Potpourri Sep 2010 by xiuliliaofz


									TAOP TRICARE Advanced Course

       There’s More???
 Medicare & TRICARE
 TRICARE Manuals
 HIPAA [not the animal…]
 TOP POC Program
 TAOP & You

                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

Medicare & TRICARE
                     Medicare & 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

                   TRICARE 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

Health Insurance Portability &
 Accountability Act (HIPAA)
 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:
 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

Exceptional Family Member Program
   Extended Care Health Option

         EFMP & ECHO
                      EFMP & 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
                   EFMP & 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


              Briefed at C&CS Conference 2010
                    EFMP & 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
                  EFMP & 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.

                              EFMP & 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.
                      EFMP & 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

                   EFMP & 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

                    EFMP & 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.


TOP POC Program
                  TOP 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

                        TOP 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.

TAOP & You
                         TAOP & 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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