Get documents about "TRO-MCSC_TRS_Brief_22_May_2006
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Document Sample
TRICARE Reserve Select
(TRS) Enrollment, Billing, and
Customer Service Procedures
TRICARE Regional Offices (TRO) and
Managed Care Support Contractors (MCSC)
Overview
• Managed Care Support Contractor POC
Information
• Roles
• Qualifying Life Events
• Reconsiderations
• TRS Information and Assistance
• Reserve Component Outreach
Slide 2
POC for TRS Enrollment, Billing, Medical
Claims, and Customer Service
Health Net Federal Services, Inc.
1-800-555-2605
www.healthnetfederalservices.com
TriWest Healthcare Alliance
1-888-TRIWEST (1-888-874-9378)
www.triwest.com
Humana Military Healthcare Services, Inc.
1-800-444-5445
www.humana-military.com
(Also Serves TRICARE Overseas) Slide 3
TRS TRO and MCSC Roles
• TRICARE Regional Offices’ Role in TRS
• Reserve Component Outreach
• Approval authority for Enrollment Denials due
to Late Initial Enrollment, Late Change in QLE,
Involuntary Disenrollment but NOT Eligibility
• Assess Contractor’s Performance
• Managed Care Support Contractor’s Role in
TRS
• Customer Service
• Enrollment Processing
• Premium Collection
• Payment of Medical Claims
Slide 4
Change of Coverage
• May change type of coverage only with a
Qualifying Life Event (QLE)
• TRS member & family to TRS member-only
• TRS member-only to TRS member & family
Slide 5
Qualifying Life Events
Major types of QLEs
1. Change in family composition
• Marriage, birth, adoption, divorce, child ages out,
death of a family member
2. Change in employment status affecting
coverage
• Gain or loss of employment offering health
coverage
• Change in status affecting employer contribution
to premium
3. Change in family health coverage
• Under TRICARE, CHAMPVA, Medicaid
• Under other federal or non-federal health plan
Slide 6
Reconsiderations
• Reconsiderations are for:
• late initial enrollment
• involuntary disenrollments, and
• late applications for qualifying life event (QLEs) or
changes in family composition (i.e. marriage) or
family health coverage (i.e. loss of employment
related insurance).
• Applications received after deadline for
enrollment are returned to the member
within 10 calendar days of receipt with a
letter advising the member they are no
longer eligible for the TRS and of his/her
reconsideration rights.
Slide 7
Deadlines and Reconsiderations
• Late initial enrollment is defined as application receipt:
< 30 days prior to start of qualification for TRS (Sel Res only)
> 60 days after active duty for Sel Res not eligible for TAMP
> 60 days when IRR transfer to Sel Res assuming within 1 year
after AD or TAMP period
• Late applications for qualifying life event (QLEs) for
changes in coverage level (self only to self and family
and vice versa) is defined as 60 days or later after
occurrence of the QLE
• Involuntary disenrollments is date of disenrollment
• If due to no fault of the member, reconsideration
requests will normally be approved.
Slide 8
TRS Information and Assistance
• For Eligibility and Service Agreement
assistance Contact your Service/Reserve
Component personnel offices:
• TRS Website:
http://www.tricare.osd.mil/reserve/reserveselect
• Reserve Affairs Web site
www.defenselink.mil/ra/
• Guard-Reserve Portal
https://www.dmdc.osd.mil/Guard-ReservePortal
• RC Member contacts respective Managed Care
Support Contractor for Enrollment, Billing,
Claims, and Customer Service.
Slide 9
Reserve Component Outreach and
Assistance
• To schedule a presentation on TRICARE Reserve Select or
other TRICARE Programs, select your TRICARE region on
the map at www.tricare.osd.mil and follow the links to your
TRICARE Regional Office.
• Regional Reserve Component Beneficiary Counseling
Assistance Coordinators (RC-BCAC) contacts for any RC
issues are at:
- South Region 1-800-554-2397
trosouthcs@tros.tma.osd.mil
- North Region 1-866-307- 9749
tronorth@tma.osd.mil
- West Region 1-800-558-1746
trow-southwest@trow.tma.osd.mil
Slide 10
Questions
Slide 11
TRS Enrollment, Billing, Medical
Claims, and Customer Service
Health Net Federal Services, Inc.
1-800-555-2605
www.healthnetfederalservices.com
TriWest Healthcare Alliance
1-888-TRIWEST (1-888-874-9378)
www.triwest.com
Humana Military Healthcare Services, Inc.
1-800-444-5445
www.humana-military.com
(Also Serves TRICARE Overseas) Slide 12
TRICARE Reserve Select
Enrollment and Premium Collection Process
Overview
• Enrollment Applications Submission and
Contractor Acceptance Window
• Coverage Effective Dates
• Payment Information
• Disenrollment
Slide 14
Submitting Enrollment Applications
Applications submitted:
• To contractor where the TRS member
resides – submitted to TSC or mailed
• Ongoing payments:
1. Accepted at TSC, by direct mail, web-site, or
800 BSR
2. Additional payment methods include EFT or
auto credit card charge
3. In South, additional credit cards accepted –
American Express and Discover
Slide 15
Application Acceptance Window
• Tier 1
• Up to 30 days before TRS qualification date
• For IRR or those not qualifying for TAMP - up to 60 days
after TRS qualification
• For Survivor Coverage – 60 days from event
• Tier 2 & 3
• Special open season (Aug 1 – Nov 30)
• For a 10/1/06 effective date - Postmarked by Sept 25, 2006
• For a 1/1/07 effective date – Postmarked after Sept 25 and
before November 25, 2006
• On-going open enrollment periods
• Postmarked by November 25
Note: For any applications received after submission deadline, the
contractors will issue a denial letter to TRS member
Slide 16
Coverage Effective Dates
• Tier 1 - First date of qualification
• Tier 2 & 3
• Special open enrollment – either Oct 1, 2006 or Jan 1, 2007
• On-going – January 1 of each year
• Newly Selected Reservists – 20th of month rule
• Qualifying Life Events
• Resulting in coverage change from Member Only to Member
and Family– date of QLE
• For existing Member and Family coverage – date of receipt by
contractor
• Newborns – date of birth
• Those under Member Only coverage – automatically covered for
first 60 days
• Those under TRS Member & Family – automatically covered for first
365 days
Slide 17
Payment Submission
• Payment must be submitted with initial
enrollment applications
• The contractors will not process the enrollment
will initial payment
• Subsequent monthly payments are due
prior to the 1st of each month
• When not received on time, will bill for second
month along with overdue amount -
delinquency notice issued next day after
overdue billing
Slide 18
Disenrollment
• By member request
• For Tier 1, will result in loss of current TRS qualification
• For Tier 2 & 3, can not request voluntary disenrollment -
will need to wait until next open enrollment period
• Disenrollment for non-payment
• Will occur at the end of the first delinquent month
• Member will still be responsible for past due amount
• Disenrollment due to death of member
• Tier 1 – Family qualifies for 6 month survivor coverage
• Tier 2 & 3 – Family is disenrolled at end of month
Slide 19
Summary
• Will use existing TRS addresses for applications
submission and established processes with some
modifications for payment submission
• The TRS member’s financial obligations for non-
payment disenrollments will be reduced as a
result of new disenrollment guidelines
• We believe the TRS enrollment and billing
enhancements make the TRS program a better
and more easily understood program for the
contractor and more importantly -the TRS
members
Slide 20
TRS Enrollment, Billing, Medical
Claims, and Customer Service
Health Net Federal Services, Inc.
1-800-555-2605
www.healthnetfederalservices.com
TriWest Healthcare Alliance
1-888-TRIWEST (1-888-874-9378)
www.triwest.com
Humana Military Healthcare Services, Inc.
1-800-444-5445
www.humana-military.com
(Also Serves TRICARE Overseas) Slide 21
TRICARE Reserve Select (TRS)
May 23, 2006
Service Agreement Process
Reserve Component Member
Enter into Service Agreement
Reserve Component
Member / Reserve Component
Execute Service Agreement
•Eligibility Recorded in DEERS
Reserve Component
Enrollment Member
Purchase TRS
Slide 23
Application Receipt & Initial Pre-screen
RC Member mails “TRS
Acknowledgement of
Enrollment Form” and one
month premium
Health Net Federal Services Inc.
TRICARE Reserve Select
Enrollment P.O. Box 870162
Surfside Beach, SC 29587-9762
TRS Enrollment Application
Received at Health Net’s Applications are Scanned Enrollment Application
Document Control Center
Slide 24
Application Development & Processing
TRS Enrollment
Representative Views
Enrollment Application
Application from
The Imaging System
Validate Application Acknowledgement Request Application
No No Returned
Completeness and Letter Sent Received
Eligibility
Yes
Enrollment
Welcome Letter and ID TRS Handbook sent
Yes card sent from DMDC from Health Net
Processed
Slide 25
Billing
One month’s premium due with enrollment form
Payment due in advance – payment applies to coverage for following month
Monthly Billing Statements are mailed on the 10 th of each month or the next business
day
First bill will include amount prorated to 1 st of month
Payment is due by the last day of each billing month
Billing Statements will include past due amounts
Billing Statements are not generated for Electronic Funds Transfer (EFT) for recurring
card (RCC) payers or credit
Proration of premium by days (based on 30-day month)
Billing statement includes opportunity to make changes to:
Method of payment (EFT/automatic recurring credit card)
Address (address card enclosed)
Annual premium increase message on Statements in November and December for
non-EFT payors, letters for all payors, including EFT and RCC payors 30 days prior to
January 1st
Slide 26
2006 TRS Premium Notice Schedule
X = extract H = Federal and BCBSSC Holidays M = date mailed
Slide 27
TRS Billing Cycle: Example
Beneficiary paid through 5/31 and the premium for June remains unpaid.
1. May 10th, statement for the June premium is sent (slide 8).
2. June 10th, if the full June premium has not been received, a second statement is sent for the
June past due premium with a message stating their account is past due. The statement will
also include the required July premium (slide 9).
4. June 12th, if the full June premium has not been received, a delinquency notice is mailed
advising the member that if the past due premium is not received by the end of June, they will
be disenrolled from TRS effective June 30th.
5. If the full June premium has not been received by June 30th, the member will be disenrolled
in DEERS. A letter will be mailed to the beneficiary advising them of the disenrollment and
that their account was referred to the Office of General Counsel (OGC) for collections.
6. Within 15 days of the disenrollment, HNFS prepares and sends the case to OGC.
Slide 28
TRS Billing Statement
Slide 29
TRS Billing Statement – Past Due
Slide 30
Initial Payment Options
Check or money order payable to Health Net Federal Services, along with
Enrollment form to:
Health Net Federal Services
TRICARE Reserve Select Enrollment
+
P.O. Box 870162
Surfside Beach, SC 29587-9762 T RS
Enrollment
Form
One-time credit card charge (Visa/MasterCard) on Enrollment Form to:
Health Net Federal Services
TRICARE Reserve Select Enrollment
P.O. Box 870162
Surfside Beach, SC 29587-9762 +
T RS
Enrollment
Form
Slide 31
Subsequent Payment Options
Check or money order (with payment Automatic Recurring Credit Card
stub) charge
Health Net Federal Services
Check Box in the credit card payment
P.O. Box 0892 section of Billing Statement
Carol Stream, IL 60132-0892
Health Net Federal Services
P.O. Box 0892
Credit Card charge - single Carol Stream, IL 60132-0892
Health Net Federal Services
P.O. Box 0892 Electronic Funds Transfer
Carol Stream, IL 60132-0892
(with payment stub) EFT Application on reverse side of Billing
Statement
(IVR) Health Net Federal Services
1-800-555-2605 P.O. Box 0892
(targeted mid-May to be available for Carol Stream, IL 60132-0892
payment)
Health Net Federal Services Website
www.healthnetfederalservices.com
(targeted mid-May to be available for
payment)
Slide 32
Health Net Federal Services
Customer Service
1-800-555-2605
Website
www.healthnetfederalservices.com
Slide 33
TRS Enrollment, Billing, Medical
Claims, and Customer Service
Health Net Federal Services, Inc.
1-800-555-2605
www.healthnetfederalservices.com
TriWest Healthcare Alliance
1-888-TRIWEST (1-888-874-9378)
www.triwest.com
Humana Military Healthcare Services, Inc.
1-800-444-5445
www.humana-military.com
(Also Serves TRICARE Overseas) Slide 34
TRICARE Reserve Select
TriWest Healthcare Alliance
May 23, 2006
Overview
• Contacting TriWest
• Payment Processes
• Forms
Slide 36
Contacting TriWest - Phone
• 1-888-TRIWEST (1-888-874-9378)
• Prompt: Provider or Beneficiary?
• Select Beneficiary
• Prompt: enter Sponsor SSN
• Call is routed to TPR Representative
• Caller can obtain
• Beneficiary eligibility
• Authorization information
• Claims status, or
• Make payments
Slide 37
Contacting TriWest - Website
• www.triwest.com
• Pay by Credit Card
• “Find a Form”
• Beneficiary forms
• # 11 “TRICARE Reserve Select Enrollment Form”
• Link to Reserve Affairs Website
• Print information update forms
• # 12 “TRICARE Reserve Select Information Update
Form
Slide 38
Forms
• TRICARE Reserve Information Update
Form
• Qualifying Life Event (QLE)
• Add family members
• Disenroll
• Change address
Slide 39
Payments
• Methods
• Call 1-888-TRIWEST (874-9378)
• www.triwest.com
• Utilize EFT and recurring credit card
• Form available with monthly statement
Slide 40
Disenrollment Procedures
• Members Must Use “TRICARE Reserve
Select Information Update Form”
• Members Cannot Disenroll by simply
stopping payment
• May go to Office of General Counsel (OGC) for
collections if unpaid
Slide 41
Questions?
