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					SIT/OHI Update

Advisory Working Group
TMA/UBO Program Support Contractor
May 2007




                www.altarum.org
          SIT/OHI Update Overview

• User Teleconferences


• SIT Table Clean-up


• Proposed SIT/OHI Changes


• SIT/OHI Management Reports with Demonstration




                                                  2
                User Teleconferences

 Total of 3 Teleconferences
• Attendance averaged about 14-16 per session (0800 and
  1400)
• Issues:
      - TPC inpatient billing/printing (MSA module) CP 310
  (released)
       - Expiration dates not being saved on policies CP 312 (2 wks)
       - Updated insurance information not crossing over to TPOCS
         (still outstanding – looking for examples to identify pattern)
• Reviewed Trouble Ticket procedure
• Next teleconference mid July

                                                                          3
                  SIT Table Clean-up

• Clean-up procedure
   – Identify duplicate insurance carriers
   – Opportunity to re-point OHI
   – Communication system with VPOC email
• Snag
   – MCSCs and Pharmacy only Cancel and Add OHI
   – No re-point capability
• Teleconference training sessions on 15 May 2007
   – NOTE: Rescheduled to – 30 and 31 May

• Anticipate beginning the process in June/July 2007


                                                       4
                 VPOC to User Email

Purpose:
• Clean up the SIT Table
• Communicate potential changes for the SIT Table
Plan:
• Notification process with a 60-day window to provide the
  MTFs the opportunity to:
        - Question the decision to change certain HICs
        - Respond via email to VPOChelpdesk@altarum.org
        - Adjust their business processes and re-point OHI



                                                             5
         Proposed SIT/OHI Changes


• DEERS, CHCS, and TPOCS have reviewed list of
  proposed changes


• MCSCs / TMA Aurora and Pharmacy to review


• SCRs to be written




                                                 6
       History of Management Reports

• There were NO reports requested in the original SIT/OHI
  requirements
• Current Reports by DMDC (Defense Manpower Data
  Center)
• Opportunity to develop additional reports




                                                            7
           OHI Management Reports

Reports Menu
• OHI by System ID
• SIT by System ID
• OHI transactions by System ID
• SIT transactions by System ID
• OHI by Claim Filing Code and System ID
• OHI by HIPAA Insurance Type Code and System ID




                                                   8
          Insurance Type Code Selection
• CI = Commercial                   • LT = Litigation
• CP = Medicare Conditionally       • MB = Medicare Part B
  Primary
                                    • MC = Medicaid
• GP = Group Policy (Self
  funded/employer based)            • MI = Medigap Part B
• HM = HMO                          • MP = Medicare Primary
• AP = Auto Insurance Policy        • OT = Other
• IP = Individual Policy            • PP = Personal Payment
• LD = Long Term Policy             • SP = Supplemental Policy


        The default Insurance Type Code is “ Commercial”



                                                                 9
              Claim Filing Code Values
09 = Self-pay (default)                     DS = Disability
10 = Central Certification                  HM = Health Maintenance
11 = Other Non-Federal Programs (Self          Organization
   insured programs, etc.)
                                            LI = Liability
12 = Preferred Provider Organization
   (PPO)                                    LM = Liability Medical
13 = Point of Service (POS)                 MB = Medicare Part B
14 = Exclusive Provider Organization        MC = Medicaid
   (EPO)
                                            OF = Other Federal Program (use for
15 = Indemnity Insurance (Old traditional
                                               Medicare)
   policies)
16 = Health Maintenance Organization        TV = Title V (Medicare Maternal Child
   (HMO)Medicare Risk                          program)
AM = Automobile Medical                     VA = Veteran Administration Plan
BL = Blue Cross/Blue Shield                 WC = Workers’ Compensation Health
CH = CHAMPUS                                   Claim
CI = Commercial Insurance Co. (Aetna,       ZZ = Mutually Defined Unknown
   Cigna, etc.)


           The default Claim Filing Code is “Self-pay”

                                                                                    10
           OHI Management Reports

Useful information for UBO Service Managers
• SIT and OHI productivity totals
• Which sites have most / least OHI
• Breakdown of Insurance Type Codes and Claim Filing
  Codes by sites and totals


Access to OHI Management Reports
• Who/How?
• Altarum Site Security Manager (SSM)


                                                       11
    Quality Data will yield better reports

Achieved by:
• Clean up of the SIT Table
• Clean up of the OHI policies
• Educate and Train staff
• Implement Insurance Type Code and Claim Filing Code
  field changes




                                                        12
                  Action Plan

• May 15 Teleconference – Clean-up process
• Begin Clean-up of SIT Table – Anticipate 6
  months to one year
• Coordination of Proposed changes/Management
  reports
• SCRs




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