Potpourri Sep 2010

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Potpourri Sep 2010 Powered By Docstoc
					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,;

                   TRICARE Manuals
 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
 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 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 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
 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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