standard Insurance Table Validation
 Web Fee Over and Underpayment Oversight
                                                 10
             Interfaces Delivered
 Fee Maintenance         Notifications
 Disenrollment for       PDTS Upgrade
  Failure to Pay Fees     TNEX Claims Inquiry
 Direct Care PCM Load    Claims Buffer
 Direct Care PCM         Cat Cap Inq/Updates
  Panel Reassignment      Cat Cap Buffer
 Civilian PCM Load       OHI Maintenance
 Enrollment Card         SIT Maintenance
 Patient Id Change       SIT Distribution
  Distribution                                   11
                Other Deliverables

Automatic reinstatement of enrollments when
 eligibility is reinstated
Reissued 3,952,019 enrollment cards
Performed conversion and delivered gold files for
 each transition with excellent data quality
Uniform Disenrollment and PCM Change Letters
Certificates of Creditable Coverage
Utilized B2B Gateway

                                                     12
Metrics



          13
                Enrollment Conversion
                Quality
Contract      Total       TNEX Data       NED Data Issues
           Enrollments                         from
                           Issues    *   MCSC/CHCS/DEERS
                                           Reconciliation
 West       1,456,169        3,522            35,872


 North      1,377,987        2,792            120,167


 South      1,289,680        3,286            25,750


* All corrected by DMDC prior to healthcare delivery.

                                                            14
             Buffer Volumes

 Month      Claims count CCD count     Totals
 Ending

 August      8,857,330   8,174,011   16,747,341

September    6,068,645   7,482,864   13,551,509

 October     4,854,545   8,621,623   13,474,168

November     2,616,187   7,751,143   10,367,330

December     1,772,717   7,261,458   9,034,175


                                                  15
              TNEX Claims Volumes

  Month     Claims count   CCD count      Totals
  Ending

 August      8,610,678     5,795,983    14,406,661

September    10,613,980    7,447,787    18,061,767

 October     17,679,690    12,057,550   29,737,240

November     17,090,745    12,054,823   29,145,568

December     19,246,418    14,220,864   33,467,282


                                                     16
                              Response Times

                                                                               Response
Application/Interface
                                                                                  Time *
Buffer Claims                                                                 Sub-Second
TNEX Claims                                                                   Sub-Second
Buffer Cat Cap                                                                Sub Second
TNEX Cat Cap                                                                  Sub Second
DOES                                                                            1 Second
PCM Research                                                                   3 Seconds
GIQD                                                                           2 Seconds


   * Response times represent internal response time. This excludes network and client side factors.

                                                                                                       17
                          DEERS System
                          Availability

Month              Aug             Sep                Oct   Nov    Dec


Online           98.32%          99.99%          99.07%     100%   100%


Point of
                  100%           99.94%          99.85%     100%   100%
   Service




* Availability excludes planned maintenance windows

                                                                          18
             In Process

• Designated Provider Implementation
• Rollout Web based Enrollment Reports
• Web PCM Research upgrade provides easier PCM
  verification by MTFs
• Interim PCM Panel reports on DEERS
• Web PCM Research upgrade for PCM Panel
  Reports
• Web PCM Load Error Research Application
• Continually reduce or eliminate system
  maintenance windows
                                             19
               Planned TNEX Final
               Projects
• ECHO Implementation (after Reserve Legislation)
• Terminate Claims and Cat Cap Buffers (April)
• Rollout OHI/SIT to MTFs
• Beneficiary based Web Enrollment
• Family Member PIN
• Final TNEX Policy Consolidation to create DOD level
  TRICARE policies instead of contract specific
• Migrate Direct Care Panel Reassignment to DEERS
• Migrate other PCM Reporting to DEERS
• Migrate Designated Provider PCMs to DEERS
                                                    20
               Requested Projects

• Identity and Authentication Assurance for TOL
• Allow MCSC users to assign a PCM with no
  capacity (i.e. override capacity enforcement)
• Provide application to allow MTF’s to adjust
  capacities directly on DEERS
• Send ADSM letters by email
• Notify Providers of Panel Changes or provide
  reports???
                                                  21
              Other DEERS
              2005 Initiatives
• TRICARE Reserve Select
• Interface with the Enterprise Scheduling
  and Registration System
• Provide DNA visibility via the web




                                             22
             Demonstrations
             Available
• Beneficiary Web Enrollment
• Web Other Health Insurance/Standard
  Insurance Table Maintenance
• Web Enrollment Reporting
• Web GIQD
• Web PCM Research
• PCM Panel Reassignment
• PCM Panel Reports
                                        23

				
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