Defense Online Enrollment System by wanghonghx

VIEWS: 235 PAGES: 144

									Defense Online Enrollment System Application
                User Manual




              Document Version 1.7

                          for
               Software Version 4
                     June, 2006




                      Prepared by:
                       EDS/DMDC
                1600 N. Beauregard Street
                  Alexandria, VA 22311
User Manual for DOES Version 4.0                                                           January 2006




Version History

 Version No.       Revision Summary                                           Date
 0.1               Development                                                June 2003
 0.3               Formatted/Edited                                           June 2003
 0.5               Peer Reviewed                                              July 2003
 0.7               Revised                                                    July 2003
 0.9               Revised                                                    August 2003
 0.11              Final Revisions                                            September 2003
 1.0               Final Approval by Product Manager                          October 2003
 1.1               Revisions Due to Software Enhancements                     March 2004
 1.2               Revisions Due to Software Enhancements                     April 2005
 1.3               Revisions Due to Echo Software Enhancements                June 2005
 1.4               Revisions Due to Final Policy Consolidation Enhancements   August 2005
 1.5               Revisions Due to Added Functionality                       November 2005
 1.6               Revisions to OHI                                           January 2006
 1.7               Revisions TRICARE Reserve Select Enhancements              June 2006




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Table of Contents

1   Introduction to the DOES Application ................................................................................................ 1
    1.1 Purpose of User Manual ................................................................................................................ 1
    1.2 Application Overview ..................................................................................................................... 1
    1.3 Screen Captures and Prints .......................................................................................................... 1
    1.4 Privacy Act Notice ......................................................................................................................... 1
    1.5 Safeguarding the Confidentiality of Information ............................................................................ 1
    1.6 DSO/DMDC Help Desk ................................................................................................................. 2
    1.7 DOES Functionality ....................................................................................................................... 2
2   DOES Application Basics .................................................................................................................... 3
    2.1 Logging into DMDC Tools ............................................................................................................. 3
          2.1.1 DMDC/DoD Rules for Passwords ...................................................................................... 4
          2.1.2 How to Change the User Password .................................................................................. 5
          2.1.3 Login Errors ....................................................................................................................... 7
    2.2 Running the DOES Application ..................................................................................................... 8
    2.3 DOES Online Help......................................................................................................................... 8
3   Pulling and Viewing Information from the National Enrollment Database ................................... 10
    3.1 Pulling Information ....................................................................................................................... 10
          3.1.1 Icons Used to Represent Females and Males ................................................................. 12
          3.1.2 Selecting a Person ........................................................................................................... 12
    3.2 Viewing a Family’s Details ........................................................................................................... 13
          3.2.1 Viewing Personal Information in a Record ...................................................................... 13
          3.2.2 Viewing Residential Address and Contact Numbers ....................................................... 14
          3.2.3 Viewing Mailing Address .................................................................................................. 15
          3.2.4 Viewing the Sponsor's Personnel Information ................................................................. 16
          3.2.5 Viewing Health Care Program Coverage Details ............................................................ 17
          3.2.6 Viewing Health Care Program Eligible Plans .................................................................. 18
                3.2.6.1 Displayed Names of Coverage Plans and their Full Names ............................. 19
          3.2.7 Viewing Catastrophic Cap and Deductible Amounts for a Health Care Plan: ................. 20
          3.2.8 Viewing Other Government Programs ............................................................................. 21
          3.2.9 Viewing Other Health Insurance ...................................................................................... 22
    3.3 Viewing Policies ........................................................................................................................... 23
    3.4 Return to Family View from Policy View ...................................................................................... 24
    3.5 Pulling Information from NED for another Family ........................................................................ 24
4   Performing Updates ........................................................................................................................... 25
    4.1 Address Update ........................................................................................................................... 25
          4.1.1 Selecting the Beneficiary and Information to Update ...................................................... 25
          4.1.2 U.S. and U.S Territory ZIP Codes ................................................................................... 28
          4.1.3 Telephone Number/Other Contact Fields Updates ......................................................... 28
          4.1.4 Address Validation - Code One Plus Address Validation Procedure .............................. 29
    4.2 Adding OHI .................................................................................................................................. 32
    4.3 Enrollment Attribute Update ........................................................................................................ 37
          4.3.1 Updating Attributes from the Main Menu ......................................................................... 37
                4.3.1.1 Updating the Work ZIP Code ............................................................................ 37
                4.3.1.2 Updating the Fee Waiver Reason ..................................................................... 38
          4.3.2 Updating Attributes as New Enrollment or Transfer ........................................................ 41
5   Performing a New Enrollment ........................................................................................................... 43
    5.1 Primary Care Manager Assignment ............................................................................................ 47
          5.1.1 Contractors, Health Plan Types and PCM Assignments ................................................. 47


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    5.2  Assigning a PCM to a Beneficiary ............................................................................................... 48
         5.2.1 Searching and Selecting a Direct Care/Resource Sharing PCM .................................... 48
                5.2.1.1 Selecting the MTF via DMIS ID ......................................................................... 48
                5.2.1.2 Searching for the PCM by Name....................................................................... 49
                5.2.1.3 Assigning the PCM ............................................................................................ 49
                5.2.1.4 Direct Care Assignments for Specific Situations ............................................... 51
         5.2.2 Selecting a Civilian PCM for a Beneficiary ...................................................................... 53
                5.2.2.1 Advanced PCM Search ..................................................................................... 56
         5.2.3 Choosing None as a PCM ............................................................................................... 58
         5.2.4 Enrolling a Beneficiary into a TRICARE Prime Remote Plan .......................................... 59
         5.2.5 Enrolling a Beneficiary into a USFHP Plan ...................................................................... 59
                5.2.5.1 USFHP Enrollment Rules: ................................................................................. 60
                5.2.5.2 Enrollment Transfers ......................................................................................... 60
                5.2.5.3 Enrollment Fee .................................................................................................. 60
         5.2.6 PCM Capacity Less than Ten .......................................................................................... 60
    5.3 Policy Enrollment Summary ........................................................................................................ 60
    5.4 Enrollment Fee Information ......................................................................................................... 62
         5.4.1 Performing a Fee Payment Operation ............................................................................. 62
         5.4.2 Rules about Payment Plan Types ................................................................................... 63
         5.4.3 Types of Payments and Screen Forms ........................................................................... 64
         5.4.4 Credit Payments Rules ....................................................................................................... 66
    5.5 New Enrollment Card Request .................................................................................................... 67
    5.6 Disenrollment ............................................................................................................................... 69
    5.7 Transferring an Enrollment .......................................................................................................... 70
    5.8 Approve Pending Enrollments ..................................................................................................... 72
         5.8.1 Pending Enrollment/PCM ................................................................................................ 72
         5.8.2 Functionality Allowed through DOES if Enrollment/PCM pending .................................. 75
         5.8.3 Functionality not allowed thru DOES if Enrollment/PCM pending ................................... 76
    5.9 Confirmation Letter Request ....................................................................................................... 76
    5.10 Enrollment Modification ............................................................................................................... 78
         5.10.1 Change Enrollment Period ............................................................................................... 78
         5.10.2 Canceling Enrollments, Disenrollments, and Transfers .................................................. 79
         5.10.3 PCM Options ................................................................................................................... 81
                5.10.3.1 PCM Assignment ............................................................................................... 81
                5.10.3.2 PCM Cancellation .............................................................................................. 82
                5.10.3.3 PCM Modification .............................................................................................. 83
6   Sending Notifications to the Database ............................................................................................. 84
7   Special Programs: ECHO, Tobacco Cessation, and Weight Management ................................... 86
    7.1 Extended Care Health Option ..................................................................................................... 86
         7.1.1 Basics of the ECHO Program .......................................................................................... 86
    7.2 The Demonstration Programs: Tobacco Cessation and Weight Management ........................... 87
    7.3 Special Program Functions ......................................................................................................... 87
         7.3.1 Performing a New Special Program Enrollment .............................................................. 88
         7.3.2 Performing a Special Programs Disenrollment................................................................ 91
         7.3.3 Canceling an Event .......................................................................................................... 92
         7.3.4 Sending Special Programs Notifications to the Database ............................................... 92
8   TRICARE Reserve Select Option ...................................................................................................... 93
    8.1 TRS Plans ................................................................................................................................... 93
    8.2 TRS Functions ............................................................................................................................. 93
    8.3 Performing a New TRS Enrollment ............................................................................................. 94
    8.4 Performing a TRS Disenrollment ................................................................................................. 99
    8.5 TRS Modifications ..................................................................................................................... 100
         8.5.1 Change Enrollment Period ............................................................................................. 100
         8.5.2 Canceling Events ........................................................................................................... 101


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     8.6   Enrollment Transfers in TRS ..................................................................................................... 101
     8.7   Updating Addresses in TRS ...................................................................................................... 104
     8.8   Updates ..................................................................................................................................... 106
           8.8.1 Updating Premium Payments ........................................................................................ 106
           8.8.2 Adding OHI in TRS ........................................................................................................ 107
           8.8.3 Notifications ................................................................................................................... 107
     8.9 Miscellaneous Options in TRS .................................................................................................. 108
           8.9.1 Reserve Select Agreement ............................................................................................ 108
9    Exiting DOES and DMDC Tools....................................................................................................... 109
Appendix A – Acronyms and Abbreviations ........................................................................................ A-1
Appendix B – Health Plan Names .......................................................................................................... B-1
Appendix C – Foreign Countries and Codes ........................................................................................ C-1
Appendix D - DOES Shortcut / “Hot Key” List ..................................................................................... D-1
Appendix E - Summary of Key DOES Business Rules ........................................................................E-1
Appendix F – DOES Application Error Codes and Solutions .............................................................. F-1




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1 Introduction to the DOES Application

1.1     Purpose of User Manual
The Defense Online Enrollment System (DOES) User Manual for system version 4.0 is designed to assist
Defense Enrollment Eligibility Reporting System (DEERS) Support Officers, Managed Care Support
Contractors (MCSCs), Designated Providers (DPs), and authorized users in foreign locations outside the
continental United States (OCONUS) with navigating the new version of DOES, explaining its
functionalities, reviewing major business rules, and highlighting new application features and functions. It
is written from both a user and task-oriented perspective.

1.2     Application Overview
DOES is the client server application for the National Enrollment Database (NED) of the Department of
Defense (DoD). This application allows enrollment functions to be performed for beneficiaries of DoD
health care and other related programs. The purpose of DOES is to validate eligibility and perform
enrollment activities within the population of military sponsors, family members, and other persons
eligible to receive DoD benefits.
DOES is utilized for such enrollment activities by MCSCs, DPs, OCONUS representatives, and DMDC
Support Office (DSO) personnel. All transactions that occur in DOES are centralized within NED as the
primary eligibility and enrollment repository for the DoD. DEERS and NED are the repositories for all
updates and the sources for all inquiries made in DOES.
The functions and events of DOES are governed by the DEERS/Medical Interface Operational
Description Business Rules. These rules govern valid and invalid transactions; data available to the user
via DOES screens; database interaction; DOES error reporting; and transactions allowed to be performed
following a warning message. The rules are available online at http://www.dmdc.osd.mil/deers.

1.3     Screen Captures and Prints
The DOES User Manual contains screen captures and prints that are current as of August 2005. If changes
made in future releases of the application are significant enough to warrant new screen prints, addendums
will be produced and sent out accordingly.

1.4     Privacy Act Notice
Due to Privacy Act considerations, protected information such as Social Security numbers (SSNs), birth
dates, addresses, and phone numbers have either been fabricated or erased in the examples used
throughout the manual.

1.5     Safeguarding the Confidentiality of Information
Only users authorized by the Defense Manpower Data Center (DMDC) may access the DOES Online
application and view or be apprised of information available within the application. In compliance with
the Privacy Act of 1974, every authorized user must safeguard the confidentiality of such information at
all times. Before leaving any personal computer unattended, all users must ensure that they are logged off
of the application. For added security, users may also lock their workstations. See the Systems
Administrator for instructions.




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1.6       DSO/DMDC Help Desk
The DSO maintains a help desk for all DMDC applications. The DOES help desk is available for users to
contact and troubleshoot application problems. It serves as a resource in those instances where the DOES
User Manual does not fully address the question and/or issue for a user.
There are some guidelines to follow when calling the DOES help desk. Those guidelines can be found in
a separate document entitled DMDC NED/DOES Issue Resolution Version 1.0, which outlines the step-
by-step comprehensive procedures for the resolution of issues related to DOES. This document should be
available for reference at your organization; however, if it is not available, alert the DMDC point of
contact (POC) so that he/she can acquire one.

1.7       DOES Functionality
DOES has a number of uses, but its primary function is to perform new enrollments and update
beneficiary information. Some key elements include:
     Eligibility Inquiries and Verification: View a beneficiary or family record in order to determine
      eligibility to enroll in a DoD health care coverage plan; view a beneficiary or family's current
      TRICARE health policies; enrollment in Other Government Programs; and Other Health Insurance
      (OHI) carrier information.
     Enrollments: Enroll eligible beneficiaries or a family into available TRICARE health plans.
     Disenrollments: Disenroll a plan sponsor or other beneficiary who has chosen to disenroll.
     Transfers: Transfer existing enrollments between contractors.
     Primary Care Manager (PCM) Actions: Perform all PCM-related enrollment-activities within
      beneficiary records, assignments, cancellations, and modifications.
     Cancellations: Cancel any activity performed in DOES that is pending being sent to NED.
     Contact Information Updates: Update a beneficiary's address, telephone number, and e-mail
      address information.
     Change Enrollment Begin and End Dates: Change the enrollment begin and end dates of enrolled
      beneficiaries.
     Add Fees to a Policy: Add fees to a policy or record fee payments made during an enrollment.
     Record Fee Waivers : Add fees to a policy or record fee payments made during an enrollment
     Other Health Insurance: Add or Update the OHI in a beneficiary‘s record.
     Send Policy or PCM Notifications to Secondary Systems: Send enrollment policy or PCM
      notifications to MCSCs, DPs, and the CHCS.
     View Historical Beneficiary Information: View historical information, such as enrollments
      terminated in the past year, via DOES.
     Approve Pending Status: Approve pending enrollments that were generated by a Web-based
      enrollment application or an enrollment performed at a prior time which needed to be confirmed.




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2      DOES Application Basics

2.1     Logging into DMDC Tools
1. The DOES application is run from the DMDC Toolbar. To access the DMDC Toolbar, log in to
   DMDC Tools.
2. Double-click the DMDC Tools Shortcut icon on the desktop. The text below the icon will read
   DOES and the version number. This manual pertains to DOES version 4.0.




3. The DEERS Login dialog box will appear.




4. Before logging in, ensure that the user‘s current site ID is displayed in the Site ID text box. If the
   correct site ID is not displayed, click the Settings button or use shortcut ALT+S. A Site ID dialog
   box will appear.




5. The user will not be able to type over the site ID given in the Site ID text box; therefore, it will need
   to be deleted first. Using the delete key on the keyboard, highlight the old site ID, and delete it. After
   the site ID has been deleted, type the correct site ID in the Site ID text box. Note: The site ID needs


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    to be six digits long. If the user‘s site ID is fewer than six digits, fill in the first several digits with
    zeros until the site ID is six digits long.
6. Click OK or use shortcut ALT+O.




7. If the user needs to change the site ID recently entered or return to the DEERS Login dialog box,
   click Cancel or use shortcut ALT+C. After the first time the site ID is entered, DOES stores it as the
   default value for future logins. Therefore, it will automatically populate the text box within the Site
   ID dialog box with the ID at future logins. If the user needs to log in to DOES under multiple site
   IDs, he/she will have to change this setting as necessary.
8. Enter the user‘s login ID (sometimes called the user‘s account code) in the Login text box.
9. Enter the user‘s password in the Password text box. Note: Passwords are case-sensitive.
10. When the user has correctly entered the login ID and password, click OK. The DMDC Toolbar will
    appear. The toolbar will look different for each user depending on the user‘s access to the various
    applications.




2.1.1         DMDC/DoD Rules for Passwords
Due to DoD and DMDC rules and regulations, DMDC/DOES passwords must conform to the following
rules:
   The password must be exactly eight characters in length.
   The password is case-sensitive and must contain both upper and lower case characters.
   The password must contain a numeral (0-9).
   The password must contain at least one special character: - ! < # % ^ & * > ?.
   No character in the password can be repeated more than twice.
   The password cannot be changed to a previously used password.
   Passwords will be valid for 45 days.
   Login IDs will be suspended after three consecutive erroneous attempts.




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2.1.2         How to Change the User Password
To change a user‘s password:
1. Click the User icon located on the DMDC Toolbar.




2. The User Information window will appear. The window contains the user‘s DEERS User ID; the
   name of the database the user is connecting to (Database Port); the Site ID; the Account ID (an
   internal reference); and a list including the Application ID, Application Name, Organization Code,
   and Access Code of applications the user has access to within that particular site.




3. Click on the Change Password icon or use shortcut ALT+P to go to the next screen.
4. The T47J password screen appears. This screen allows the user to enter their old password and a new
   password.




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5. Enter the user‘s old password in the Old Password text box
6. Enter the user‘s new password in the New Password text box using the rules outlined in section
   2.1.1: DMDC/DoD Rules for Passwords.
7. Verify the user‘s new password by retyping it in the Confirm New Password text box.




8. Click OK or use shortcut ALT+O to send the password change.
9. If the user needs to change the new password before sending it, click Cancel or use shortcut ALT+C.
10. If the password meets all the rules, it will be accepted.
11. The user will receive a password confirmation message.




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12. To close the message, click OK.

2.1.3         Login Errors
When attempting to log in to the DOES application, the user may encounter an error message instead of
the main screen. There are two types of login error messages that might appear when trying to log into
DMDC Tools.
1. If the user receives an Error dialog box with messages indicating the password was not matched or
   the ID was invalid, this indicates that the user entered the login ID and/or the password incorrectly.




                                                      OR




2. Click OK to close the error message to return to the DEERS Login dialog box.
3. If the user‘s login ID was entered incorrectly, type the correct login ID in the Login text box. Type
   the correct password in the Password text box.
4. Click OK to reattempt logging on.

5. There is also another type of error message the user might encounter. If there is a 9 followed by any
   other number in the parentheses of the error message, it indicates that DEERS is temporarily down. It
   does not indicate that the user entered the login/password incorrectly. If the user receives this error
   message, copy down the numbers inside the parentheses of the error message. Click OK to close the
   Error dialog box.




6. Click OK to return the user to the DEERS Login dialog box, where the user can click Cancel to
   close it. Contact the DMDC POC to inform him/her that DEERS is down and give the POC the
   numbers from the error message to aid in resolving the problem.




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2.2     Running the DOES Application
Once the DMDC Tools Launcher toolbar is displayed, the DOES application can be run by double-
clicking the DOES 4.0 icon (indicated by the yellow arrow) on the DMDC Tools Launcher toolbar.




2.3     DOES Online Help
Online Help for the DOES application is an indexed, searchable set of links that assist the user in
understanding the functions of the application. It can be searched through two ways: via the Contents or
via the Index. The Contents is a catalog of the application‘s main topics listed in accordance with the
manual‘s Table of Contents. The Index is also a catalog of the application‘s topics; however, they are
listed alphabetically. When utilizing the Index, the user can also type in keyword(s) that he/she would like
to conduct a search on. Doing so highlights only those help topics related to the keywords entered by the
user.
To access Online Help:
1. Click on the Help option on the main menu bar located at the upper-right side of the screen to display
   Online Help topics.




2. The user is given the following options from which to choose:




3. If the Contents option is selected, the Table of Contents will appear. The Help topics in the Table of
   Contents are listed in accordance with the manual‘s Table of Contents.




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4. If the Search for Help On option is selected, the Index tab of the Help Topics: DOES dialog box is
   displayed. The Help topics are listed alphabetically and a text box exists to allow the user to search
   via topic letters.




Note: The Search for Help On option and the                 icon return the same Index tab of the Help
Topics: DOES dialog box.


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5. If the About option is selected, a window listing the application‘s system components and current
   version number is displayed. The information assists the DEERS POC when reporting issues and
   problems with the application. Often, the first line of defense in troubleshooting may be getting the
   user the most recent copy of DOES or some of its component parts.
6. If the New Changes in DOES option is selected, a summary page listing the major differences in the
   pre-T-NEX (3.0) version of DOES and the T-NEX (4.0) version of DOES is displayed. This serves as
   a quick reference for those users already familiar with the DOES application.


3   Pulling and Viewing Information from the National Enrollment
Database

3.1     Pulling Information
1. Upon startup of the DOES application, the Inquire National Enrollment Database dialog box will
   be displayed in the middle of the application window. This box contains fields for Program Type
   and Person SSN. By default, the Program Type drop-down list will contain the information relevant
   to the last program searched.




2. If the Program Type drop-down list does not display the program for which the user needs to
   perform an enrollment activity, click the drop-down arrow and select the appropriate Program Type.




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3. In the Person SSN text box, enter the SSN, Foreign Identification Number (FIN) or TIN of the
   sponsor or family member the action is being performed on. The person ID defaults to the last person
   DOES performed a search upon.




4. Click OK. Note: If the SSN or other ID entered does not belong to a sponsor, the user will receive a
   message indicating the ID is not a sponsor match but that a record was found.




5. Click OK or use shortcut ALT+O to close the message. If the user enters a SSN or other ID that has
   more than one person associated to it, the user will receive a message indicating that he/she must
   choose one of the individuals partially matched to the ID.




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6. After selecting the individual from the list, click OK or use shortcut ALT+O. In either case, once the
   individual is selected, the DOES application will return information for the selected individual and
   their family from NED, as seen below in the DOES main screen.




3.1.1         Icons Used to Represent Females and Males
The DOES application differentiates male and female persons by a Male or Female icon located on the
left side of the individual‘s name.
For example:




3.1.2         Selecting a Person
A red check mark appears over the Male or Female icon when an individual is selected and his/her
information is displayed on the right side of the DOES main window.
Examples:

Indicates that Robert Leaver is the selected person and that his information is the information displayed
on the right side of the DOES main screen.


Indicates that Erin Leaver is the selected person and that her information is the information displayed on
the right side of the DOES main screen.



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By default, the person whose SSN or other ID the user entered is the selected person with his/her
information displayed by the DOES application on the right side of the DOES main window.

3.2     Viewing a Family’s Details
In DOES there are two main views for beneficiary information: the Family View and the Policy View.
Within those two views, the subsets of information are stored. The first and main view is the Family
Screen also referred to as the main screen. This section provides a description of the information in the
Family screen. The following screen is an example of a family tree, expanded so the user can see most of
the options:




3.2.1         Viewing Personal Information in a Record
1. When a person's name is selected from the family tree by clicking or using the arrow keys, the first
   set of information displayed on the right side of the DOES main window is the Person Details tab.
   These details can also be accessed by clicking on the Person Details icon in the tree, clicking the
   Person Details tab on the main screen, or using shortcut ALT+P.




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2. The Person Details tab includes the following information: Person ID/Type (usually SSN); Last
   Name, First Name, Middle Name, and Cadency Name (Jr., Sr., II, III, etc.) used to distinguish
   males in the same family who have the same name; Birth Date; Death Date (if applicable); and
   Gender.




3. To view the information for an associated family member, click the person's name from the family
   tree on the left side of the screen and their details will appear in the Person Details tab.

3.2.2         Viewing Residential Address and Contact Numbers
There are now separate screens for residential and mailing addresses. To view a person's residence
address and contact telephone number:
1. Click the house icon   located under the person's name in the family tree, click the Residence
   Address tab in the main screen, or use shortcut ALT+R to view the Residence Address tab.
2. The Residence Address tab contains a Residence Address section and Contact Information
   section. The Residence Address section includes: Street, City, State, Zip Code, Country, and Last
   Updated Source. The Contact Information section includes: Home, Fax, and Work (telephone
   numbers).
3. Within the Residence Address tab, click the Additional Reporting Information button to view the
   effective date of the last address update and any e-mail address information.
4. The Last Updated Source field is now part of the Residence Address tab. It identifies the name of
   the last system used to update the residential address. This field is not editable by the user; however,
   when an address update is sent by any DEERS application, NED is updated, and the change is
   reported back during a query.




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3.2.3         Viewing Mailing Address
To view a person‘s mailing address to see if it is different than the residential address:
1. Click on the mailbox icon located below the selected name in the family tree, click on the Mailing
   Address tab in the main screen; or use shortcut ALT+M to view the Mailing Address tab.
2. The Mailing Address and Residence Address tabs are very similar, except that the mailing address
   does not have any telephonic or electronic contact information. The Mailing Address Tab includes:
   Street, City, State, Zip Code, Country, and Last Updated Source. In addition, the Additional
   Reporting Information button only provides the effective date of the last update.
3. The Last Updated Source field is also part of the Mailing Address tab. It identifies the name of the
   last system used to update the mailing address. This field is not editable by the user; however, when
   an address update is sent by any DEERS application, NED is updated, and the change is reported
   back during a query.




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3.2.4         Viewing the Sponsor's Personnel Information
Most sponsors are Active Duty Service Members (ADSM) with Personnel Information.
To view the user‘s Personnel information:
1. Click the Personnel Information icon      located below the individual‘s name in the family tree,
   click the Personnel Information tab in the main screen, or use shortcut ALT+S to view the
   Personnel Information tab.




2. The Personnel Information tab window includes Personnel Information and Work Location
   sections. The Personnel Information section includes: Personnel Category; Branch of Service;
   Rank; Pay Plan/Pay Grade; and Pay Grade Date. The Work Location section includes: Unit
   Identification Code (UIC); Work ZIP Code; and Country.


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Note: The work ZIP code is important as a data element in DOES calculations for beneficiary eligibility
in remote plans. The UIC is an important piece of data for an ADSM when enrolling into a TRICARE
plan with a Direct Care PCM by allowing the PCM choice to default based on UIC information.

3.2.5         Viewing Health Care Program Coverage Details
From the family tree, the user can view information the current Health Care Program, the sponsor, and
beneficiaries are enrolled in via the Coverage Details and the plans they are eligible for in the Eligible
Plans section of the tab.
To view an individual‘s current Health Care Program information:
1. Click or arrow down to the Health Care Program located in the family tree below the name of the
   individual whose information the user wants to view or use shortcut ALT+C.
2. The Health Care Program window appears. By default, when the user clicks Health Care
   Program, the Coverage Detail window is displayed first.




3. The information on the Coverage Details screen includes Enrollment Details and PCM sections.
   The Enrollment Details section includes: Health Care Program the selected individual is currently
   enrolled; (Enrollment) Begin Date; (Enrollment) End Date (which for most plans notes the end of
   eligibility, or is one calendar year from the date of enrollment for an Extended Care Health Option
   [ECHO] plan). The Enrollment Details section will also show if a enrollment is waiting for approval.
   There is also an Additional Reporting Information command button that provides the effective date
   of the last address update and any e-mail address information. Note: The Coverage Detail window
   does not display enrollment end reason.
4. The PCM section includes a Period drop-down list box that displays the enrollment segment to
   which the PCM information is attached. If there is more than one PCM assignment, click the drop-
   down arrow to view information on the other assignments.


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5. The general PCM information available on the first screen is: PCM ID, PCM Name, Defense
   Management Information System (DMIS) ID (a four-digit code that identifies the PCM enrolling
   division), PCM Phone; DEERS Region to which the PCM is attached, type of Network Provider
   (Direct Care, Resource-Sharing, Civilian, Uniformed Service Family Health Plan (USFHP)/DP, or
   Named PCM Provider) and PCM Specialty.
6. Verify that the code displayed in the Region text box is valid. Valid Region codes for T-NEX are:
       13 - OCONUS Europe
       14 - OCONUS Pacific
       15 - OCONUS Latin America/Canada
       17 - T-NEX North
       18 - T-NEX South
       19 - T-NEX West
7. To view information relevant to the PCM segment previously selected in this window, click the
   Details tab, tab to the Details window of the PCM, or use shortcut ALT+D.
8. Information listed in the Details tab includes: (Enrollment) Period; Group Name (to which the PCM
   is attached); the Place of Care to which the PCM is attached for the individual; the Group ID, and
   the ZIP Code. Note: A PCM can be associated with more than one place of care and more than one
   group. In these cases, there would be two PCMs the user could select to view information.




3.2.6         Viewing Health Care Program Eligible Plans
To view the Health Care Coverage plans and the eligibility period for a selected beneficiary, click
Eligible Plans located below the individual‘s name in the tree, click the Eligible Plans tab, or use
shortcut ALT+P. This will show all plans the selected beneficiary is eligible for, as well as eligible
enrollment periods for these plans. Notice that at the bottom of the screen, there is also a list of plans that
the selected beneficiary is currently enrolled in:




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The plans that the user is eligible for are visible at the bottom of the screen:




3.2.6.1       Displayed Names of Coverage Plans and their Full Names
If the user experiences any difficulty with deciphering a short name for a coverage plan, refer to
Appendix B: Health Plan Names. The table provides the full name of the coverage plan for each short
name that may appear in the DOES application, and is sorted alphabetically by the short name for the
coverage plan.


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3.2.7         Viewing Catastrophic Cap and Deductible Amounts for a Health Care Plan:
To view a family‘s current fiscal year totals paid for Catastrophic Cap and Deductible (CC&D):
1. If a beneficiary is enrolled in a plan which requires CC&D, the icon will appear under the
   beneficiary‘s name under the Health Care Plan section of the tree when expanded, or if applicable,
   an additional tab will appear on the Health Care Program screen.




2. The information returned in a CC&D inquiry includes the fiscal year Cat Cap totals paid to date for
   the family. Note: Individual totals for any selected year are not shown. The Deductible Payment and
   POS Deductible Amount are functions of the plans which the sponsor and the family members are
   enrolled into, and the fees paid to date are reported in DOES as sent by DEERS.




3. During an inquiry, the calendar date is locked by the system so that the CC&D amounts can be
   calculated correctly.
4. The user can also view CC&D information from the main DOES menu. Click View, and then choose
   CCAP and Deductible Totals.




5. The Family Fiscal Year Cat Cap and Deductible Total screen is returned. It shows the same
   information as in the other view; however, it is formatted differently.

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6. Click on the Close button or use shortcut ALT+C to return to the family view.

3.2.8         Viewing Other Government Programs
To view other government health care programs an individual may be enrolled in (i.e. Medicare,
CHAMPUS) or receiving benefits from:

1. Click the Other Government Programs icon            located below the individual‘s name in the family
   tree or use shortcut ALT+O.
2. If there is any information available on the beneficiary, the screen will show the Type Code (type of
   government insurance), Eligibility Reason, Effective Date, and Expiration Date.




3. If there is no information available, the user will receive a message indicating the beneficiary is not
   receiving Medicare benefits.


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3.2.9         Viewing Other Health Insurance
If plan beneficiaries have OHI, DOES will display the information sent by the database. OHI information
can be added as necessary during an enrollment in DOES. OHI can be viewed in the same ways as other
sections of the record.
To view OHI for a beneficiary:

1. Click on the Other Health Insurance icon      located below the individual‘s name, click the Other
   Health Insurance Policy tab, or use shortcut ALT+I to view the Other Health Insurance Policy
   tab.
2. OHI information is separated into Other Health Insurance Policy and OHI Coverages tabs. The
   user can click on either tab or use shortcut ALT+I to view the Other Health Insurance Policy tab or
   shortcut ALT+V to view the OHI Coverages tab. The Other Health Insurance Policy tab contains
   summary information about the current OHI policy including Health Insurance Carrier (HIC) ID,
   Policy ID, End Reason, Effective Date, and Expiration Date. The HIC ID is derived from the
   Standard Insurance Table (SIT). The insurance carrier must be included on the SIT to be considered a
   valid carrier. The following screen is an example of the Other Health Insurance Policy tab.




    The OHI Coverages tab contains information about the types of OHI policies the selected
    beneficiary carries including the Coverage Type and Eligibility Period. The following screen is an
    example of the OHI Coverages tab.




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3.3     Viewing Policies
The other main view for information in DOES is the Policy view. On this screen the user can see the
sponsor and all the beneficiaries who are either currently enrolled in a Health Care Coverage Plan or
those who have had a Policy enrollment period within the last year.
1. To view the current health care coverage policy or policies for a family going back one year, check to
   see if the View Policy button along the top menu bar is enabled. If it is enabled, there is at least one
   policy applicable to the family to view. Below is an example of an enabled View Policy button.




2. If the View Policy button is not enabled, there is no policy applicable to the family. Below is an
   example of a disabled View Policy button.




3. To view an enabled policy, click the policy applicable to the family or use shortcut CTRL+P. The
   user sees the following split screen for policies.




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4. By default, the most recent valid policy under the DoD Policy group will be selected, and the Policy
   Details tab will be displayed.
5. At the bottom of the Policy Details tab for the selected policy, the Beneficiary (enrollee name);
   Enrollment Begin Date, Enrollment End Date, and if applicable, the Enrollment End Reason and
   Enrollment Contractor are displayed.




6. To view the Policy Details tab and enrollee information for another policy, click the policy or expand
   the policy to see the policy broken up into fiscal year (FY) policies.
7. To view additional policies within the family, click the policy or expand the policy to see the policy
   displayed by fiscal year (FY).

3.4     Return to Family View from Policy View
To return to the Family View window from the Policy View window, or any other part of the DOES
application, click the View Family button or use shortcut CTRL+V. This brings the user back to the
Family View screen to review information on the selected family from any previous windows.

3.5     Pulling Information from NED for another Family
If the user is done with the current record and ready to select another individual, he/she must first perform
a NED inquiry for another family.
To pull the information for another family from NED, click the New Family button at the top left of the
DOES Application window or use shortcut CTRL+F. This will re-open the Inquire National
Enrollment Database dialog box, allowing the user to start with the next SSN he/she needs to pull.




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4       Performing Updates
In DOES, the user can update the majority of elements in a record. From the main DOES menu, the user
can choose to update an address (residential or mailing); add OHI (other health insurance); update the fee
waiver reason (if a beneficiary is enrolled in a plan with fees); and update/enter a work ZIP code. This
section of the manual covers those areas as well as some of the rules behind the functionality.

4.1     Address Update

4.1.1         Selecting the Beneficiary and Information to Update
Address Update allows the user to update either or both the residential and mailing address of the plan
sponsor and any associated beneficiaries. Address Update can be activated as a stand-alone function but
is always enabled when performing a new enrollment or a transfer.
When updating addresses and/or phone numbers, it is recommended that the effective date be updated to
let others know when the addresses were last changed. If during an update the effective date is not
changed, DOES will return a warning but allow the user to continue.
DOES uses Code One Plus, a commercial off-the-shelf product, as the application‘s address validation
package during the address update function. Code One Plus is activated after the address change is made
and the user clicks Next. OCONUS addresses are not validated with Code One Plus.
1. To update address and telephone information, click the Address button located at the upper-left side
   of the window or use shortcut CTRL+A.




2. The Address Update screen will appear. The sponsor will be selected by default.




3. Initially during an update, Mailing Address fields are disabled. If the user wants to enter a mailing
   address different from the residence address, select from the radio buttons which address is to be
   updated. The user can choose residence only, mailing only, or both.
4. Once the address type is selected, if it is both or mailing only, then the Enter if Different than
   Residence check box and all the Mailing Address fields will be enabled.
5. Enter the new mailing address.




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6. If the beneficiary selected is not the person whose address or telephone information the user wants to
   update, select the person by clicking the tab that corresponds to the correct person. This will change
   the person selected.



7. If the user is making a residential address or telephone number update that applies to the selected
   person only, leave the first radio button selected by the beneficiary name (as it is by default) or use
   shortcut ALT+P. This will only update the selected individual.
8. If the residential address or telephone number update is applicable to one ore more family members,
   click the second radio button under the Residence column or use shortcut ALT+M to copy the
   information to other family members.
9. Select those family members for whom the residence address or telephone number update also applies
   in the Select the Family Member(s) dialog box. A family member is selected when a check mark
   appears beside his/her name.




10. If the residential address or telephone number update applies to all other family members shown,
    click the third radio button to copy the residence address to all other family members. This will
    automatically select all family members.




11. After selecting all the family members to whom the residence address/telephone number and/or
    mailing address update applies, change the Effective Date. Click the up or down arrow buttons to the



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    right of the text box to move the date forward or back. The user may also select ALT+D or click on
    the date in the text box to enter the appropriate date. Enter the date in YYYY-MM-DD format.




12. If there is a previous effective date, double-click the Effective Date to highlight the old date.



13. Enter the more recent effective date for the update in the Effective Date box.




14. Select the location of the residence address for the Address Option. If the address is in the United
    States (U.S.) or a U.S. territory, click the U.S. and Territories option button.




15. When U.S. and Territories button is selected, Guam (GU), Puerto Rico (PR), and the U.S. Virgin
    Islands (VI) are listed as states. The correct two-letter code auto-populates when the zip code is
    entered.
16. If the address is not in the U.S. or is not a U.S. territory, click the Foreign option button.




17. The Address Update screen changes to accommodate OCONUS addresses and telephone
    information.




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18. If the Country text box for a non-U.S. address is blank or the information needs to be changed, click
    the drop-down arrow and a list of country abbreviations will appear. The list of foreign country names
    and codes can be found in Appendix C: Foreign Countries and Codes.
19. After determining which country abbreviation to use, there is a shortcut for finding and selecting the
    abbreviation quickly. After clicking the drop-down arrow, type the first letter of the country
    abbreviation. For example, if the address is in Uruguay (with country abbreviation UY), type ―U.‖
    This will take the user to the top of the list of country abbreviations that begin with ―U.‖
20. When the correct country abbreviation is located, click it or use the drop-down arrow until the correct
    country abbreviation is highlighted. After highlighting the correct abbreviation, click Enter.
21. For non-U.S. addresses (OCONUS) the user will be able to type data in the City, State, and ZIP
    Code text boxes.
22. Click Next to activate the Code One Plus address validation. Note: If the user enters the same
    information for both residential and mailing, DOES will discard the mailing address and only the
    residential address will be validated by Code One Plus.

4.1.2         U.S. and U.S Territory ZIP Codes
1. If the user is updating a U.S or U.S. territory address, he/she will be able to add or change the ZIP
   code and ZIP + 4 extensions in the ZIP Code text boxes. If the text boxes are blank upon update, the
   user can type the ZIP code and the ZIP + 4 extensions into the text boxes.
2. If either of the ZIP code text boxes is already populated; however, it needs to be edited, double-click
   in either text box to highlight the old information.




3. Type the updated information into the ZIP Code text boxes.
4. DOES will look up the ZIP code from its tables and automatically populate the City and State from
   that information.



5. After the automatic population of the City and State, enter the new street address. There are two lines
   to accommodate supplemental information, such as an apartment number.




4.1.3         Telephone Number/Other Contact Fields Updates
1. Enter the home, work, and fax telephone numbers into the Home, Work, and Fax text boxes. Be sure
   to include area codes, but not extension numbers. For OCONUS phone numbers include the country
   code and city code. Below is an example of U.S and Territory telephone numbers:




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    Below is an example of OCONUS telephone numbers:




2. Enter the e-mail address (if applicable). The E-mail text box is for one e-mail address. This is an
   optional field and the DOES application will let the user continue if this box is left blank.

4.1.4         Address Validation - Code One Plus Address Validation Procedure
1. After all address and contact updates are completed, click Next or use shortcut ALT+N to activate the
   Code One Plus address validation. If the user decides not to save the information updated, click
   Cancel.
2. Clicking Cancel will exit the user from the Address Update screen without saving any of the
   information changed. If the user chooses to cancel an address update, DOES will warn the user that
   the changes will be lost. A warning screen will appear, prompting the user for an action.




3. If the user wants to exit the update without saving the changes, click Yes. Otherwise, click No. The
   user will then return to the Address Update screen where additional changes can be made or verified.
   To save the changes, click Next.
4. Click Next or use shortcut ALT+N to activate the Code One Plus address validation.
5. The Code One Plus address validation will return the following result codes and corresponding
   messages:
       Address Error: The address is incorrect and no correction was made to the address.
       Address Corrected and Verified: The address was corrected during address validation.
       Address Verified: The address was correct and verified.
6. As the Code One Plus address validation is completed in the background, if the address is valid, the
   DOES application will accept the data entered into NED. Otherwise, the user will receive an error
   message, which gives the user an opportunity to correct the data or exit the Address Update dialog
   box.


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7. The top of the Address Validation Summary dialog box lists the individuals for which the user is
   validating addresses. Begin the validation by clicking one of the names in the list and the addresses
   populate the validation screen.




8. The user entered address in the top portion of the screen and the Code One suggested address below.
   If the user accepts the Code One Plus address validation suggestions, an Address Quality code will be
   set from one to nine (in the background). One represents the highest quality, and nine represents the
   worst quality.




9. The user has the option to accept the Code One address suggestion for all in the list; keep the user-
   entered information as-is by choosing each name individually; or reject both the suggested and the
   currently entered address and go back and make a correction.
10. The following are the Code One command buttons which guide the user through the selections which
    are found at the bottom of the Code One screen.




11. If the user clicks Accept Validation Suggestions, then all the family members listed get the
    suggested address updated to their record without the user selecting each one individually. Make a


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    Correction or shortcut ALT+M sends the user back to the Address Update dialog box with the
    existing data for correction. When the validation process is complete, clicking Send to the National
    Enrollment Database ends the validation and sends the address changes to NED. Clicking Cancel
    overrides all Code One Plus functions. The application will exit the Address Update dialog box and
    the results from the Code One Plus address validation will be discarded without any changes to the
    entered data.
12. For each address validation, Code One Plus will return one or more messages that detail the nature of
    the error or the corrective actions it performed on an address.
    Note: Address validation will be done on P.O. Box addresses, Army Post Office, and Fleet Post
    Office zip codes. Due to the delayed response caused by the validation process, the user will not see
    immediate results. They will appear at the Address Validation Summary screen at the end of the
    address update or enrollment.
    The following screen is an example of a full Code One Address Validation:




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4.2      Adding OHI
If a beneficiary has OHI from a carrier other than within the Military Health System plan, such as OHI
acquired from a spouse‘s employment, this is the area in which to record the OHI.
The required fields to add OHI for a beneficiary are the following:
     HIC ID
     OHI Policy ID
     OHI Policy Effective Date
     Insurance Type (if not known, DOES defaults to CI – Commercial)
     Coverage Claim Filing (if not known, DOES defaults to 09 – Self Pay)
     Person Association (if not known, DOES defaults to 01 – Spouse)
The optional OHI fields to add OHI for a beneficiary are the following:
     OHI Policy Expiration Date (If not known, DOES defaults to blank.)
     OHI Coverage Type Code (If not known, DOES defaults to XM - Comprehensive Medical.)
     OHI Coverage Precedence ID (If not known, DOES defaults to 1 – Primary (default))
     OHI Coverage Effective Date (If not known, DOES defaults to the current system date.)
     OHI Coverage Expiration Date (If not known, DOES defaults to blank.)
OHI can be added as a stand-alone transaction, during a new enrollment, or during an enrollment transfer.
It is accessible by clicking the Add OHI button on the Enrollment/Transfer screen or Add OHI from
the main DOES menu (under the Updates menu).
1. The Add OHI screen will appear. The required information is located at the top of the screen, while
   the optional information is located at the bottom of the screen.




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2. Select the Beneficiary (or beneficiaries) for whom the user is adding OHI from the Select Family
   Member dialog box. The selected person(s) have a check next to their name. The user can add OHI
   for multiple eligible family members at the same time.


3. Perform a search on the HIC ID by clicking Search or using shortcut ALT+H.
4. The Health Insurance Carrier Search screen will appear.




5. The HIC Criteria requires the user to enter the OHI Carrier Name (at least the first three letters), a
   City (at least three letters), and a State.
6. Click Search or use shortcut ALT+S to retrieve a list of HIC IDs as validated by the SIT.




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7. Once the user finds the HIC ID that matches the information the beneficiary has provided, select the
   record and click Assign HIC or use shortcut ALT+A. Note: If the user makes an error or would like
   to look for additional HIC IDs, click Clear in the criteria selection to clear out the boxes and resume
   the search.




8. If the Health Insurance Carrier ID the user is looking for is not in the table, the user has the option to
   Add the OHI with a placeholder HIC entry of UNKVA0001. There are three ways to search on the
   placeholder: City and State, HIC Name and State, and HIC Name City and State. To add a
   placeholder HIC entry of type UNKVA0001, use the following values for City, State, and HIC Name
   when searching for a HIC ID: City = Falls Church, State = VA, HIC Name = Placeholder HIC ID.
9. In those instances, a placeholder is sent to the SIT with the value ―Unknown.‖ The Policy ID is the
   number designated to the policy, which is supplied by the policyholder. An end reason will be
   displayed if there is an expiration date. If an expiration date was not provided, the value for ―No date
   can be predicted,‖ will be displayed as the date. The effective date and expiration date indicate the
   dates of coverage for the OHI.
10. After correctly selecting the HIC ID, the user is returned to the initial Add OHI screen.
11. Enter Policy ID, Policy Effective Date, and Policy Expiration Date (if known). All of these fields
    are required. The lower date limit is the beneficiary date of birth, and the upper date limit is the
    beneficiary date of death. If there is no value for the latter, it defaults to blank.
12. Select the OHI Coverage Type.
13. Enter the Coverage Effective Date. If left blank, the date will default to the current system date.
14. Enter the Coverage Expiration Date (if known). If it is not known, it will default to blank.
15. Once all the required information is entered, click Apply or use shortcut ALT+A.




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16. After the OHI has been added and the Apply button is clicked, a yellow File Folder icon will appear
    next to the selected beneficiary to indicate that there is OHI information for that beneficiary. The user
    can enter a new OHI for another beneficiary. Note: The screen will expand to display all the
    information entered.




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17. If the user sets Insurance Type (located within the Additionally Policy Information section) to
    GP-Group Policy, then the Group Policy Entries box will appear and must be populated:




18. If the coverage the user is entering is not Medical, the user can choose the appropriate coverage from
    the Coverage Type drop-down list. The available coverage and associated values are listed in the
    table below.
     MD          Medical
     DN          Dental
     IP          Inpatient
     OP          Outpatient
     LT          Long-Term Care
     MH          Mental Health
     PH          Partial Hospitalization
     SN          Skilled Nursing Care
     RX          Pharmacy
     VI          Vision
     XM          Comprehensive
                 Medical (also the
                 default value)


19. If the user realizes he/she has made an error and needs to start over, click Undo or use shortcut
    ALT+U. DOES returns the user to the individual coverage or policy screen.
20. If the user wants to cancel all changes made to the family, click Undo All to undo all the OHI
    assigned or click Cancel to exit the OHI screen. Click No to disregard all changes.
21. If all information is correct, click the Send to National Enrollment Database or use shortcut
    ALT+S.
22. Once the record is sent to NED and a positive acknowledgement is sent back, DOES will re-pull the
    family and return the user to the main screen.




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4.3       Enrollment Attribute Update
The user can update a beneficiary‘s enrollment attributes (EAU) during a new enrollment or an
enrollment transfer. The attributes available to update are dependent upon how the user accesses the
update option, the beneficiary being updated, and the plan in which the beneficiary is enrolled.
If the user begins an attribute update from a new enrollment or an enrollment transfer, the user can
update the fee waiver reason, deselect the option to produce a new enrollment card, change the service
center application receive date, and change the contractor application receive date. The work zip
code cannot be updated this way since it was auto-populated from the prior address update screen as part
of the new enrollment or transfer.

4.3.1         Updating Attributes from the Main Menu
Two EAU items available to update from the main menu bar include sponsor Work Zip Code (shortcut
CTRL+O) and Fee Waiver Reason (shortcut CTRL+X). Note: The fee waiver will only be available if
the selected beneficiary is enrolled in a plan that allows this because not all plans requiring fees allow fee
waivers.

4.3.1.1       Updating the Work ZIP Code
If the Work ZIP code option is enabled then at least one of the beneficiaries are enrolled in a TRICARE
Prime Remote (TPR) plan with the same contractor, or the sponsor is enrolled in an ADSM plan. If the
Work ZIP code option is not enabled, none of the beneficiaries are enrolled in TPR plans nor is the
sponsor enrolled in an ADSM plan or such a plan enrollment exists; however, it exists with a different
contractor or a different plan. Beneficiaries being updated must be currently enrolled with the same
contractor performing the update (i.e. T-NEX North to North, not T-NEX North to West.)
1. Updating the work ZIP code is done through the Work Zip Updates screen.
2. Enter the new work ZIP code in the Enter Sponsor’s Work Zip text box. If there is a current work
   zip code from the database, it automatically populates and can be changed.




3. After the work ZIP code is entered, click Apply or use shortcut ALT +A. The work ZIP code is
   validated by the database to see if it falls within the remote region associated with the contractor. If
   the ZIP code does not fall within the acceptable parameters, the user will receive an error message.




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4. After reading the error message, click Yes or No. If the user clicks Yes, the work ZIP code is updated
   for all the TPR and related sponsor enrollments. If the user clicks No, the work ZIP code is defaulted
   to the existing work ZIP code in the database.
    Below is an example of the screen when Yes is clicked:




    Below is an example of the screen when Clear is clicked. If the user clicks Clear, all the work zip
    updates are cleared for attached beneficiaries and the field is enabled to enter a new ZIP code.




5. If the user clicks Cancel, the transaction is canceled and the work ZIP code is not updated.
6. If the user clicks Send to the National Enrollment Database, the update to the database is
   performed.
    Note: When the ZIP code is updated, all beneficiary records under that sponsor are changed
    regardless of the contractor or region the record is under at the time of the update.

4.3.1.2       Updating the Fee Waiver Reason
The Fee Waiver Reason screen is enabled from the main screen only if the sponsor or beneficiaries are
enrolled in plans which allow fee waivers (i.e. Non Active Duty plans.) Beneficiaries being updated must
be currently enrolled with the same contractor performing the update (i.e. North to North, not North to
West.).The Fee Waiver Reason screen lists the plan sponsor and all the beneficiaries who are eligible for


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fee waiver reasons. The screen lists the beneficiary name, the abbreviated Coverage Plan name and the
Coverage Period of the plan.
To update a fee waiver reason:

1. Select a beneficiary to update from the Beneficiary category. A check      will appear next to the
   name.




2. Select the fee waiver reason from the Fee Waiver Reason drop-down box or tab to the Fee Waiver
   Reason drop-down box and type A, B, C, D, or U in the open space and the appropriate selection will
   populate the box.




3. Once the fee waiver reason is selected and the user clicks Apply, a closed File Folder icon appears
   next to the beneficiary name.
4. The user then has the option to Send, Undo, or Cancel the transaction.




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    Note: The fee waiver reason can be updated for all beneficiaries at the same time. This is done by
    clicking on multiple beneficiaries simultaneously, selecting a waiver reason, and clicking Apply.




5. If the beneficiary has an existing fee waiver reason, when the user selects the individual, the Fee
   Waiver Reason drop-down box is defaulted to the current reason from the database. If the user wants
   to change the reason, it can be removed by setting the reason to (None) or a different reason. For
   example, in the screen above, the user would choose from the drop-down box and the new selection
   will be applied as shown in the next Fee Waiver Reason Updates screen example.




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4.3.2         Updating Attributes as New Enrollment or Transfer
    If the user begins an attribute update from a new enrollment or an enrollment transfer, the following
    selection of buttons will appear at the bottom of the screen. Depending upon the beneficiary selected,
    the user will have the option to update the fee waiver reason or the plan sponsor‘s work ZIP code.




    When the Enrollment Attribute Updates screen from Enrollment/Transfers is viewed, only the
    beneficiaries eligible for enrollments or transfers are shown. If the beneficiary selected is the plan
    sponsor, the work ZIP code can be updated from the screen.




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1. Click on the beneficiary whose enrollment attributes need to be updated.
2. If the beneficiary‘s plan has a fee waiver reason, the Fee Waiver Reason text box is enabled. Enter
   the reason using the drop-down arrow to the right of the text box.
3. If there is no reason to update, then the user does not need to make a selection for this field.
4. If there is already a reason, then None can be chosen to remove the current waiver reason.
5. If there is a reason and the user clicks None, the message ―No Change to Data‖ will be returned.
6. Other Attributes that can be updated include:
       Uncheck the New Enrollment Card check box if the user does not want to have a new card
        issued for the updated beneficiary since the default value is a check.
       Enter or change the Service Center Application Received Date. This is an optional field that
        indicates the calendar date on which the TRICARE Service Center received the current
        application for enrollee placement into the appropriate program.
       Enter or change the Contractor Application Received Date. This is an optional field that
        indicates the date the application was received by the Enrollment Management Contractor (EMC)
        for the current Health Care Delivery Program (HCDP).
7. After all updates for the selected beneficiary have been made, click Apply or use shortcut ALT + A.
8. The user can click Undo, which will clear all the selections.
9. After clicking Apply, the beneficiary whose enrollment was updated will now show a closed File
   Folder icon beside his/her name.




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10. The user can click Back, to move back one screen to the New Enrollment or Enrollment Transfer
    screens where Enrollment Attribute Update was first selected.
11. The user can click Cancel to cancel the entire transaction. The user is brought back to the New
    Enrollment or Enrollment Transfer screens


5      Performing a New Enrollment
Enrolling beneficiaries into health care coverage plans is a primary function of DOES. While the basic
steps for enrolling a beneficiary into a health care plan in DOES are universal, there are differences in the
enrollment parameters depending upon the contracting organization performing the enrollment and the
selected health plan of the beneficiary.
This section is the only segment of the manual that the directions will be divided by contractor. The three
organizations which perform enrollments are: the MCSCs, the US. Family Health Plan contractors or
DPs, and the TRICARE Lead Agents (TLAs) which perform enrollments for OCONUS beneficiaries.
Differences among them include the plans that each contractor has available for the various categories of
enrollees; rules that govern the plans available for beneficiaries; and the methods of and options for
choosing PCMs for beneficiaries.
Note: In the future, DoD beneficiaries will have access to a Web-based application that will allow them to
perform enrollment related activities such as changing a PCM, address update, enrollment transfer,
disenrollment, limited cancellation of events, request for a new enrollment card, and submission of an
initial enrollment application. Upon this application‘s use in the field, it will be required that the MCSCs,
DPs, or TLAs ―shall review and acknowledge all pending enrollment-related activities within NED and
do so within a certain amount of time using DOES Approve Pending menu item.‖
DOES is an integral element of the business functions for all TRICARE contracting organizations.
1. To perform a new enrollment, begin from the DOES command bar or the main DOES menu. To enter
   from the command bar, click the Enrollment command button or use shortcut CTRL+E. The
   following is an example of an enabled button.




2. If the sponsor and beneficiaries are already enrolled in current plans, or eligibility has expired, a new
   enrollment will not be allowed and the command button will not be enabled. The following is an
   example of a disabled button.



3. To access the new enrollment screens from the main menu, click on Enrollment or use the shortcut
   CTRL+E.




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4. At the start of every new enrollment is the Address Update screen. The Address Update screen
   during an enrollment is the same, including the address validation steps, as the stand-alone update
   except that the user does not have the option to send the record to NED until the rest of the enrollment
   is complete. The record is updated only if the effective date of the update is more recent than the date
   shown in the record.
5. The zip code in the Address Update screen is automatically populated by DOES from the
   beneficiary‘s residential address. DOES validates the residential and work zip codes and sends a
   warning message to the user if the zip codes are invalid for the enrolling contractor‘s region.
6. The user has the option to override the warning by clicking OK and continuing the enrollment or
   clicking Cancel and entering a new zip code.
    The following is an example of an address validation warning:




7. After the address update and the Code One Plus address validation have been completed, click OK.
8. DOES sends the user to the Enrollments Family Coverage Summary screen.




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9. The Family Coverage Summary lists the plan sponsor and all the associated beneficiaries eligible to
   receive health benefits under the sponsor‘s SSN or ID number. The summary information listed in
   this section includes Beneficiary name; Coverage Plan (short name); current Enrollment Period for
   the beneficiary with the end date (if applicable); and Status of the enrollment. (This part of the screen
   is automatically populated and cannot be changed).
10. Only those beneficiaries with no coverage plan or enrollment period are eligible for a new enrollment,
    unless an enrollment cancellation has just occurred and been sent to NED.




11. The Enrollment Details section includes a Family Coverage Summary which includes the
    Beneficiary name, Coverage Plan, Enrollment Period, and Status.
12. Coverage Plan is a drop-down list of all the health plans the non-enrolled beneficiaries, including the
    sponsor, are eligible to enroll in. Click the drop-down arrow or use shortcut ALT +P to view the
    coverage plan(s) for which the beneficiaries (including the sponsor) are eligible.




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13. Once a plan is selected, the family members eligible for that plan populate the Eligible Family
    Members for Enrollment portion of the screen.




14. To continue with an enrollment, the user must select one or more of the names which appear in the
    Eligible Family Members for Enrollment portion of the screen. Those selected will have a check
    mark in the box to the left of their name.




15. When a family member‘s name is highlighted, the details of their eligibility automatically populate
    the Eligibility Information section of the screen to the right. That section contains the beneficiary‘s
    SSN and the valid period of eligibility based on the chosen plan as shown above.
16. The next step before adding the beneficiary to the enrollment summary and choosing a PCM is to
    choose the Enrollment Begin Date. The begin date can be 90 days in the future or 289 days in the
    past of the system date.
17. Once the user clicks Add, the beneficiaries with checks next to their names in the Eligible Family
    Members for Enrollment portion of the screen move to the New Enrollment portion of the screen.
    This section of the screen includes the Beneficiary Name, the Enrollment Begin Date, the
    Enrollment End Date, the Coverage Plan (short name), and the PCM Status (if the plan requires
    it).




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18. Before moving to the next part of an enrollment, the Primary Care Manager Assignment, the user
    can Add OHI, or perform Enrollment Attribute Updates for the selected beneficiary/beneficiaries.
    See section 4.2: Adding OHI and section 4.3: Enrollment Attribute Update for those instructions.

19. The user also has the ability to Remove (ALT+R) any of the listed beneficiaries from the New
    Enrollments list. The user first selects the beneficiary they want to remove from the list by clicking
    on the name and then clicking Remove.

20. If at any point in this enrollment process, the user realizes they have made an error, or needs to
    change information within a record before or after selecting Apply, click on or select Previous or use
    shortcut ALT+V. After making the correction(s), select Apply again.

21. Clicking or selecting Next or using shortcut ALT+N will bring up the PCM selection.


5.1     Primary Care Manager Assignment
PCMs are based upon the managed care concept of every beneficiary having a medical POC for
coordination of all medical needs during valid enrollment segments. During an enrollment, DOES will
force the assignment of a PCM, provided the plan the beneficiary is enrolling into requires one. The new
T-NEX requirement not only necessitates the name of a place of care (such as a Military Treatment
Facility [MTF] as the PCM) but also the name of a PCM, especially in the Direct Care/Resource Sharing
plans. Instructions on how to perform PCM by Name searches is a main feature of this section.

5.1.1         Contractors, Health Plan Types and PCM Assignments
There are three types of contractors performing enrollments requiring PCMs: the MCSCs, the USFHP
contractors (the DPs), and the OCONUS contractors. There are six major categories of TRICARE Health
Benefit plans that the three contractors can enroll beneficiaries into: Prime, Plus, Remote, USFHP (a
geographically limited managed care option offered for beneficiaries not eligible for Prime), OCONUS
Prime (TOP), and Global Remote Overseas (TGRO).
Within each plan category, there are a number of plan types and coverage options. Available plans for a
beneficiary are based on the individual‘s status within the DoD system as reported by the database (for a
complete list of health care plans, please refer to Appendix B: Health Plan Names of the manual). Each
plan type has different rules and limitations regarding PCMs. The next section of the manual will cover
the process and rules about selecting Direct Care, Resource Sharing, or Civilian PCMs, and the steps to
follow when the choice of a PCM is none.
Note: PCM assignment follows the same procedure during a new enrollment or update. The differences
occur in the steps prior to the PCM assignment, the PCM search and PCM selection.




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5.2         Assigning a PCM to a Beneficiary
1. To begin a PCM assignment, select a beneficiary's name from the list of Beneficiaries. The selected
       family member will then have a                    next to his/her name.




2. Depending upon the plan the beneficiary is enrolling into, the user will have the option to select
   Direct Care, Resource Sharing, Civilian, or None as a PCM option by clicking the appropriate
   radio button or using shortcut ALT+O in the Provider Type section of the PCM Assignment screen.

5.2.1           Searching and Selecting a Direct Care/Resource Sharing PCM
To begin performing a Direct Care or Resource Sharing PCM search, start by choosing the Direct Care
or Resource Sharing button at the top of the PCM search screen. This will bring up a list of MTFs and
their corresponding 4-digit DMIS ID.

5.2.1.1          Selecting the MTF via DMIS ID
The MTF can be searched on by name or by DMIS ID. If the user begins to type in the DMIS ID of the
MTF in the box, DOES scrolls to that MTF ID that the beneficiary has requested assignment into. The
DMIS list can also be searched by using the scroll arrows on the right side of the box.
The MTFs will be listed in order of proximity to the beneficiary using the residence zip code. Those
DMISs within the beneficiary‘s catchment area1 will have a * next to them. To view the full list of Direct
Care facilities within the region, click the drop-down arrow to the right of the DMIS text box.




Note: When assigning PCMs to multiple family members who have different residential zip codes,
DOES will calculate a shared catchment area and list the family members who are within the area
underneath the DMIS list with the *.




1
    The DMIS Catchment Area Calculation
When performing a Direct Care/Resource Sharing PCM assignment, the DMIS ID catchment area must be calculated. This references the
residence ZIP code of the plan sponsor. The catchment area calculation is used to determine if the beneficiary lives within 50 miles of an MTF.



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5.2.1.2       Searching for the PCM by Name
1. Once the DMIS is selected, click the PCM Search button.
2. The Primary Care Manager Search screen will appear.
3. The first item in the search box is the DMIS ID and the MTF name (already populated). Check to
   ensure the DMIS previously selected is the one which now populates the box.
4. Continue by entering search criteria. The user can search on any combination of Direct Care PCM
   criteria as seen above in the Direct Care PCM Search screen. They include Place of Care (if
   known or chosen, only those specialties attached to the place of care (PLOC) will appear in the drop-
   down box); Specialty (if known or chosen, only those PLOCs within the DMIS that have such a
   specialty will be shown); and Gender (if solely selected, the user will be prompted to select at least
   one other criteria before a search can be performed).
5. If the beneficiary has stated a PCM preference by Name, Group Name, or Gender, enter it and click
   Search or use shortcut ALT+S. Note: During a name search, a minimum of two letters or a full group
   name is needed. Note: When searching by PCM Name, at least two letters of a name are required;
   however, if the user types [―*‖character 1 character 2] the result that will be returned are all names
   with the two letters anywhere in the name. For example, *DO returns Doe, Doug, Amador, etc. as
   opposed to DO which returns DOE, JOHN; DOUGLAS, STEPHEN etc. The same rules apply when
   searching by Group Name.
6. After the desired criteria are selected and the user clicks Search a list of PCMs by name populate the
   PCMs Found result table. The PCMs listed are those whom have met the search criteria and who
   have available capacity for the enrollment categories of the beneficiaries selected. Note: PCM
   capacity is not shown, that detail is obtained by the PCM Research Application.
7. The user can scroll through the list of PCM or click ALT+SHFT+> to go forward 50 entries or to the
   next page of PCMs. At maximum, any search returns 500 PCMs at a time. After reviewing the first
   set of 500, if the user does not find the PCM the beneficiary is looking for, and DEERS returned more
   than 500 PCMs click on Next Set of PCMs and the database will retrieve the next set of those
   records.
8. Once the desired PCM is found, click the Select PCM button at the lower right portion of the results
   screen.

5.2.1.3       Assigning the PCM
DOES populates the PCM Assignment screen with the chosen PCM and any affiliating information such
as Place of Care, Group Name, Specialty, and Gender. PCM Begin Date and End Date for the
beneficiary are listed as well.




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1. From the Assignment Summary screen the user can Assign or Cancel the PCM. Assigning the
   PCM, depending on the action invokes the enrollment summary screen or the summary screen for the
   selected action such as PCM modification or enrollment transfer. Canceling the assignment sends the
   user back to the PCM Assignment screen where another search for a PCM is performed.




2. Once selected (by being assigned), the PCM is moved into the PCM Summary on the PCM
   Assignment screen. A closed File Folder icon will appear next to the selected beneficiary indicating
   that the PCM selection is complete.
3. If there is more than one name listed under Beneficiaries and the user selects Assign or shortcut
   ALT+A, the user will receive a warning message.




4. If the user clicks Yes from the warning message, the selection is complete and the Enrollment screen
   is returned. If the user clicks No, the user remains at the PCM Assignment screen and can choose to
   undo the completed PCM assignments or assign the current PCM and perform a new search for the
   unassigned beneficiary.




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5. Depending upon the beginning action, from here the user may continue with an enrollment or
   transfer, or send the PCM modification to the NED.
6. If a PCM is already assigned to a individual for the enrollment plan then the following message will
   display asking if you would like to change the PCM assignment.




5.2.1.4       Direct Care Assignments for Specific Situations
This section addresses PCM assignments in specific situations that users may come across.
PCM Assignments for Beneficiaries in Different Enrollment Categories
DOES will allow the user to assign PCMs to multiple beneficiaries in different enrollment category codes
during the same search. The user starts out by choosing beneficiaries using the same process. After the
PCM criteria are entered and the PCMs are returned and one is selected for assignment, DOES returns a
message in the upper-right corner of the PCM Search Summary screen indicating to the user if any of
the selected beneficiaries are not eligible to be enrolled with the selected PCM.




If the user chooses to continue with the assignment, a warning message is returned.




If the user clicks Yes, then the assignment is cleared for the currently selected beneficiaries and the user is
sent to the PCM Search screen. If the user clicks No, then the PCM is assigned to the selected
beneficiaries and then the user is sent back to the PCM Assignment screen to choose a PCM for the
unassigned beneficiary.
Enrolling Beneficiaries from Multiple Zip Codes to One DMIS
When enrolling multiple beneficiaries into a plan with a Direct Care PCM within a region but who have
different zip codes, the search process is the same but the catchment area for DMIS IDs is expanded. The



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box below the DMIS ID list will show the names of the beneficiaries in which the DMIS ID selected is
within the catchment area.
The DMIS ID, not being in the catchment area for a beneficiary does not preclude that person‘s
enrollment, in the selected DMIS.




The rest of the steps for searching and assigning a PCM are the same as described above.
Assigning a PCM by Default
The original Default option available was only by the plan sponsor‘s UIC. But now with the expanded
ability to assign PCMs across enrollment categories, this option has changed. If the Default button is
enabled and the user has selected multiple beneficiaries across enrollment categories, clicking Default
will begin a search and return the PCMs with the highest capacity and apply the PCM to those with
associated enrollment categories. If, after the assignment some beneficiaries are still without a PCM,
DOES will perform another search and look for the PCM with the highest capacity in those enrollment
categories and assign them. If the results found no matches for a selected enrollment category, the
affected beneficiary/beneficiaries would be deselected while the others in the search would be assigned
and the user will be prompted to perform another search for the unmatched individuals.




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Resource Sharing PCM Sharing
Resource Sharing PCM searches, selections, and assignments are handled exactly as Direct Care PCM
searches. The only difference is the radio button selected. The following is an example of the difference
in an assignment of a Resource Sharing PCM. The DMIS table is the same but the PCMs to be returned
will be Resource Sharing PCMs. Once the search is complete; the information populated in the PCM
information section of the screen will look similar to the Direct Care PCM information.




5.2.2         Selecting a Civilian PCM for a Beneficiary
1. To select a Civilian PCM for a beneficiary, begin the search the same way, except click the radio
   button to the right of the beneficiary name and select Civilian.
    The Civilian PCM search is no longer based on the DMIS ID. While a DMIS is still reported for each
    PCM, the primary search key is the Remote Enrollment Assignment code which alerts DOES to the
    availability of that PCM for remote/non-remote enrollments. The Civilian PCM still has a DMIS
    ID and the combination is still 69/70 (69, non-remote and 70-remote) and the two-digit
    region code; however, that field is not the primary search key. DOES will look for those with
    the Remote Enrollment Assignment code of ―Y‖ or YES and then continue with the other values.
2. After the DMIS ID populates, click PCM Search or use shortcut ALT+S to enable the Civilian PCM
   Search screen. The searchable fields for a Civilian PCM search are slightly different than those for a
   Direct Care PCM search. The additional fields available are City, State, Zip Code, PCM ID, and
   PCM ID Type.
3. A search can be performed on the following combinations of Civilian PCM search criteria:
       PCM ID and at least PCM Name (minimum of two characters).
       If the user chooses the ID field, other criteria instead of Name are valid as long as the criteria
        follow the other search rules.
       PCM Name (must be at least two characters)
       PCM Group Name
       PCM ZIP Code (must be at least three digits)


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       PCM City (at least one character) and State
       PCM Specialty and Zip Code
       PCM Specialty, City, and State
       PCM Gender and Zip Code
       PCM Gender, City, and State
    Note: If performing a Civilian PCM search using the PCM name, the same flexibility applies as from
    the Direct Care PCM search. When searching by PCM Name, at least two letters of a name are
    required; however, if the user types *LtLtr the result that will be returned are all names with the two
    letters anywhere in the name. For example,*DO returns Doe, Doug, Amador, etc. as opposed to DO
    which returns DOE, JOHN; DOUGLAS, STEPHEN etc. The same rules apply when searching by
    Group Name.
4. During a search, if the user selects two or more boxes that are linked, an arrow will appear next to
   each required item. These must contain data before a search can be performed.




5. Once the criteria are selected, a list of PCMs is returned.
6. If the list occupies more than one screen (i.e., more than 50 PCMs), click Next button or use shortcut
   ALT+SHFT+ to go to the next page.
7. If the user wants to view the prior 50 PCMs, click Previous or use shortcut ALT+SHFT+.
8. After reviewing the first set of PCMs returned, if the user does not find the PCM they are looking for,
   click on Next 500 and if any more meet the search criteria they will be returned.
9. From the list, find and select the PCM by highlighting the requested name.
10. After the user locates the PCM, click Select PCM to return to the PCM Assignment screen. The
    beneficiary who was assigned a PCM will now have a closed File Folder icon beside his/her name.
11. Click the selected beneficiary‘s File Folder icon. The user is given the following four options:
       Click or select Assign or use shortcut ALT+A to go to the Policy Summary screen.
       Click or select Cancel or use shortcut ALT+C to cancel the transaction so the user can start over.
       Click or select Undo or use shortcut ALT+U to clear the entire PCM selection.
       Click or select Return to Search Results or use shortcut ALT+T to go back to the last set of
        search results.
    Note: If there is no File Folder icon beside a beneficiary's name, a PCM has not yet been assigned to
    the beneficiary. The user can assign a PCM to a beneficiary displayed by selecting his/her name and
    repeating the PCM Assignment process.
12. Once the selection is made as to the PCM assignment, continue with the enrollment from the
    Enrollment Summary screen, or choose another activity to perform upon the record if the action was
    a PCM update.
    The following is an example of a Civilian PCM Results screen sorted by name:




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The following is an example of a Civilian PCM Assignment after a selection is made:




5.2.2.1       Advanced PCM Search
During a Civilian PCM search, if too many PCM names are returned and the user wants to narrow the
field, the user can click on Advanced Search or use shortcut ALT+A to perform a more refined search of

the listed search results.                 If in an original PCM search of ―Name = Sm‖, the Advanced
Search, can be used to select ‗Smith‘, or Specialty of ‗family practice‘, or Group Name of ‗Medical
Associates‘ or State of ‗FL‘. All PCMs matching the additional criteria from within the original search
results will be returned.




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The following is an example of a Civilian PCM by Name search on Name ―Miller‖:




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The following is an example of the results of performing an advanced search on ―Miller‖ and then by
family practice physician:




After the PCM searches are complete, click Select PCM.            The user will be sent back to the
Enrollment Summary screen or the main screen, depending upon if the function was part of a new
enrollment or a PCM update.

5.2.3         Choosing None as a PCM
In the cases where the PCM is not a forced option and the beneficiary does not wish to choose a PCM by
name, the user can select None as the option instead of Direct Care, Resource Sharing, or Civilian. When
None is selected, the DMIS ID and the MTF are defaulted to a pre-selected regional DMIS ID and MTF.




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5.2.4         Enrolling a Beneficiary into a TRICARE Prime Remote Plan
TRICARE Prime Remote is similar to other Prime plans except that neither the sponsor nor the
beneficiary lives within 50 miles of an MTF; therefore, Direct Care PCMs are not available to these
beneficiaries. The only PCMs available are those in the Civilian network of providers and the DPs for
ADSMs, or to choose None for PCM. PCM by Name search is not offered for a remote ADSM plan.

Note: The eligibility for remote distance is calculated based on the beneficiary‘s region and residence zip
code and sponsor work zip code. The information works in conjunction with the Distance and
Catchment data tables.

5.2.5         Enrolling a Beneficiary into a USFHP Plan
The USFHP is a TRICARE Prime option available to families of active duty military, retirees, and their
eligible family members (including those age 65 and over) through networks of community-based
hospitals and physicians in six areas of the country. The six geographic areas are limited to areas defined
by zip codes for the six providers.
USFHP Plan Eligibility:
   Husbands, wives, unmarried dependent children (until their 21st birthday, or their 23rd birthday if
    full-time students), or other qualified dependents of active duty service members
   Retirees, their spouses or survivors, unmarried dependent children, and dependent parents
   Eligible former spouses of active duty or retired service members
   Unremarrried widows or widowers, or children of deceased active duty or retired service members
   Medal of Honor recipients


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5.2.5.1       USFHP Enrollment Rules:

Each USFHP provider has a unique contractor code similar to the MCSCs or the TLAs. When a user is
logged in as a USFHP provider, the contractor code has a one-to-one relationship with a DMIS ID. The
only exception is Christus Health, which has two DMIS IDs. For USFHP contractors using DOES, the
DMIS ID is seen when a beneficiary record is viewed.

USFHP contractors do not assign PCMs by name so all the screens related to PCM search and selection is
bypassed. Therefore, when performing an enrollment or transfer, once the beneficiaries are selected for
enrollment and the plan and fees (if any) paid are chosen, the user is sent directly to the
Policy/Enrollment Summary screen. USFHP users will not see any options to add or request enrollment
cards through DOES.

5.2.5.2       Enrollment Transfers
     Eligible beneficiaries living in an area serviced by both a USFHP and a regional TRICARE Prime
      program may transfer enrollment from one plan to the other one time within a 12-month period.
     No change in residence is necessary for the transfer to take place.
     USFHP members may transfer their health care coverage to a USFHP provider in another area of the
      country or to one of the regional TRICARE Prime programs.
     When making a permanent move to a region that offers USFHP or TRICARE Prime, the current plan
      to which the beneficiary is enrolled should be contacted initially to see what options are available.
     Retirees and their family members may transfer enrollment two times during an enrollment year, as
      long as the second transfer is back to the original region or enrollment.

5.2.5.3       Enrollment Fee

There are no enrollment fees for Active Duty families or those individuals that are Medicare-eligible and
paying for Medicare Part B coverage. Members will be asked to provide proof of coverage in Medicare
Part B in lieu of enrollment fee payment. All other must pay the standard TRICARE enrollment fee for
the program they choose to join.

5.2.6         PCM Capacity Less than Ten
During a Direct Care or Resource Sharing search, if there is a PCM capacity of ten or less at any level
such as the group, place of care, or the PCM by name, DOES performs a final capacity check before the
update is sent to the database. The check is done on panels that are nearly full so that they cannot accept
more than ten new patients. If the PCM capacity is less than ten, upon PCM assignment, DOES will allow
the transaction. However, if on the last check, other contractors have sent PCM selections with the same
PCM and the capacity reaches zero, the user will receive an error message.
Note: There are no partial enrollments in DOES. If a user is attempting to enroll three beneficiaries to a
PCM and, upon the final check, there are only spaces available for two; the user will receive an error
message indicating that the capacity has been exceeded.

5.3       Policy Enrollment Summary
After assigning the PCM, the last step in a new enrollment for a plan without fees is to verify all elements
of the enrollment before the record is sent to the database. All the information is captured in the Policy
Enrollment Summary screen. It shows the name of each Policy and the names of the Beneficiaries


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assigned. Included in the same section is the Fee Waiver Reason, if fees and waivers were applicable to
the enrollment. The second section of the Enrollment Summary screen provides all the details of the
selected policy including the short name of the Policy, the Policy Period with an enrollment end date (if
applicable), the Contractor Name verifying the contracting region and entity performing the enrollment,
and the Enrollment End Reason (if known).




1. Before sending the record to the database, the user should review and verify the information on the
   screen.
2. To make edits to the record click < Previous or use shortcut ALT+P.
3. To start over and clear all the previous work completed on the pending enrollment, click Cancel.
4. After the information has been verified, click Send to the National Enrollment Database or use
   shortcut ALT+S.
5. If the record is sent successfully, the user will receive an acknowledgement message.




6. If the plan the user are enrolling a beneficiary into has fees attached to it, before exiting the Policy
   Enrollment Summary screen, the user will be asked if he/she would like to enter fee information.
   Click Yes to bring up the Fee Entry window.



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5.4      Enrollment Fee Information
Currently, the only plans requiring fees are (listed by short name):
     Prime Individual Cvg for Survivors of ADSMs, Non Active Duty (NAD), and Medal of Honor,
      Survivors of GRDS, Transitional Survivors of GRDS.
     Prime Family Cvg for Survivors of ADSM, NAD and Medal of Honor, Survivors of GRDS,
      Transitional Survivors of GRDS.
     USFHP DC Individual Coverage for Survivors of Active Duty Diseased Sponsors (ADDS), NAD,
      and GRDS
     USFHP DC Family Coverage for Survivors of ADDS, NAD, and GRDS

5.4.1         Performing a Fee Payment Operation
1. To begin entering fee or credit information, click Yes from the Policy Enrollment Summary screen
   to bring up the Fee Entry screen.
2. Select the payment type tab (Fee or Credit tab). The Fee tab will be the default.
3. Select the plan and policy fiscal year period to perform a new fee payment operation or update the fee
   payment information.
4. Select the transaction type from the Transaction Type drop-down box or use shortcut ALT+P. Valid
   fee transaction type selections are New and Adjustment.




5. If there is a valid Fee Waiver Reason, the user will be alerted to it by the text in the highlighted
   dialog box. Other information in the box includes the Total Fee to be Paid, the Total Coverage Fee
   for the Policy, and any other additional messages.




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6. Using the information provided, choose the option for the fee waiver from the Fee Exception Reason
   drop-down box or use shortcut ALT+X.




7. Select the Payment Plan from the Payment Plan drop-down list. The options are: Q- Quarterly; A-
   Annual; R-Request to begin allotment/EFT or M-Monthly after Request to begin allotment/EFT
   is applied. In the case of a fee update, monthly is an option. However, the example above is for a
   new fee payment option; therefore, it is not available to the user.




5.4.2         Rules about Payment Plan Types
   Quarterly: This payment type is applicable for a three month-period. If the policy period is not a
    multiple of three (e.g. a five-month enrollment period), the first period is always the smaller period of
    time. For a five-month enrollment period, the first period would be two months long and the second
    period would be three months long. Valid payment type codes for monthly payments are M-Money
    Order. C-Check, O-Other, and D-Credit Card.
   Annual: This payment type is applicable for the entire policy period regardless of the enrollment
    period (12 months or less). Valid payment type codes available for annual payments are M-Money
    Order, C-Check, O-Other, and D-Credit Card.
   Request to Begin Allotment/EFT: This payment type is applicable for a period of three months
    (similar to quarterly payment). If the enrollment fiscal year period is less than three months, DOES
    will split the payment between the two fiscal years that the payment is applied to and apply the fee
    overage to the new enrollment fiscal year period. If the policy end period is less than three months,
    then the payment amount is based on the months left in the policy. Therefore, for a two-month plan,
    payment plan ―R‖ is applied for the last two months. The payment type codes available are A-
    Allotment and E-Electronic Funds Transfer.
   Monthly: This payment type can only be selected if there is a previous payment plan of R-Request to
    begin Allotment/EFT, provided the previous payment is within the current enrollment period for
    which the fee is being applied or is found in any of the previous contiguous periods (i.e., the previous
    period should have the same begin date for the same plan and contractor codes). Monthly cannot be
    selected as the initial payment for any enrollment period if there is no fee payment in the previous


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    period with the type of ―R‖ or ―M‖. The payment type codes available for monthly payments are A-
    Allotment and E-Electronic Fund Transfer.




5.4.3         Types of Payments and Screen Forms
1. Once the Payment Plan is chosen, the Payment Amount (the required fee for the stated policy
   period located in the yellow dialog box) automatically populates. The other value is the total amount
   to be paid for the policy listed as a Coverage Fee.
2. The amount can be changed to reflect any amount the beneficiary decides to pay at the time of
   enrollment. To change the amount, highlight the payment amount and enter the new amount paid. The
   user must use decimal points, but DOES will automatically populate the ‗$‘ before the amount.


                                   changed to
3. The two date fields, Payment Date and the Paid Through Date automatically populate based on the
   payment plan type. For example, if the system date is 06/01/2004 and the enrollment date is
   07/01/2004, if the payment plan is quarterly, the payment date populates as the system date and the
   paid through date is the end of the quarter (09/30/2004).
4. Payment Date and the Paid Through Date can be changed. However, the new date must be within
   the policy enrollment period. Click the up or down arrow buttons to the right of the text box to move
   the date forward or back. The user may also select ALT+D or click on the date in the text box to enter
   the appropriate date. Enter the date in YYYY-MM-DD format.
5. Click the down arrow button to the right of the Payment Type list box or use shortcut ALT+T to
   select the appropriate payment type.




6. Choices for Payment Type include:
       Allotment - monthly allotment from Sponsor‘s paycheck
       Check - standard draft
       Credit Card
       Electronic Fund Transfer (EFT) - transfer of funds between beneficiary‘s financial institution and
        DEERS



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       Money Order
       Other (includes cash)
7. If the user chooses C-Check, enter the check number in the Payment ID text box. If the user
   attempts to Apply the fee without a value in the Payment ID field, the user will receive a warning
   message. Up to 20 characters can be entered in the Payment ID field. If the user clicks Yes to
   continue, DOES sends the record to the database. If the user clicks No, they are returned to the Fee
   Payment screen to enter the missing data.




8. DOES treats M-Money Order(s) in the same way as checks. The user enters the money order
   number in the Payment ID text box.




       Allotment - The allotment screen is temporary, until further instructions are received as to how
        TMA would like to handle this option; the screen will look similar to C-Check and M-Money
        Order.




9. When all the appropriate values have been entered for fee processing, click the Apply to Fee Policy
   command button or use shortcut ALT+A.



10. If the user has made any errors or received any error messages, click Clear or use shortcut ALT+R or
    click Cancel or shortcut ALT+C, as appropriate.
11. If the user has no errors and wishes to proceed, click Apply Fee to Policy. The window will shade to
    gray.
12. The user has the following options:
   Undo - Restarts the Fee Payment window.
   Back - Brings the user back to the Policy Enrollment Summary screen.


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   Cancel - Cancels all enrollment activity. All changes will be lost.
13. If the user clicks Back, then he/she will have the following options:
   Previous - Brings the user back to the Enrollment dialog box.
   Update - Brings the user back to the Enrollment dialog box.
   Send to the National Enrollment Database - Sends the information.
   Cancel - Cancels the transaction and brings the user back to the Family View dialog box.
Note: Clicking Cancel will erase all the enrollment information entered without any of it being saved to
NED. If the user clicks Cancel in error, a message box will appear, stating that the user will lose the
changes made. If the user does not want lose the changes, click No. If the user wishes to Cancel and lose
the changes made, click Yes.




14. To save all the enrollment information the user entered to NED; click the Send to the National
    Enrollment Database command button at the bottom of the Policy/Enrollment Summary dialog
    box.
15. If the transaction completed successfully, the user will receive an acknowledgement message.
16. Click OK to return to the New Family dialog box. The user will be prompted to enter another SSN or
    other ID for a new search.

5.4.4 Credit Payments Rules
1. Payments, Adjustments, or positive credit will only be allowed if there are no positive cumulative
   credit amounts on the fiscal year that the payment is applied. Payments and adjustments will always
   be allowed on previous fiscal years.
2. A positive credit is not allowed for a fiscal year if a positive credit cumulative amount already exists
   for that fiscal year.
3. If there is an existing positive credit it must be reversed (negative credits) before another credit may
   be applied.
4. If a New Payment is added to a fiscal year that results in a overpayment (credit) then the user will be
   asked if they would like to split the payment into two (New Payment and Credit). If Yes then a New
   Payment that equals the amount owed for the current fiscal year and the rest of the payment will be
   applied to a Credit payment. The Credit payment can not be added to a previous fiscal year, any
   Credit added to a previous fiscal year will get applied to the current fiscal year. If No (payment not
   split between New Payment and Credit) then create a New Payment for the payment amount and add
   it to the fiscal year that the payment is applied to.
5. Payment credits are not allowed on past fiscal years.




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6. A cumulative credit amount for a fiscal year cannot be less than zero.
7. There can be multiple negative ‗Credit‘ adjustments as long as the resulting cumulative credit amount
   for fiscal year is not less than zero.

5.5     New Enrollment Card Request
There are two ways in which DOES produces an enrollment card for a beneficiary. One way is from the
EAU screen and the other is from the main DOES menu.
To produce an enrollment card for a beneficiary:
1. Select Card Request from the Enrollment menu or use shortcut CTRL+S.
2. The Card Request dialog box will appear.




3. Select the New Card option button if the request is for a new card (this is selected by default), or the
   Replace Card option button for a replacement card.
4. Select the beneficiaries for whom the card request is being processed under the Beneficiary column.
   A check mark will appear beside the name of a selected beneficiary.




5. Click Apply.
6. A File Folder icon will appear to the left of the beneficiaries‘ names and the card request type for
   each beneficiary will be displayed under Request Type.




7. If the user needs to undo a card request for a beneficiary, select the beneficiary‘s name.



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8. Click Undo or use shortcut ALT+U.



9. Once the correct card request information has been processed, click the Send to the National
   Enrollment Database command button. Note: The user may click Cancel to cancel the card request.

10. More than one type of card request can be sent at the same time. The user can choose a new card for
    one beneficiary and a replacement card for another, using the same steps as above, except for
    choosing the other radio button option.




11. The user also has the option to Undo a card request. Selecting the beneficiary name once the File
    Folder icon is there activates the Undo option.




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12. Once the correct card request information is correct, click the Send command button.
13. If it is successful, the user will receive an acknowledgement message. The user can also Cancel the
    card request.
Note: If the beneficiary is enrolled in a TRICARE Plus or a USFHP plan, there is no New Enrollment
Card option.

5.6     Disenrollment
Disenrollment of a beneficiary occurs in DOES when coverage is lost, when a beneficiary moves from
CONUS to OCONUS or the reverse, when a sponsor is deceased and the remaining beneficiaries are to be
enrolled in a transitional plan and, as part of other DEERS enrollment related events. Extended
disenrollment business rules are listed in Appendix E: Summary of Key DOES Business Rules of the
manual.




1. To disenroll a beneficiary from a coverage plan, select Disenrollment from the Enrollment menu or
   use shortcut CTRL+D.
2. The Disenrollment dialog box will appear, listing all beneficiaries in the family currently enrolled in
   a coverage plan.




3. Select the beneficiary to be disenrolled. A check mark will appear beside the name when the
   beneficiary is selected.




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4. When the user selects a beneficiary's name, the Disenrollment Effective Date will be automatically
   populated with today's date. Click the up or down arrow buttons to the right of the text box to move
   the date forward or back. The user may also select ALT+D or click on the date in the text box to enter
   the appropriate date. Enter the date in YYYY-MM-DD format. The date must be within 289 days
   prior to system date or 30 days in the future.
5. To apply a lockout (to indicate to the user that the 12-month lockout period is in effect), click the
      Apply Lockout check box                       or use shortcut ALT+L.
6. Select the down-arrow button in the Reason for Disenrollment list box or use shortcut ALT+R and
   select the appropriate reason from the list.
      5          Disenrollment because person has other health insurance
      B          Failure to comply with program requirements, or disruptive behavior
      G          Duty station change to health care facility/clinic area
      H          Permanent Change of Station
      I          Relocation
      J          Moved outside of service area (OCONUS for dental)
      L          Enrolled to another health care delivery program
      O          Voluntary disenrollment by beneficiary
      P          Dissatisfied with program


Note: There are other valid disenrollment reasons in DEERS that are used globally. The above list
contains only those values that are valid for DOES.
7. Click Apply after the proper fields have been filled.
8. If the user needs to disenroll another beneficiary shown in the list, select his/her name and repeat the
   disenrollment process.
9. Click the Send to the National Enrollment Database command button once all the appropriate
   beneficiaries have been selected for disenrollment and the required fields have been populated.
10. The user can also Cancel the transaction. This action clears the form and sends the user back to the
    main view.
      Note: If there is a record of fees paid in the beneficiary record and the disenrollment date is earlier
      than the paid through date, DOES sends a message to the database to send out a credit.

5.7       Transferring an Enrollment
1. To transfer one or more beneficiaries to the user‘s region, select Transfers from the Enrollment
   menu or use shortcut CTRL+T.




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2. Similar to a new enrollment, the next screen is the Address Update. The same rules about the Code
   One Plus address validation and effective date apply.
3. Click Next after applying the Code One Plus address validation program changes or to keep the
   information the user entered.
4. The Enrollment Transfers dialog box will appear.




5. The user can apply an enrollment transfer to a beneficiary displayed, one beneficiary at a time. Select
   the beneficiary to perform the enrollment transfer.




6. A check mark will appear beside his/her name, and the Coverage Plan and Transfer Date boxes will
   automatically populate under Transfer Details.




7. By default, the Transfer Date box will display today's date. Click the up or down arrow buttons to
   the right of the text box to move the date forward or back. The user may also select ALT+D or click
   on the date in the text box to enter the appropriate date. Enter the date in YYYY-MM-DD format.
8. Click Apply or use shortcut ALT+A. A File Folder icon will appear beside the name of the
   beneficiary whose enrollment is being transferred.




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9. The user can now update the beneficiary‘s enrollment attributes. Click Add OHI or use shortcut
   ALT+D, or click the Enrollment Attribute Update screen or use shortcut ALT+E, as applicable.



10. After the user is finished with those functions, click Next. The PCM Assignment screen will appear.
11. After assigning a PCM, the Policy/Enrollment Summary screen will appear.
12. If the plan requires fees and there were none applied to the prior policy, the user follows the same
    procedures as described in the Fee section of this manual.
13. The same options and functionality exist with this summary screen. The user may select P-Previous,
    U-Update Fee Information, S-Send to NED, and C-Cancel.
14. Click Send to National Enrollment Database to complete the transfer.
15. Upon sending the information to NED, DOES performs the same PCM capacity check as during a
    new enrollment. (This includes the capacities ten and under check).

5.8     Approve Pending Enrollments
There are instances in DOES when an enrollment or other elements of an enrollment such as a PCM
change are pending approval by the contractor and need to be verified prior to approval. The pending
enrollment may have come from the Web-based enrollment application or an enrollment performed at a
prior time which needed to be confirmed. If the user pulls a beneficiary ID and the menu option is
enabled, then the enrollment has been performed but not sent to the database. Choosing this function
confirms the enrollment and sends it to the database.

5.8.1         Pending Enrollment/PCM


1. The DOES main screen Health care coverage screen displays the status field if enrollment or PCM is
   pending.




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2. To begin, select the function from the Enrollment menu or use shortcut CTRL+W.




3. The name of the Beneficiary pending approval is displayed along with the name of the Plan they are
   being enrolled into, the Enrollment Period, and the Current Status of the enrollment, which
   defaults to Pending.




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4. If a PCM need to be assigned to the sponsor‘s enrollment before approval, the following dialog
   appears:




    Yes – Will send you to the PCM Assignment screen
    No – Will send you back to the Enrollment Pending Approval screen (You must assign a PCM to continue)




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    You must undo any temporary assigned DMIS ID: 0000 before assigning a valid PCM
    Completing the PCM assignment will bring the user back to the Enrollment Pending Approval Screen

5. The user approves the transaction by clicking Apply. The status switches from Pending to
   Approved. The status will then change in the window.
6. After the beneficiary is approved, the user can Undo, Cancel, or Send to the National Enrollment
   Database.
7. Sending the approved enrollment to the database returns an acknowledgement back from the
   database.

5.8.2         Functionality Allowed through DOES if Enrollment/PCM pending
        New Enrollments which don‘t change the plan of the pending enrollment
        Canceling the pending enrollments and assigning new enrollments
        Disenrollments (ADSM enrollment with partial PCM is not allowed)
        Modifications (ADSM enrollment with partial PCM is not allowed)
        PCM Modifications (ADSM enrollment with partial PCM is not allowed)
        Cancel Enrollments
        Cancel Disenrollments
        Address update
        OHI changes


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         Notification requests
         PCM cancel-assign new PCM
         PCM cancel-reinstate old PCM
         Work Zip updates if sponsor’s enrollment has complete PCM assignment

5.8.3         Functionality not allowed thru DOES if Enrollment/PCM pending
         Change in plan/HCDP for the beneficiary whose enrollment/PCM is pending
         Transfers
         PCM Assign
         Card Request
         Letter Request
         Work ZIP updates if the sponsor has incomplete PCM
         Fee waiver updates
         Fee updates if there is a pending enrollment associated with the policy

5.9       Confirmation Letter Request
In DOES there are two types of letters that a contractor can request to have sent to a beneficiary. They
include a disenrollment confirmation letter and a PCM change confirmation letter. The user can perform
a letter request from the main DOES menu or using shortcut CTRL+Y.
1. From the Enrollment option, select PCM/Disenrollment Confirmation or use shortcut CTRL+Y.




2. The Letter Request dialog box appears.




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3. The Letter Request dialog box displays the list of beneficiaries to/for whom the user can send these
   confirmations. Select the appropriate beneficiary by highlighting the name.
4. Upon selecting a beneficiary, a check is placed next to the name and the radio button auto-populates
   with the type of letter that can be generated based upon the prior activity on the record.




5. Click Apply. A File Folder icon will appear next to the name, and the type of letter requested will
   appear under Request Type.




6. After selecting the beneficiaries for whom letters will be produced, click Send to National
   Enrollment Database.
7. If the transaction is successful, the user receives an acknowledgement message back from the
   database.




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5.10     Enrollment Modification

5.10.1        Change Enrollment Period
DOES allows the user to modify certain elements of the beneficiary enrollment record separately from
other update functions.
1. To change an enrollment period for a beneficiary, select Modifications from the Enrollment menu.
2. Select Change Enrollment Period or use shortcut CTRL+M.




3. The Modifications screen will appear.




    Note: Since the menu option was to change the enrollment period only, all the other elements are
    unavailable for update.
4. Continue the modification by selecting the name of the beneficiary whose policy enrollment period is
   to be changed.




5. Modify the begin date in the Modify the Begin date text box. Click the up or down arrow buttons to
   the right of the text box to move the date forward or back. The user may also select ALT+D and enter


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    the appropriate date in the box in YYYY-MM-DD format. Note: Modifying the begin date does not
    change the end date.
6. Click the Apply Lockout check box to apply lockout to the record so that no other user can alter the
   record as it is sent to the database.
7. Click Apply after making the needed modifications. A File Folder icon will appear beside the name
   of the beneficiary for the row of the enrollment period that was modified.




8. The user can either Undo the changes or click Send to National Enrollment Database to send the
   changes.
9. If Undo is chosen, the File Folder icons are removed and the user remains at the Modifications
   screen.
10. If the send is successful, the user will receive an acknowledgement message.

5.10.2        Canceling Enrollments, Disenrollments, and Transfers
DOES allows the user to cancel actions throughout the program by clicking the Cancel button. It also
allows the cancellation of enrollment related events after they have been sent to the database. The events
eligible to be cancelled include enrollments, disenrollments, and transfers.
The following general rules apply to Enrollment and Disenrollment cancellations:
   Enrollment or disenrollment (including PCM information) will be removed and will not be displayed
    by the database in subsequent transactions.
   Any fee payment adjustments should be made prior to canceling the last enrollment in a policy. Once
    all enrollments have been cancelled, the fee information will be locked.
   For disenrollment cancellations, the database will reinstate the enrollment (including fee information)
    as it existed prior to the disenrollment.
   The database will adjust policy dates for the family, as necessary.
   The database will send policy change notifications to all systems participating in the management of
    the enrollment.
   Only the current MCSC/USFHP provider managing the enrollment can perform enrollment and
    disenrollment cancellations.
   When an enrollment is cancelled, DOES will reinstate the previous enrollment if it ended due to a
    change in coverage plans within the same HCDP (e.g., changed enrollment from Prime to Plus).
   The enrollment cancellation date must be 60 days prior or 90 days after the system date to be valid.
   Both current and future enrollments can be canceled. If both types exist in the record, the user must
    first cancel the future enrollment before the current enrollment can be cancelled.
   Both current and previous disenrollments can be cancelled. If both types exist in the record, the user
    must first cancel the prior disenrollment before the current one.
   Upon a disenrollment cancellation, the prior enrollment is reinstated along with any fees and fee
    payments.



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The following general rule applies to Transfer cancellations:
   If there has been a transfer of enrollment, the gaining contractor may only cancel the transfer, not the
    enrollment.
To perform an Enrollment, Disenrollment, or Transfer Cancellation:
1. Pull the family information from the database.
2. Select Modification from the Enrollment menu, and then select Cancel Event or use shortcut
   CTRL+R.




3. The Cancel Events screen will appear which displays the beneficiaries who have valid events in their
   record for cancellation.




    Note: If the user is canceling a transfer or a disenrollment, the screen is the same except for the
    Current Event. Cancel Enrollment will be replaced with Cancel Transfer or Cancel
    Disenrollment.
4. To cancel an event, highlight the beneficiary that corresponds to the event. A check mark will appear
   to the left of the beneficiary's name. Note: More than one beneficiary can be selected at one time.




5. Click Apply. A File Folder icon appears next to the beneficiary name.




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6. To send the transaction to NED, click Send to National Enrollment Database or click Cancel to
   cancel the transaction. Canceling the transaction brings up a warning indicating that all current
   changes will be lost.
7. If the transaction was successfully sent to NED, the user will receive an acknowledgement message.
Note: In the case of a Transfer Cancellation, upon sending the information to the database, the
beneficiary‘s enrollment reverts back to the prior contractor and the prior plan. Also, if only one
beneficiary from a family was transferred out of a family plan, that enrollment is transferred into an
individual plan.

5.10.3        PCM Options
There are a number of actions the user can perform on PCMs within DOES. This section of the manual
deals with the three options available under the Enrollment menu: PCM Assign (CTRL+I), PCM
Cancellation (CTRL+L), and PCM Modification (CTRL+G).




5.10.3.1      PCM Assignment
Assigning a PCM is the same as adding a PCM to a beneficiary. The user must have a beneficiary with a
current or future enrollment segment and a valid PCM for that segment.
1. To assign a new PCM, select the PCM Assign option from the menu or use shortcut CTRL+I.
2. The PCM Assign/Change screen will appear.
3. Select the beneficiary for whom to change/reassign a PCM.
4. Two critical elements are the PCM Assignment Date and the End Reason. Note: Without those two
   data elements the user will not be able to complete the transaction.
5. Enter the PCM Assignment Date. Click the up or down arrow buttons to the right of the text box to
   move the date forward or back. The user may also select ALT+D and enter the appropriate date in the
   box in YYYY-MM-DD format.
6. Enter the End Reason using the down arrow to the right of the Enter the End Reason text box.


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7. Click Apply.

8. After clicking Apply, the Select PCM Details                       button (shortcut ALT+S) is
   activated. Upon clicking that button, the user is sent to the main PCM Search screen prompting the
   user to go through the same PCM selection process as during an enrollment or transfer.




9. After the user selects the PCM and clicks Apply, an      icon appears next to the name signifying that
   the PCM was assigned to the record.
10. Click Send to the National Enrollment Database to send the transaction to NED or select other
    family members to assign another PCM.

5.10.3.2      PCM Cancellation
The following general rules apply to PCM cancellations:
   Only the current MCSC/USFHP provider managing the enrollment can update PCM information.
   Only the MCSC/USFHP provider that performed the PCM transfer may cancel it.
   During a PCM cancellation, the user can reinstate the previous PCM or replace the current PCM with
    a new one. If there is only one PCM for the enrollment segment, the PCM cancellation will not be
    allowed. The user must cancel the entire enrollment.
   If the action is a valid PCM cancellation, then the PCM selection being cancelled will be removed
    and will not be displayed by the database in subsequent transactions.
   The database will send policy change notifications to all systems participating in the management of
    the enrollment.
   The PCM or transfer effective date cannot be more than 60 days in the past.
To perform a PCM cancellation:
1. Highlight a beneficiary from the Beneficiary column.
2. Depending upon the beneficiary and the number of PCMs attached to the record, the user will either
   view a screen with radio button options or have the option to cancel the entire enrollment.
3. Once a beneficiary is chosen, a check is placed next to the name and the appropriate screen appears.



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4. During a cancellation with multiple PCMs, if the user chooses Cancel Current and Re-instate
   Previous, upon clicking Apply, the previous PCM will be reinstated to the beneficiary record.
5. During the cancellation, if the use chooses Cancel Current and Assign New, upon clicking Apply,
   the cancellation occurs and DOES forces the user to choose a new PCM beginning with the PCM
   Select screen.
The following screen is an example of a PCM cancellation with more than one PCM in the segment:




The following screen is an example of a beneficiary with only one PCM in the enrollment segment:




5.10.3.3      PCM Modification
The following general rules apply to a PCM modification:
   Only the current MCSC/USFHP provider managing the enrollment can update PCM information.
   A modification can only be performed on a beneficiary with two or more PCMs in their record for
    one enrollment period.
   Performing a modification changes the begin date of the most recently assigned or chosen PCM. In
    doing so, this changes the end date of the prior or current PCM depending on the system date.
       The date must be on or after the Enrollment Begin Calendar date.



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       If the date is before the Enrollment End Calendar date, the DOES application will provide
        warnings, but will not prevent the action.
   There can be no date gaps for PCMs:
       Dates can be no greater than 60 days in the past if it is the initial assignment to this PCM.
       If updating an existing PCM, the date cannot be greater than 60 days in the past of the current
        PCM Selection Begin Calendar date.
   The DOES application will populate the previous PCM Selection End date as the day prior to new
    PCM Selection Begin date.




The PCM Modifications screen lists Beneficiaries, the PCM Name/DMIS ID, the Provider Type, and
the PCM Period for the beneficiary.
To perform a PCM modification:
1. Highlight the appropriate beneficiary from the Beneficiary column.
2. Modify the Begin date by using the arrows or clicking in the text box and typing a new date.
3. The Modify the End Date text box defaults to deactivated; therefore, the user cannot change it.
4. Modify the End Reason by selecting a reason from the drop-down menu.
5. Click Apply. A File Folder icon appears.
6. Click Send to National Enrollment Database to send the transaction to NED or click Undo to undo
   the action.


6       Sending Notifications to the Database
1. Notifications can be sent by the user after an enrollment or a PCM selection is complete.
2. To send a notification, select Notifications from the menu bar located at the top of the window.
3. Choose Send Notifications or use shortcut CTRL+N.




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4. A Notifications dialog box will appear. Before selecting a beneficiary, choose the type of notification
   to be sent. By default, the Enrollment notification type is selected.




5. After selecting the correct notification type, highlight the beneficiary for whom the notification is
   being sent.
6. Click Apply.




    Note: DOES allows multiple notifications and multiple types within one send to the database.
7. After applying the notification request to a beneficiary, a File Folder icon will appear to the left of
   the beneficiary's name.
8. To undo a notification request for a beneficiary, highlight his/her name again under the Beneficiary
   column. Click Undo.




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9. Once all notifications for beneficiaries have been applied as needed, click Send to the National
   Enrollment Database or click Cancel to cancel the transaction.
10. If the transaction was successful, the user will receive an acknowledgement message.


7   Special Programs: ECHO, Tobacco Cessation, and Weight
Management

7.1       Extended Care Health Option
ECHO is a special health care delivery program (HCDP Type ‗S‘) and replaces the Program for Person
with Disabilities. In addition to offering the benefits of the PFPWD, ECHO also offers respite care and
greater comprehensive home-based medical care than available under the ―part-time‖ or ―intermittent‖
benefit of the TRICARE Home Health Agency Prospective Payment System (HHA-PPS) benefit.
Beneficiaries are registered into the program rather than enrolled. Only people who qualify for
TRICARE may enroll in ECHO. The registration is similar to Prime Plans for ADFMs. The software
does not distinguish between enrollment and registration; therefore, throughout the manual the ECHO
nomenclature is listed and the DOES nomenclature is in ( ).
Note: A person may be enrolled in only one of the following programs at any given point in time:
         ECHO
         Tobacco Cessation
         Weight Management

7.1.1         Basics of the ECHO Program
     There is only one health plan in ECHO.
     The plan begin date is September 1, 2005.
     ECHO will only be available in T-NEX.
     The ECHO Respite Care benefit and the ECHO Home Health Care benefit are available in the 50
      States, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands only where there are


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      Medicare-certified Home Health Agencies available to provide such services.
     Active duty family members are eligible for ECHO if they have a qualifying condition and require
      services not available under the TRICARE Basic Program.
     Beneficiaries can be enrolled in another health care delivery program at the same time as ECHO.
     Active duty sponsors are not eligible for this plan.
     There are no PCM assignments with ECHO.
     Echo is not available to family members using TRICARE Reserve Select
     The enrollment start date cannot be changed

7.2       The Demonstration Programs: Tobacco Cessation and Weight Management
The Weight Management program and the Tobacco Cessation program are currently offered as
demonstration programs and are subject to the following:
     An enrollee can be enrolled in only one of the following programs at any one time:
              a. ECHO
              b. Weight Management (WM)
              c. Tobacco Cessation (TC)
     An enrollee must be enrolled in TRICARE to be enrolled in WM or TC. Since an enrollee in WM or
      TC must be enrolled in TRICARE, changing an enrollee‘s TRICARE enrollment dates may shorten
      or even cancel an enrollment in a demonstration program. Therefore, care must be taken before
      altering TRICARE enrollment dates.
     A sponsor may not enroll in WM since the armed forces provide their own versions of this program
      to their personnel. Only a sponsor‘s beneficiaries may enroll in WM. Both sponsors and their
      beneficiaries, however, may enroll in TC.
     Currently, WM is offered only in the North region, while TC is offered only in the West region, and
      beneficiaries of these programs must live in a demonstration state. The demonstration states for WM
      are IL, IN, OH, and MI, while the demonstration states for TC are CO, MN, MO, and KS. Potential
      enrollees must also reside more than 40 miles from an inpatient MTF to qualify. It is the user’s
      responsibility to enforce these rules. (DOES will warn a user if a beneficiary is ineligible due to
      residing out of region, but it will not perform an address check for correct state and distance criteria.
      Even when DOES generates an incorrect region warning, it will not actually block an enrollment.)
     The end date for these programs can be changed only through one of the following:
              a. Disenrollment from the program
              b. Changing TRICARE
      The start date for these programs may be changed only by changing TRICARE.

7.3       Special Program Functions
     Registration (New Enrollment)
     De-Register (Disenrollment)
     Cancel Events



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   Cancel Registration (Cancel Enrollment)
   Cancel De-Registration (Cancel Disenrollment)
   Notifications
   Address Update
The menus and dialog boxes look the same as those encountered during TRICARE Prime registration,
except there are not as many activity options available under the special programs.
Under the Enrollment menu, the user can perform the following functions:
   Registration (New Enrollment) (shortcut CTRL+E)
   De-Register (Disenrollment) (shortcut CTRL+D)
   Cancel Events (shortcut CTRL+C)
Under the Update menu, the user can only perform the following function:
   Address Update (shortcut CTRL+A)

The Notifications menu acts exactly like the Prime Notifications menu by sending notifications to NED.
The View menu in ECHO is also the same as the TRICARE Prime View menu in that the user can View
the family (shortcut CTRL+V) or View the policy (shortcut CTRL+P) details in this window.

7.3.1         Performing a New Special Program Enrollment
1. Select families by SSN, FIN, or other allowable ID. Open a family from the Window menu or use
   shortcut CTRL+F to bring up the Inquire NED dialog box, where the user can select the Program
   Type (i.e., ECHO, Tobacco Cessation, or Weight Management) and the ID to search.
2. Select New Enrollment from the Enrollment Menu or use shortcut CTRL+E.




3. Prior to enrollment, the user is prompted to the Address Update window, as in a TRICARE Prime
   enrollment. Use the same rule about address effective date here as in Prime.
4. After the address is updated, there is also a Code One Plus address validation. It follows the same
   procedure as the one in Prime Enrollment.
5. After the Code One address validation check, the user is sent to the Enrollments dialog box.




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6. The Enrollments dialog box has the same sections as in Prime but only one Coverage Plan in the
   drop-down box—ECHO, Tobacco Cessation, or Weight Management. The Family Coverage
   Summary section displays all the family members and their latest enrollment details regardless of
   whether they are eligible for the special program selected, which is why the sponsor is listed. The
   Enrollment Details section contains the Coverage Plan drop-down menu for the plan the user is
   enrolling the beneficiary into. There will be only one option in the Coverage Plan drop-down menu.
   The Enrollment Details portion also contains the Eligible Family Members for Enrollment box,
   which lists each eligible family member.
7. Click the check box next to the appropriate family member‘s name.




8. The Eligibility Information region will populate with the selected member‘s information.




    Note: ECHO, Tobacco Cessation, and Weight Management each allows multiple family member
    enrollments simultaneously by selecting more than one check box. If more than one family member is
    being enrolled, DOES will find the common allowable enrollment date ranges of the selected


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    beneficiaries and sets the lower and higher enrollment begin date range accordingly. As the family
    members are selected, the calculated Enrollment Period is copied to the summary section
9. Enter the Enrollment Begin Date. The date defaults to the system date and can be changed to 90
   days in the future or 60 days in the past. Click the up or down arrow buttons to the right of the text
   box to move the date forward or back. The user may also use shortcut ALT+D and enter the
   appropriate date in the box in YYYY-MM-DD format.
10. Click Apply Enrollment or use shortcut ALT+A or click Remove Enrollment or use shortcut
    ALT+R. Applying the enrollment moves that enrollment information to the New Enrollment
    Summary, where the Policy End Date defaults to the end of eligibility. Removing the enrollment
    moves the selected individual back to the Eligible Family Members for Enrollment section and
    removes the information from the summary section.




11. To continue with the enrollment, once the user selects the individual and the begin date; the person is
    listed in the summary section. Click Previous or use shortcut ALT+P, which brings the user back to
    the Address Update, or click Next or use shortcut ALT + N, which brings the user to the
    Policy/Enrollment Summary screen (the same as in the Prime enrollment).




12. Click the Send to the National Enrollment Database command button or use shortcut ALT+S if all
    the information in the Policy/Enrollment Summary screen is correct.
13. If the transaction completed successfully, the user will receive an acknowledgement message.
14. Click Previous or use shortcut ALT+P, if upon review the user sees something that needs to be
    changed.
15. Click Cancel or use shortcut ALT+C, if the user has made an error and want to restart.



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7.3.2         Performing a Special Programs Disenrollment
1. To disenroll an individual from a special program, select Disenrollment or use shortcut CTRL+D
   from the Enrollment menu.




2. The Disenrollment dialog box will appear, listing all beneficiaries in the family currently enrolled in
   the coverage plan the user is disenrolling from.




3. Highlight the appropriate beneficiary from the list. A check mark will appear next to the name.




4. Enter the disenrollment date in the Disenrollment Effective Date box. The date defaults to the
   system date, and can be changed to 30 days in the future or 60 days in the past. The date must be
   within the beneficiary‘s eligibility period and within the period of enrollment. Click the up or
   down arrow buttons to the right of the text box to move the date forward or back. The user may also
   select ALT+D and enter the appropriate date in the box in YYYY-MM-DD format.
5. Select the appropriate reason for disenrollment from the Reason For Disenrollment list box. The
   reasons for disenrollment are the same as those used in a Prime Disenrollment, and the same rules
   apply regarding the available messages appropriate for the enrolled plan.
6. Click Apply or use shortcut ALT+A to apply the change to the record.
7. A File Folder icon will appear next to the beneficiary‘s name.




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8. Click the Send to the National Enrollment Database command button or use shortcut ALT+S, or
   click Cancel or use shortcut ALT+C to cancel the disenrollment.
9. If the transaction completed successfully, the user will receive an acknowledgement message.

7.3.3         Canceling an Event
Canceling an event in ECHO, Tobacco Cessation, or Weight Management works the same as canceling a
Prime enrollment or Prime disenrollment. See section 7.3.1: Performing an ECHO Disenrollment, for
details. The following is a sample screen of how ECHO events are cancelled:




7.3.4         Sending Special Programs Notifications to the Database
Sending notification is similar to sending Prime notification; however, only Enrollment notifications can
be sent.




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8        TRICARE Reserve Select Option
TRICARE Reserve Select (TRS) is an extension of TRICARE military health benefits, and offered, for a
fee, to reservists who meet the following criteria:
     Have served on an identified contingency, on or after September 11, 2001, for a continuous 90 days
      or more,
     Commit to serve as a Selected Service Reserve member for one or more years with an identified Unit,
      and
     Indicate their intent to commit to the Selected Service Reserves before coming off of Active Duty or
      before the end of their transition period (TAMP).
Reservists indicate their intent through the TRS Web Application, available through their Reserve Affairs
office. Approved program applications are mailed, with premium payment, to the appropriate MCSC.
Upon receiving an enrollment form, the MCSC uses DOES to enroll the eligible Member into either the
TRICARE Reserve Select Member Only Coverage (HCDP_PLN_CVG_CD=401) or TRICARE Reserve
Select Member and Family Coverage (HCDP_PLN_CVG_CD=402).

8.1       TRS Plans
     Reserve Select Tier 1 member only coverage (contingency ops)
     Reserve Select Tier 1 member and family coverage (contingency ops)
     Reserve Select Tier 1 survivor continuing with individual coverage
     Reserve Select Tier 1 survivor continuing with family coverage
     Reserve Select Tier 1 survivor new individual coverage
     Reserve Select Tier 1 survivor new family coverage
     Reserve Select Tier 2 member only coverage (certified qualifications)
     Reserve Select Tier 2 member and family coverage (certified qualifications)
     Reserve Select Tier 3 member only coverage (service agreement)
     Reserve Select Tier 3 member and family coverage (service agreement)

8.2       TRS Functions
     Enrollment
     Disenrollment
     Modifications
     Transfers
     Address Update
     Fee Updates
     OHI Updates
     Notifications



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8.3       Performing a New TRS Enrollment
1. Select New Enrollment in the Enrollment menu or use shortcut CTRL+E. The Inquire National
   Enrollment Database dialog box will appear. Select the appropriate program from the Program
   Type drop-down list and enter the appropriate SSN, FIN, or allowable ID in the Person SSN field.




2. Click OK. The main DOES screen will appear.




3. Select the Enrollment button. The Address Update screen will appear with the current address
   information for the sponsor and any beneficiaries.

      Note: The assigned region for each individual is linked to the current ZIP code. You may update
      address information for sponsors and beneficiaries, if necessary. Information on updating addresses
      can be found in Section 8.6, Updating Addresses in TRS.




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4. If you do not need to update addresses, select the Next > button. The Enrollments screen will appear.




5. Select the appropriate coverage plan from the Coverage Plan drop-down list in the Enrollment
   Details region.
6. Select (check) all appropriate family members to be enrolled in the plan in the Eligible Family
   Members for Enrollment list box.
7. Enter the appropriate start date in the Enrollment Begin Date field, in the Enrollment Date Entry
   region. The date defaults to the system date and can be changed to 90 days in the future or 60 days in
   the past. You may use the up/down arrow buttons to enter the date, or type in the appropriate date in
   the field in YYYY-MM-DD format.
8. Click the Apply Enrollment button. The New Enrollments region will populate with information on
   all family members‘ new enrollments.
9. Click the Next > button to go to the Policy/Enrollment Summary screen. A dialog box will appear
   asking if you want to view fee information.




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10. Click Yes to go to the Premium Entry screen and view the fee information. Enter the appropriate
    paid through date in the Paid Through Date field and click the Apply Fee to Policy button.




11. Click the Back button to return to the Policy Enrollment Summary screen.




12. Select the appropriate beneficiaries in the Beneficiary list. The Policy Details region will populate
    with each beneficiary‘s enrollment information.
13. Click the Send to the National Enrollment Database button. A dialog box will appear confirming
    the update to the NED.




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14. Click OK. The Inquire National Enrollment Database screen will appear.




15. To view the new enrollments, enter the appropriate search information and click OK. Then click the
    View Policy button. The View Policy screen will appear with the new enrollment information
    displayed at the bottom of the screen.




Enrollment information is listed by the beneficiary name, enrollment dates, enrollment end reason, and
contractor. Note: Enrolling beneficiaries in a family plan automatically terminates any previous
individual enrollment plan for the sponsor.




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8.4      Performing a TRS Disenrollment
1. To disenroll an individual from TRS, select Disenrollment from the Enrollment menu or use
   shortcut CTRL+D. The Disenrollment screen will appear.




2. Select the appropriate beneficiary to disenroll from the Beneficiary list. A check mark will appear
   next to the name.
3. Enter the disenrollment date in the Disenrollment Effective Date box.
4. Select the appropriate reason for disenrollment from the Reason for Disenrollment drop-down
   menu.
5. Click Apply, and click Send to the National Enrollment Database. A dialog box will appear
   confirming that the disenrollment was successful.




6. Click OK to return to the Inquire National Enrollment Database screen. To view the
   disenrollment, enter the appropriate information and click OK. Then click the View Policy button.
   The View Policy screen will appear and display the disenrollment status for the specific individuals.




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8.5      TRS Modifications

8.5.1         Change Enrollment Period
As with Prime, TRS allows the user to modify certain elements of the beneficiary enrollment record
separately from other functions.
1. To change an enrollment period for a beneficiary, select Modification from the Enrollment menu,
   and then select Change Enrollment Period or use shortcut CTRL+M. The Modifications screen will
   appear.




2. Select the name of the beneficiary whose enrollment period is to be changed. A check mark will
   appear next to the name.
3. Enter the new begin date in the Modify the Begin date text box. Click the up or down arrow buttons
   to the right of the text box to move the date forward or back, or select ALT+D and enter the
   appropriate date in YYYY-MM-DD format. Note: Modifying the begin date does not change the end
   date.
4. Enter the new end date in the Modify the End date text box. Note: The new Begin and End dates
   must fall within the sponsor‘s date range.
5. Select the appropriate reason for modifying the end date from the Modify the End Reason drop-
   down list.
6. Click Apply after making the necessary modifications. A file folder icon will appear beside the name
   of the beneficiary whose enrollment period is being modified.
7. Click Send to the National Enrollment Database to send the changes, or click Undo to cancel the
   changes. A dialog box will appear confirming that the changes were successfully sent to the NED.
   Note: If Undo is selected, the file folder icons are removed.




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8.5.2         Canceling Events
TRS allows the user to cancel the previous event for an individual. Canceling an event reverts the
individual‘s record to the previous status before the last event.
1. Select Modification from the Enrollment menu, and then select Cancel Event or use shortcut
   CTRL+R. The Cancel Events screen will appear.




2. Select the name of the beneficiary that corresponds to the event in the Beneficiary column. A
      check mark will appear next to the name. Note: Multiple beneficiaries may be selected at one
      time.
3. Click Apply. A file folder icon will appear next to the beneficiary name.

4. Click Send to the National Enrollment Database to send the transaction. A dialog box confirming
   that the transaction was successfully sent will appear. You may also click Cancel to cancel the
   transaction. Canceling the transaction beings up a warning indication that all current changes will be
   lost.

8.6       Enrollment Transfers in TRS
1. To perform an enrollment transfer, select Transfers from the Enrollment menu or use shortcut
   CTRL+T. The Address Update screen will appear.




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2. Select (check) the check box next to the appropriate individuals in the Select the Family Member(s)
   list box.

3. Select the appropriate radio buttons to update the addresses if the selected individuals, as appropriate,
   in the How would you like to change the addresses for this family region.

4. Enter the appropriate address information for each individual. Note: Ensure that you enter the correct
   ZIP code information, as each specific region is linked to the ZIP code entered.

5. Click Next >. The Address Validation Summary screen will appear.




6. Ensure that the address information is correct and click Accept Validated Suggestions. You may
   click Make Correction if any information needs to be changed.

7. Click Apply Changes. The Enrollment Transfers screen will appear.




8. Select the name of the individual to transfer from the Beneficiary list. The Transfer Details region
   will activate and the appropriate coverage plan will appear in the Coverage Plan text box.


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9. Enter the appropriate date of enrollment transfer in the Transfer Date field. Click the up or down
   arrow buttons to the right of the text box to move the date forward or back, or select ALT+D and
   enter the appropriate date in YYYY-MM-DD format.
10. Click Apply. A file folder icon will appear next to the name of the individual(s) to be transferred.
    Click Undo to cancel the changes.
11. Click Next >. The Policy/Enrollment Summary screen will appear. You can view each individual‘s
    policy details by clicking on the appropriate name in the Beneficiary list. The Policy Details region
    will populate with the selected individual‘s information.




12. Click Send to the National Enrollment Database to send the information. A dialog box will appear
    confirming that the transfer was sent successfully.




13. Click OK to return to the Inquire National Enrollment Database screen.




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14. Enter the appropriate search information and click OK. The main Policy View screen will appear
    with the new transfer information displayed for each individual at the bottom of the screen.




8.7      Updating Addresses in TRS
Address Update allows the user to update either or both the residential and mailing address of the plan
sponsor and any associated beneficiaries. As in Prime, Address Update can be activated as a stand-alone
function, but is always enabled when performing a new enrollment or transfer.
When updating addresses in TRS, it is important to remember that the enrolling contractor is determined
by the ZIP code that is entered.

1. To update address and telephone information, select Add/Update Address from the Address menu
   or use shortcut CTRL+A. The Address Update screen will appear.




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2. Select (check) the appropriate family members whose addresses need updating in the Select the
   Family Member(s) list box. The sponsor will be selected by default.

3. Select the appropriate radio buttons corresponding to the addresses that need updating in the How
   would you like to change the addresses for this family region.

4. Enter the appropriate address and telephone information for each individual in their respective tabs.

5. Click Next>. The Address Validation Summary screen will appear.




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6. Review the address and telephone information and click Accept Validated Suggestions. You may
   click Make Correction to change any information.

7. Click Apply Changes to apply the updated information, or Cancel to override all entered updates.

      Note: If the address change is within the same region, or is a future enrollment, the Send to the
      National Enrollment Database button will appear; click this button to apply the updated
      information.
Note: Updating addresses for currently enrolled individuals requires an enrollment transfer if the
individual is transferring from one region to another (based on ZIP code). If a transfer is required, the
Enrollment Transfers screen will appear after the user clicks Apply Changes in the Address Validation
Summary screen. The procedure for transferring an enrollment is the same as outlined in Section 8.5,
Enrollment Transfers in TRS.

8.8       Updates

8.8.1         Updating Premium Payments

1. To update premium payments in TRS, select Premium Payments from the Updates menu. The
   Premium Entry screen will appear.




2. Enter the new paid through date in the Paid Through Date field in the Premium Payment
   Information region. Click the up or down arrow buttons to the right of the text box to move the date
   forward or back, or select ALT+D and enter the appropriate date in YYYY-MM-DD format.

3. Click Apply Fee to Policy to apply the changes, or click Undo Update to cancel the changes.

4. Click Send to the National Enrollment Database to send the new premium payment information. A
   dialog box will appear confirming that the information was sent successfully. Click OK to return to
   the Inquire National Enrollment Database screen.




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8.8.2         Adding OHI in TRS
Adding OHI in TRS functions the same as it does in regular Prime; the only difference is that the regions
in TRS are linked to the specific ZIP codes.
1. Select Add OHI from the Updates menu. The OHI Assignment screen will appear.




Refer to Section 4.2, Adding OHI, for instructions on adding OHI in TRS.

8.8.3         Notifications
Sending notifications in TRS is similar to sending them in Prime.
1. To send notifications in TRS, select Send Notification from the Notifications menu. The
   Notifications screen will appear.




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Refer to Section 6, Sending Notifications to the Database, for information on sending notifications in
TRS.

8.9      Miscellaneous Options in TRS

8.9.1         Reserve Select Agreement
The Reserve Select Agreement is a new feature in TRS that provides information on the status of a
sponsor‘s enrollment being accepted by the appropriate Service. This feature only applies to a sponsor‘s
record.
1. To view Reserve Select Agreement information, select the sponsor‘s name under View Family in the
   Person ID box on the main DOES screen. The sponsor‘s detailed records will appear.




2. Select the Personnel Information tab. The Personnel Information section will appear and display the
   sponsor‘s records status in the Reserve Select Agreement region.




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9      Exiting DOES and DMDC Tools
1. Click the Exit icon or use shortcut CTRL+Q to exit the DOES application.



2. Click the Exit button on the DMDC Tools Launcher toolbar to exit DMDC Tools.




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Appendix A – Acronyms and Abbreviations

The following abbreviations and acronyms aid in the understanding of this document.

ADDS            Active Duty Deceased Sponsor

ADSM            Active Duty Service Member

CC&D            catastrophic cap and deductible

DEERS           Defense Enrollment Eligibility Reporting System

DMDC            Defense Manpower Data Center

DMIS ID         Defense Military Information System ID

DoD             Department of Defense

DOES            Defense Online Enrollment System

DP              Designated Provider

DSO             DMDC Support Office

EAU             Enrollment Attributes Update

ECHO            Extended Health Care Option

EFT             electronic funds transfer

EMC             Enrollment Management Contractor

FIN             Foreign Identification Number

HCDP            Health Care Delivery Plan

HIC             Health Insurance Carrier

MCSC            Managed Care Support Contractors
MTF             Military Treatment Facility

NAD             Non Active Duty

NED             National Enrollment Database

OCONUS          outside the continental United States

OHI             Other Health Insurance

PCM             Primary Care Manager

PLOC            Place of Care


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POC             Point of Contact

SIT             Standard Insurance Table

SSN             Social Security Number

TIN             Temporary Identification Number

T-NEX           TRICARE -The Next Generation of Contracts

TPR             TRICARE Prime Remote
UIC             Unit Identification Code

USFHP           Uniform Services Family Health Plan (also referred to as DPs)




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Appendix B – Health Plan Names


                                    Health Plan Names
              Plan Short Name                           Plan Extended Name
Bergstrom AFB - CAM Program (history)      Bergstrom Air Force Base (AFB) - Catchment
                                           Area Management (CAM) program (history)
BRAC Pharmacy Program                      BRAC Pharmacy
CHAMPUS Reform Initiative (CRI) -          CHAMPUS Reform Initiative (CRI) - CHAMPUS
CHAMPUS Prime (history)                    Prime (history)
CHCBP Family Cvg                           Continued Health Care Benefits Program Family
                                           Coverage
CHCBP Individual Cvg                       Continued Health Care Benefits Program
                                           Individual Coverage
DP Fam for Survivors of AGR Deceased       TRICARE Dental Plan Family Coverage for
Sponsor                                    Survivors of Active Guard/Reserve (AGR) Family
                                           Members
DP Fam for Survivors of Mob-asset IRR      TRICARE Dental Plan Family Coverage for
Deceased Sponsor                           Survivors of Mobilization-Asset Individual Ready
                                           Reserve (IRR) Deceased Sponsors
DP Fam for Survivors of SelRes Deceased    TRICARE Dental Plan Family Coverage for
Sponsor                                    Survivors of Selected Reserve (SelRes) Deceased
                                           Sponsors
DP Family Cvg for ADFMs                    TRICARE Dental Plan Family Coverage for
                                           Active Duty Family Members
DP Family Cvg for AGR FMs                  TRICARE Dental Plan Family Coverage for
                                           Active Guard/Reserve (AGR) Family Members
DP Family Cvg for SelRes FMs               TRICARE Dental Plan family coverage for
                                           Selected Reserve (SelRes) family members
DP Family for Mobil-asset IRR FMs          TRICARE Dental Plan Family Coverage for
                                           Mobilization-Asset Individual Ready Reserve
                                           (IRR) Family Members
DP Family for non-Mobil-asset IRR FMs      TRICARE Dental Plan Family Coverage for Non-
                                           Mobilization-Asset Individual Ready Reserve
                                           (IRR) Family Members
DP Family for Survivors of ADFMs           TRICARE Dental Plan Family Coverage for
                                           Survivors of Active Duty Deceased Sponsors
DP Family Remote Cvg for SelRes FMs        TRICARE Dental Plan Family Remote Coverage
                                           for Selected Reserve (SelRes) Family Members


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DP Family Remote Cvg for AGR FMs            TRICARE Dental Plan Family Remote Coverage
                                            for Active Guard/Reserve (AGR) Family
                                            Members
DP Family Remote for ADFMs                  TRICARE Dental Plan Family Remote Coverage
                                            for Active Duty Family Members
DP Family Remote for Mobil-asset IRR        TRICARE Dental Plan Family Remote Coverage
FMs                                         for Mobilization-Asset Individual Ready Reserve
                                            (IRR) Family Members
DP Family Remote for non-Mobil-asset IRR    TRICARE Dental Plan Family Remote Coverage
FMs                                         for Non-Mobilization-Asset Individual Ready
                                            Reserve (IRR) Family Members
DP Ind for Survivors of AGR Deceased        TRICARE Dental Plan Individual Coverage for
Sponsor                                     Survivors of Active Guard/Reserve (AGR) Family
                                            Members
DP Ind for Survivors of Mob-asset IRR       TRICARE Dental Plan Individual Coverage for
Deceased Sponsor                            Survivors of Mobilization-Asset Individual Ready
                                            Reserve (IRR) Deceased Sponsors
DP Ind for Survivors of SelRes Deceased     TRICARE Dental Plan Individual Coverage for
Sponsor                                     Survivors of Selected Reserve (SelRes) Deceased
                                            Sponsors
DP Individual Cvg for ADFMs                 TRICARE Dental Plan Individual Coverage for
                                            Active Duty Family Members
DP Individual Cvg for AGR FMs               TRICARE Dental Plan Individual Coverage for
                                            Active Guard/Reserve (AGR) Family Members
DP Individual Cvg for Mobil-asset IRR       TRICARE Dental Plan for Mobilization-Asset
Sponsor                                     Individual Ready Reserve (IRR) Sponsors
DP Individual Cvg for SelRes FMs            TRICARE Dental Plan Individual Coverage for
                                            Selected Reserve (SelRes) Family Members
DP Individual Cvg for SelRes Sponsor        TRICARE Dental Plan Individual Coverage for
                                            Selected Reserve (SelRes) Sponsors
DP Individual for Mobil-asset IRR FMs       TRICARE Dental Plan Individual Coverage for
                                            Mobilization-Asset Individual Ready Reserve
                                            (IRR) Family Member
DP Individual for non-Mobil-asset IRR FMs   TRICARE Dental Plan Individual Coverage for
                                            Non-Mobilization-Asset Individual Ready
                                            Reserve (IRR) Family Members
DP Individual for non-Mobil-asset IRR       TRICARE Dental Plan for Non-Mobilization-
Sponsor                                     Asset Individual Ready Reserve (IRR) Sponsors
DP Individual for Survivors of ADFMs        TRICARE Dental Plan Individual Coverage for
                                            Survivors of Active Duty Deceased Sponsors
DP Individual Remote Cvg for AGR FMs        TRICARE Dental Plan Individual Remote


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                                           Coverage for Active Guard/Reserve (AGR)
                                           Family Members
DP Individual Remote Cvg for SelRes FMs    TRICARE Dental Plan Individual Remote
                                           Coverage for Selected Reserve (SelRes) Family
                                           Members
DP Individual Remote for ADFMs             TRICARE Dental Plan Individual Remote
                                           Coverage for Active Duty Family Members
DP Individual Remote for Mobil-asset IRR   TRICARE Dental Plan Individual Remote
FMs                                        Coverage for Mobilization-Asset Individual
                                           Ready Reserve (IRR) Family Members
DP Individual Remote for non-Mobil-asset   TRICARE Dental Plan Individual Remote
IRR FMs                                    Coverage for Non-Mobilization-Asset Individual
                                           Ready Reserve (IRR) Family Members
FEHBP Family High Cvg                      Federal Employees Health Benefits Program
                                           (FEHBP) Family High Coverage
FEHBP Family Standard Cvg                  Federal Employees Health Benefits Program
                                           (FEHBP) Family Standard Coverage
FEHBP Individual High Cvg                  Federal Employees Health Benefits Program
                                           (FEHBP) Individual High Coverage
FEHBP Individual Standard Cvg              Federal Employees Health Benefits Program
                                           (FEHBP) Individual Standard Coverage
Fort Carson- CAM Program (history)         Fort Carson - Catchment Area Management
                                           (CAM) Program (history)
Fort Sill - CAM Program (history)          Fort Sill - Catchment Area Management (CAM)
                                           Program (history)
Luke/Williams AFB - CAM Program            Luke/Williams Air Force base (AFB) - Catchment
(history)                                  Area Management (CAM) Program (history)
Pharmacy Redesign Pilot (PRPP)             Pharmacy Redesign Pilot Project (PRPP)
Prime Family Cvg for ADFM                  TRICARE Prime Family Coverage for Active
                                           Duty Family Members
Prime Family Cvg for NAD and Medal of      TRICARE Prime Family Coverage for Retired
Honor                                      and Medal of Honor Sponsors and Family
                                           Members
Prime Family Cvg for Survivors of ADSM     TRICARE Prime Family Coverage for Survivors
                                           of Active Duty Deceased Sponsors
Prime Family Cvg for Survivors of GRDS     TRICARE Prime Family Coverage for Survivors
                                           of Guard/Reserve Deceased Sponsors
Prime Family Cvg for TAMP                  TRICARE Prime Family Coverage for
Sponsor/Family                             Transitional Assistance Sponsors and Family
                                           Members



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Prime Family Cvg for Transitional        TRICARE Prime Family Coverage for
Survivors of ADSM                        Transitional Survivors of Active Duty Deceased
                                         Sponsors
Prime Family Cvg for Transitional        TRICARE Prime Family Coverage for
Survivors of GRDS                        Transitional Survivors of Guard/Reserve
                                         Deceased Sponsors
Prime Individual Cvg for ADFM            TRICARE Prime Individual Coverage for Active
                                         Duty Family Members
Prime Individual Cvg for ADSM            TRICARE Prime Individual Coverage for Active
                                         Duty Sponsors
Prime Individual Cvg for NAD and Medal   TRICARE Prime Individual Coverage for Retired
of Honor                                 and Medal of Honor Sponsors and Family
                                         Members
Prime Individual Cvg for Survivors of    TRICARE Prime for Individual Coverage for
ADSM                                     Survivors of Active Duty Deceased Sponsors
Prime Individual Cvg for Survivors of    TRICARE Prime Individual Coverage for
GRDS                                     Survivors of Guard/Reserve Deceased Sponsors
Prime Individual Cvg for TAMP            TRICARE Prime Individual Coverage for
Sponsor/Family                           Transitional Assistance Sponsors and Family
                                         Members
Prime Individual Cvg for Transitional    TRICARE Prime Individual Coverage for
Survivors of ADSM                        Transitional Survivors of Active Duty Deceased
                                         Sponsors
Prime Individual Cvg for Transitional    TRICARE Prime Individual Coverage for
Survivors of GRDS                        Transitional Survivors of Guard/Reserve
                                         Deceased Sponsors
TPR Family Cvg for ADFMs                 TRICARE Remote Family Coverage for Active
                                         Duty Family Members
TPR Individual Cvg for ADFMs             TRICARE Remote Individual Coverage for
                                         Active Duty Family Members
TPR Individual Cvg for ADSMs             TRICARE Remote Individual Coverage for
                                         Active Duty Sponsors
TRICARE Senior Prime                     TRICARE Senior Prime Individual Coverage for
                                         Retired Sponsors and Family Members
TRICARE Senior Supplement                TRICARE Senior Supplement
Demonstration
USFHP DC Cvg for ADFM                    TRICARE USFHP Direct Care Coverage for
                                         Active Duty Family Members
USFHP DC Family Coverage for Survivors   TRICARE USFHP Direct Care Family Coverage
of ADDS                                  for Survivors of Active Duty Deceased Sponsors



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USFHP DC Family Cvg for NAD                TRICARE USFHP Direct Care Family Coverage
                                           for Retired Sponsors and Family Members
USFHP DC Family Cvg for Survivors of       TRICARE USFHP Direct Care Family Coverage
GRDS                                       for Survivors of Guard/Reserve Deceased
                                           Sponsors
USFHP DC for Transitional Survivors of     TRICARE USFHP Direct Care Coverage for
ADDS                                       Transitional Survivors of Active Duty Deceased
                                           Sponsors
USFHP DC Individual Coverage for           TRICARE USFHP Direct Care Individual
Survivors of ADDS                          Coverage for Survivors of Active Duty Deceased
                                           Sponsors
USFHP DC Individual Cvg for NAD            TRICARE USFHP Direct Care Individual
                                           Coverage for Retired Sponsors and Family
                                           Members
USFHP DC Individual Cvg for Survivors of   TRICARE USFHP Direct Care Individual
GRDS                                       Coverage for Survivors of Guard/Reserve
                                           Deceased Sponsors
TRS Individual Coverage Tier 1             Reserve Select Tier 1 member only coverage
                                           (contingency ops)
TRS Family Coverage Tier 1                 Reserve Select Tier 1 member and family
                                           coverage (contingency ops)
TRS Individual Survivor Continuing         Reserve Select Tier 1 survivor continuing with
Coverage Tier 1                            individual coverage
TRS Family Survivor Continuing Coverage    Reserve Select Tier 1 survivor continuing with
Tier 1                                     family coverage
TRS Individual Survivor New Coverage       Reserve Select Tier 1survivor new individual
Tier 1                                     coverage
TRS Family Survivor New Coverage Tier 1    Reserve Select Tier 1 survivor new family
                                           coverage
TRS Individual Coverage Tier 2             Reserve Select Tier 2 member only coverage
                                           (certified qualifications)
TRS Family Coverage Tier 2                 Reserve Select Tier 2 member and family
                                           coverage (certified qualifications)
TRS Individual Coverage Tier 3             Reserve Select Tier 3 member only coverage
                                           (service agreement)
TRS Family Coverage Tier 3                 Reserve Select Tier 3 member and family
                                           coverage (service agreement)




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Appendix C – Foreign Countries and Codes

(Sorted alphabetically by full country name.)


                                            Country   Abbreviation
              Afghanistan                                 AF
              Albania                                     AL
              Algeria                                     DZ
              American Samoa                              AS
              Andorra                                     AD
              Angola                                      AO
              Anguilla                                    AI
              Antarctica                                  AQ
              Antigua And Barbuda                         AG
              Argentina                                   AR
              Armenia                                     AM
              Aruba                                       AW
              Ascension                                   SH
              Ashmore and Cartier Islands                 N/A
              Australia                                   AU
              Austria                                     AT
              Azerbaijan                                  AZ
              Bahamas, The                                BS
              Bahrain                                     BH
              Bangladesh                                  BD
              Barbados                                    BB
              Bassas Da India                             N/A
              Belarus                                     BY
              Belgium                                     BE
              Belize                                      BZ
              Benin                                       BJ
              Bermuda                                     BM
              Bhutan                                      BT



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                                               Country   Abbreviation
              Bolivia                                        BO
              Bosnia And Herzegovina                         BA
              Botswana                                       BW
              Bouvet Island                                  BV
              Brazil                                         BR
              British Indian Ocean Territory                 IO
              British Virgin Islands                         VG
              Brunei                                         BN
              Bulgaria                                       BG
              Burkina Faso                                   BF
              Burma (Myanmar)                                MM
              Burundi                                        BI
              Cambodia                                       KH
              Cameroon                                       CM
              Canada                                         CA
              Cape Verde                                     CV
              Cayman Islands                                 KY
              Central African Republic                       CF
              Chad                                           TD
              Chile                                          CL
              China                                          CN
              Christmas Island                               CX
              Clipperton Island                              N/A
              Cocos (Keeling) Islands                        CC
              Colombia                                       CO
              Comoros                                        KM
              Congo, Dem. Rep. Of                            CD
              Congo, Rep Of                                  CG
              Cook Islands                                   CK
              Coral Sea Islands                              N/A
              Costa Rica                                     CR
              Cote D' Ivoire                                 CI
              Croatia                                        HR


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                                          Country   Abbreviation
              Cuba                                      CU
              Cyprus                                    CY
              Czech Republic                            CZ
              Denmark                                   DK
              Djibouti                                  DJ
              Dominica                                  DM
              Dominican Republic                        DO
              East Timor                                TL
              Ecuador                                   EC
              Egypt                                     EG
              El Salvador                               SV
              Equatorial Guinea                         GQ
              Eritrea                                   ER
              Estonia                                   EE
              Ethiopia                                  ET
              Europa Island                             N/A
              Falkland Islands                          FK
              Faroe Islands                             FO
              Fiji                                       FJ
              Finland                                    FI
              France                                    FR
              French Guiana                             GF
              French Polynesia                          PF
              French Southern And Antarctic Lands       TF
              Gabon                                     GA
              Gambia, The                               GM
              Gaza Strip
              Georgia                                   GE
              Germany                                   DE
              Ghana                                     GH
              Gibraltar                                 GI
              Glorioso Islands                          N/A
              Greece                                    GR


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                                          Country   Abbreviation
              Greenland                                 GL
              Grenada                                   GD
              Guadeloupe                                GP
              Guam                                      GU
              Guatemala                                 GT
              Guernsey                                  N/A
              Guinea                                    GN
              Guinea-Bissau                             GW
              Guyana                                    GY
              Haiti                                     HT
              Heard Island And Mcdonald Islands         HM
              Holy See (Vatican City)                   VA
              Honduras                                  HN
              Hong Kong                                 HK
              Howland Island                            N/A
              Hungary                                   HU
              Iceland                                    IS
              India                                     IN
              Indonesia                                 ID
              Iran                                      IR
              Iraq                                      IQ
              Ireland                                    IE
              Isle Of Man                               N/A
              Israel                                     IL
              Italy                                      IT
              Jamaica                                   JM
              Jan Mayen                                 N/A
              Japan                                      JP
              Jarvis Island                             N/A
              Jersey                                    N/A
              Johnston Atoll                            N/A
              Jordan                                    JO
              Juan De Nova Island                       N/A


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                                           Country     Abbreviation
              Kazakhstan                                   KZ
              Kenya                                        KE
              Kingman Reef                                 N/A
              Kiribati                                     KI
              Kuwait                                       KW
              Kyrgyzstan                                   KG
              Laos                                         LA
              Latvia                                       LV
              Lebanon                                      LB
              Lesotho                                      LS
              Liberia                                      LR
              Libya                                        LY
              Liechtenstein                                 LI
              Lithuania                                    LT
              Luxembourg                                   LU
              Macau                                        MO
              Macedonia, Former Yugoslav Republic Of       MK
              Madagascar                                   MG
              Malawi                                       MW
              Malaysia                                     MY
              Maldives                                     MV
              Mali                                         ML
              Malta                                        MT
              Marshall Islands                             MH
              Martinique                                   MQ
              Mauritania                                   MR
              Mauritius                                    MU
              Mayotte                                      YT
              Mexico                                       MX
              Micronesia, Federated States Of              FM
              Midway Island                                N/A
              Moldova                                      MD
              Monaco                                       MC


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                                         Country   Abbreviation
              Mongolia                                 MN
              Montserrat                               MS
              Morocco                                  MA
              Mozambique                               MZ
              Namibia                                  NA
              Nauru                                    NR
              Nepal                                    NP
              Netherlands                              NL
              Netherlands Antilles                     AN
              New Caledonia                            NC
              New Zealand                              NZ
              Nicaragua                                NI
              Niger                                    NE
              Nigeria                                  NG
              Niue                                     NU
              Norfolk Island                           NF
              North Korea                              KP
              Northern Mariana Islands                 MP
              Norway                                   NO
              Oman                                     OM
              Pakistan                                 PK
              Palau                                    PW
              Palmyra Atoll                            N/A
              Panama                                   PA
              Papua New Guinea                         PG
              Paracel Islands                          N/A
              Paraguay                                 PY
              Peru                                     PE
              Philippines                              PH
              Pitcairn Island                          PN
              Poland                                   PL
              Portugal                                 PT
              Puerto Rico                              PR


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                                          Country            Abbreviation
              Qatar                                              QA
              Reunion                                            RE
              Romania                                            RO
              Russia                                             RU
              Rwanda                                             RW
              Saint Helena                                       SH
              Saint Kitts And Nevis                              KN
              Saint Lucia                                        LC
              Saint Pierre And Miquelon                          PM
              Saint Vincent And The Grenadines                   VC
              Samoa                                              WS
              San Marino                                         SM
              Sao Tome And Principe                              ST
              Saudi Arabia                                       SA
              Senegal                                            SN
              Serbia And Montenegro                              N/A
              Seychelles                                         SC
              Sierra Leone                                       SL
              Singapore                                          SG
              Slovakia                                           SK
              Slovenia                                            SI
              Solomon Islands                                    SB
              Somalia                                            SO
              South Africa                                       ZA
              South Georgia And The South Sandwich Islands       GS
              South Korea                                        KR
              Spain                                              ES
              Spratly Islands                                    N/A
              Sri Lanka                                          LK
              Sudan                                              SD
              Suriname                                           SR
              Svalbard                                            SJ
              Swaziland                                          SZ


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                                             Country   Abbreviation
              Sweden                                       SE
              Switzerland                                  CH
              Syria                                        SY
              Taiwan                                       TW
              Tajikistan                                   TJ
              Tanzania                                     TZ
              Thailand                                     TH
              Togo                                         TG
              Tokelau                                      TK
              Tonga                                        TO
              Trinidad And Tobago                          TT
              Tromelin Island                              N/A
              Tunisia                                      TN
              Turkey                                       TR
              Turkmenistan                                 TM
              Turks And Caicos Islands                     TC
              Tuvalu                                       TV
              Uganda                                       UG
              Ukraine                                      UA
              United Arab Emirates                         AE
              United Kingdom                               GB
              United States                                US
              United States Virgin Islands                 VI
              Uruguay                                      UY
              Uzbekistan                                   UZ
              Vanuatu                                      VU
              Venezuela                                    VE
              Vietnam                                      VN
              Wake Island                                  N/A
              Wallis And Futuna                            WF
              West Bank                                    PS
              Western Sahara                               EH
              Yemen                                        YE


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                                   Country   Abbreviation
              Zambia                             ZM
              Zimbabwe                           ZW




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Appendix D - DOES Shortcut / “Hot Key” List

Commands on the menu, tabs of an information view, command buttons, and other tools often include an
underlined letter in their label. The underlined letter is called a shortcut key (also referred to as a hot key).
By holding down the ALT key and pressing the Shortcut key, the user can move directly to the
corresponding tool.
For example, to open the file menu on the menu bar below, hold down the ALT key and press the letter
'F'; for the Enrollment menu, ALT+E; for the Update options, ALT+U and so forth.



The list below will not contain all the ―ALT+?‖ Hot Key functions since a letter may have
numerous uses in DOES depending on the menu the user is in.
Shortcut              Function
ALT+F4                Closes the application in use.
                      Displays the programs that are currently open. Hold down the ALT key and continue
ALT+TAB
                      to press the TAB key to select one of the open programs.
CTRL+A:               The Address Update screen appears.
CTRL+D:               The Disenrollment screen appears.
                      The Address Update screen appears to perform a new enrollment of a family
CTRL+E:
                      member.
                      The Inquire National Enrollment Database dialog box appears which provides the
CTRL+F:
                      opportunity to open a new family.
CTRL+G:               The PCM Modifications screen appears.
CTRL+I:               The PCM Assign/Change screen appears.
CTRL+L:               The PCM Cancellation screen appears.
CTRL+M:               The Modifications screen appears.
CTRL+N:               The Notifications dialog box appears.
CTRL+P:               Changes the current screen to the Policy Details tab.
CTRL+Q:               Exits the application.
CTRL+R:               The Cancel Events Screen appears.
CTRL+S:               The Card Request Dialog Box appears.
CTRL+T:               The Transfer screen appears
CTRL+U:               The Enrollment Attribute Updates screen appears
CTRL+V:               Switches from the current tab to the Person Details Tab.
CTRL+ESC              Windows Start Button



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Shortcut            Function
WIN key             Displays the options from the Windows Start menu.
F1                  Displays the DOES Help file.
F2                  Displays the DOES Help Topics Index tab.
F4                  If the user‘s focus is on a combo box, it will force it to drop down.
F11                 The DOES 3.0 box appears.
ESC                 Displays the Enrollment main screen.




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Appendix E - Summary of Key DOES Business Rules

The table starting on this page is a summary of the DOES business rules as outlined in the TRICARE System Manual – Chapter 3, Appendix D.
The table is divided by business event and within each event the major business rules which govern the event. The rules are current as of March
2004.
Event                              Rule
Eligibility for Enrollment         Eligibility for Enrollment inquiries will show the current health care program information for the inquiry date.
Inquiry
                                   If an enrollment exists in the last 12 months, enrollment information will be returned in the Eligibility for
                                   Enrollment Inquiry response.
                                   PCM information (if applicable) will be displayed for the past 12 months.
                                   If the beneficiary is eligible to enroll in other coverage plans for the HCDP requested, DEERS will return all
                                   appropriate coverage plans and dates of eligibility.
Enrollment Into Health Benefit     Length of enrollment is indefinite or less (based on eligibility).
Program
                                   A person cannot be enrolled in multiple coverage plans during the same time period.
                                   Until policies are consolidated across contracts, a family cannot have multiple coverage policies of the same plan
                                   type with the same contractor during the same time period.
                                   Once policies are consolidated across contracts, a family cannot have multiple coverage policies of the same plan
                                   type during the same time period.
                                   Enrollment fee payments may be waived. DEERS will allow this information to be communicated through the
                                   HCDP Individual Enrollment Fee Waiver Reason Code.
                                   MCSC/USFHP providers should use the Enrollment Fee Payment Exception Reason Code to indicate the reason
                                   an enrollment fee payment is less than expected.
                                   A beneficiary can only enroll in a plan for which he/she is eligible (based upon the DEERS response to Eligibility
                                   for Enrollment Inquiry).
                                   DEERS will validate that the enrollee lives within the enrolling organization's jurisdiction. If the enrollee's zip
                                   code is outside jurisdiction (as determined on the Service Area File), DOES will provide a warning message but
                                   will allow the enrollment.


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Event                              Rule
                                   DEERS will validate that the PCM Region Code falls within the enrolling organization's contractor code.
                                   The policy enrollment period begin date is set based on the first person enrolled in the coverage plan and is equal
                                   to that person's enrollment begin date.
                                   Enrollment fees and Other Health Insurance may be added to DEERS at the time of enrollment.
                                   Person must not be enrolled in any other managed care programs established or operated under the auspices of the
                                   DoD.
                                   Enrollment in the CHCBP program cannot extend beyond 36 months (except in the case of an unremarried
                                   former spouse).
Disenrollment                      DOES will display all active enrollments in the family for the user to select appropriate beneficiaries to disenroll.
                                   DEERS will set the PCM Selection End Calendar Date based on the EMC Enrollment End Calendar Date.
                                   DEERS will set the PCM Selection End Reason Code based on the EMC Enrollment End Reason Code.
                                   DEERS will revert coverage to the DEERS assigned health coverage plan starting the day following the
                                   disenrollment if the beneficiary is still eligible for coverage.
                                   Disenrollments can only be performed on the latest active enrollment.
                                   A disenrollment is done for an individual.
                                   If an Active Duty sponsor loses eligibility, DEERS will disenroll all family members.
                                   DEERS will send disenrollment notifications to all enrollment management and PCM enrolling divisions systems
                                   as necessary.
                                   If an Active Duty sponsor dies, DEERS will automatically disenroll all family members from the Active Duty
                                   plan and enroll them in a Transitional Survivor plan for three years (or less depending on eligibility) following
                                   the date of death. If the family member was enrolled in TPR with no PCM, DEERS will not re-enroll into the
                                   Transitional Survivor plan, it is the responsibility of the MCSC to do so.
                                   If a retired sponsor dies, family members will not be disenrolled from their coverage plan.
                                   When enrollees with a USFHP PCM lose eligibility for TRICARE Prime due to reaching age 65, DEERS will
                                   automatically disenroll them from Prime and enroll them in the appropriate TRICARE USFHP Direct Care
                                   coverage plan.
                                   If a Parent/Parent-in-Law disenrolls from the program, he or she will not be eligible to re-enroll at any time.


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Event                              Rule
Modification of Enrollment         The user may reinstate the previous PCM or replace the current PCM with a new one.
(PCM Cancellation and
                                   If there is only one PCM for the enrollment, thus no PCM to reinstate, a PCM cancellation will not be allowed,
Transfer Cancellation)
                                   the user must cancel the enrollment.
                                   The instance of the PCM selection being cancelled will be removed and will not be displayed by DEERS in
                                   subsequent transactions.
                                   DEERS will send policy change notifications to all systems participating in the management of the enrollment.
                                   Only the current MCSC/USFHP Provider managing the enrollment can update PCM information; only the
                                   MCSC/USFHP Provider that performed the transfer may cancel it.
                                   The PCM or transfer effective date cannot be more than 60 days in the past.
Modification of Enrollment         A transfer of enrollment is done for each family member being transferred.
(Transfer)
                                   When an enrollee relocates to another contractor's region, the transfer is done by the gaining contractor.
                                   DEERS will validate that the enrollee lives within the enrolling organization's jurisdiction. If the enrollee's zip
                                   code is outside jurisdiction (as determined on the Service Area File), DOES will provide a warning message but
                                   will allow the transfer.
                                   If there are current and future enrollments for the person being transferred, the future segment must first be
                                   cancelled by the MCSC/USFHP Provider managing that future enrollment.
                                   DEERS will check that enrollment fees for the previous policy, if applicable, have been paid to date. If fees are
                                   not current, DOES will provide the user with a warning, but will allow the transfer.
                                   Enrollment fees and OHI may be added to DEERS at the time of transfer. Refer to the Online Enrollment Fee
                                   Payment and OHI Addition Business Rules for more details.
                                   DEERS will send policy change notifications to all systems participating in the management of the enrollment.
                                   Parents/Parents-in-Law are no longer eligible to enroll. However, if they are already enrolled, their enrollments
                                   can be modified but the PCM selection must remain within the USFHP network.
                                   DEERS will set the EMC Enrollment End Calendar Date and the PCM Selection End Calendar Date for the
                                   losing organization, and the EMC Enrollment Begin Calendar Date and PCM Selection Begin Calendar Date for
                                   the gaining organization based on the transfer effective date.
Modification of Enrollment         An enrollment cannot extend past eligibility.



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Event                              Rule
(Enrollment Period Change)         DEERS will send enrollment change notifications to all systems participating in the management of the
                                   enrollment.
                                   DEERS will ensure enrollment periods do not overlap.
                                   DEERS will only allow modification of a begin date to the latest current or future enrollment if it began within
                                   the past 289 days. DEERS will allow modification to the last terminated enrollment's end date if the current end
                                   date is within the past 289 days and there is no later enrollment.
                                   Only the entity that managed the enrollment may change the enrollment end date and the change must be made
                                   within 289 days of the disenrollment date. The end date can be changed to an earlier date that does not fall into an
                                   earlier PCM segment with a different DMIS ID than the last PCM and is not more than 289 days in the past of the
                                   current date. The end date may be changed to a later date within eligibility that does not overlap a later
                                   enrollment and is not more than 90 days in the future of the current date.
                                   If there has been a change of coverage plan within the HCDP (e.g. change from Prime to Plus) and the begin date
                                   of the later enrollment is modified, the end date of the previous enrollment will be modified accordingly to
                                   provide continuous enrollment.
                                   Only the entity that created the enrollment may change the enrollment begin date. The begin date can be changed
                                   to an earlier date that does not overlap another enrollment and is not more than 289 days from the current date.
                                   The begin date can be changed to a later date that is not more than 90 days in the future of the current begin date
                                   and there is not a later PCM segment with a different DMIS ID than the first PCM.
                                   DEERS will notify all systems participating in the management of the enrollment as necessary.
                                   DOES will update the policy enrollment period for a family based on the new enrollment dates. DOES will honor
                                   differences in an individual's enrollment begin date. Family members may have different enrollment end dates
                                   based on length of eligibility.
Modification of Enrollment         The system identifier must be the system who managed the enrollment.
(Enrollment End Reason Code
                                   The EER Code may only be changed within the 60 days following the disenrollment date and only if it is the
Change)
                                   latest enrollment.
                                   EER Codes set by DEERS cannot be changed.
Modification of Enrollment         The instance of the enrollment or disenrollment (including PCM information) will be removed and will not be
(Enrollment/Disenrollment          displayed by DEERS in subsequent transactions.
Cancellation)
                                   Any fee payment adjustments should be made prior to canceling the last enrollment in a policy. Once all


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Event                              Rule
                                   enrollments have been cancelled, fee information will be inaccessible.
                                   For disenrollment cancellations, DEERS will reinstate the enrollment, including fee information, as it existed
                                   prior to the disenrollment.
                                   DEERS will adjust policy dates for the family as necessary.
                                   DEERS will send policy change notifications to all systems participating in the management of the enrollment
                                   For enrollment and disenrollment cancellations, the system identifier must be the current MCSC/USFHP Provider
                                   managing this enrollment. If there has been a transfer of enrollment, the gaining contractor may only cancel the
                                   transfer, not the enrollment.
                                   When an enrollment is cancelled, DOES will reinstate the previous enrollment if it ended due to a change in
                                   coverage plans within the same HCDP (e.g. changed enrollment from Prime to Plus).
                                   An enrollment cannot be cancelled if there is more than one PCM segment with a different DMIS ID than the first
                                   PCM segment.
Online Enrollment Fee Payment      This transaction is used for making enrollment fee payments and adjustments, and for disenrollment requests for
                                   failure to pay fees.
                                   DEERS will accumulate individual enrollment fee payments for each policy enrollment period at the policy level.
                                   Partial or non-payment of enrollment fees will be accepted by DEERS and should be communicated through the
                                   HCDP Enrollment Fee Payment Exception Reason Code.
                                   Fee payments may be made for the last two policies that are previous, current or future.
                                   The system identifier is obtained by DEERS from the message header and is used to track the system that sent the
                                   enrollment fee payment notification.
                                   DEERS only accepts fee payments (or adjustments) and disenrollment requests for policies that require fees.
                                   DEERS will not allow a disenrollment for "Failure to Pay Fees" if enrollment fees are current for the policy or if
                                   the person is waived from paying fees.
                                   MCSCs/USFHP must correct and resubmit to DEERS any fee transaction that has resulted in a warning or
                                   rejection.
Batch Enrollment Fee Payment       DEERS will accumulate individual enrollment fee payments for each policy enrollment period at the policy level.
                                   Partial or non-payment of enrollment fees will be accepted by DEERS and should be communicated through the


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Event                              Rule
                                   HCDP Enrollment Fee Payment Exception Reason Code.
                                   The system identifier is obtained by DEERS from the message header and is used to track the system that sent the
                                   enrollment fee payment notification.
                                   DEERS only accepts fee payments (or adjustments) and disenrollment requests for policies that require fees.
                                   DEERS will not allow a disenrollment for "Failure to Pay Fees" if enrollment fees are current for the policy or if
                                   the person is waived from paying fees.
Enrollment Fee Waiver Update       There are no dates associated with the waiver; it can be set or removed as necessary and no history is kept on the
for an Individual                  setting of this field.
Beneficiary Update                 When an enrollee's address is updated in DOES, a policy notification will be sent to the MCSC managing the
                                   enrollment, and a notification will be sent to the appropriate CHCS host site (if any).
                                   The Mailing Address Maintenance source code will indicate whether the address was last updated by an MCSC, a
                                   USFHP Provider, CHCS, or a military personnel update.
Partial Match Inquiry              If a coverage inquiry for claims is requested for a family member, both sponsor and family member person
                                   information is returned. If there is a duplicate on the sponsor SSN, this information will repeat.
                                   This information will repeat if dual eligibility exists.
                                   If there is a duplicate on the family member identification, this information will repeat. If a person has more than
                                   one address, this information will repeat.
OHI Policy Addition                OHI identifies non-DoD health insurance. OHI transactions allow adding, updating, canceling, deactivating, or
                                   viewing all OHI information. OHI additions can accompany enrollments or be performed alone.
                                   OHI information can be added or updated on DEERS through multiple mechanisms. At the time of enrollment
                                   the MCSC will determine the existence of OHI. The MCSC can add or update OHI through the DOES
                                   application used by the MCSC to enter enrollments into DEERS. Other MHS systems can add or update the OHI
                                   through the Web application provided by DEERS. The presence of an OHI Policy discovered during routine
                                   claims processing shall be updated on DEERS within two business days of receipt of the required information.
                                   All messages sent to DEERS will receive an acknowledgement accepting or rejecting the add/update.
OHI Policy Update                  OHI policies and coverage can be updated (U) or cancelled (C) by using the
                                   OHI Action Code.
                                   OHI updates can accompany enrollments or be performed alone.


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Event                              Rule
                                   Data exchanged between DEERS and external clients for OHI will contain full image OHI data, except for
                                   enrollment requests through DOES, which will contain base information for OHI.
OHI Policy Cancellation            OHI policies and coverage can be cancelled by using the OHI Action Code.
                                   All data exchanged between DEERS and external clients for OHI will contain full image OHI data.
SIT Addition                       The HIC table is maintained in DEERS by the DoD VPOC.
                                   A copy of HIC table is maintained locally by user sites.
                                   There are several actions that can be taken:
                                   Adding a new HIC and associated coverage(s).
                                   Adding HIC Coverage(s) to an existing HIC.
                                   New carrier and coverage additions are validated by the DoD VPOC.
                                   Submission of all carrier information in the add transaction will assist the rapid validation of the HIC table by the
                                   DoD VPOC.
                                   Reference the data dictionary for current code values.
SIT Update                         The HIC table is maintained in DEERS by the DoD VPOC.
                                   A copy of HIC table is maintained locally by user sites.
                                   There are several actions that can be taken:
                                   An update of Health Insurance Carrier information.
                                   An update of HIC Coverage information.
                                   Deactivation of a HIC.
                                   Cancellation of a HIC addition that has not been validated by the DoD VPOC.
                                   All carrier and coverage updates and carrier deactivatation are validated by the DoD VPOC.
                                   Submission of all carrier information in the update transaction will assist the rapid validation of the SIT by the
                                   DoD VPOC.
SIT Cancellation                   The HIC table is maintained in DEERS by the DoD VPOC.
                                   A copy of HIC table is maintained locally by user sites.


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Event                              Rule
                                   There are several actions that can be taken:
                                   Cancel a HIC.
                                   Cancel HIC Coverage.
                                   Users can cancel Add transactions that have not been validated by the DoD VPOC. Users can not
                                   cancel update transactions to existing Carriers.
                                   When canceling an Add transaction, all data must be provided.
                                   If a Carrier is cancelled, all subordinate coverages are cancelled.
                                   If the HIC ID, HIC Coverage Type Code, and HIC Coverage Payer Type Code do not match against an existing
                                   HIC record and the HIC Action Code is C, an error message is returned.
CMS File                           Monthly feed from DEERS to the TRICARE dual-eligible fiscal intermediary contractor to pass Medicare data.
                                   The MCSC should match internally in their system on this field for person identification information.
SIT Subscription                   Local holders of the SIT will receive an initial load. After the initial load, local holders are expected to subscribe
                                   to changes to the SIT, at a minimum, on a daily basis.
                                   Reference the data dictionary for current code values.




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Appendix F – DOES Application Error Codes and Solutions

Return codes specific to New-Medical Knowledge Base (KB) for return status code of 4 common in
DOES. The errors are listed by number.


    Code Description (Error                     Explanation                            Solution
          Number)

                            Application Errors Due to Malformed Transactions
Cannot update Medical data:            Notification to/from DEERS          After 5 minutes. Go to pending
notification pending (00302)           pending on selected record so       transactions and re-send.
                                       DEERS is unable to update the
                                       data. Attempt re-send in 5
                                       minutes.


No notification created on updated     After record sent to DEERS.         Report issue to DEERS Support
Medical data (00303)                   DEERS did not process a             Center who will begin
                                       notification to CHCS or MCSC.       investigation using the affected
                                                                           DEERS Fam_ID or SSN.

Enrollment starting too close to end   If a beneficiary enrollment for a   Choose a different HCDP with an
of program (00304)                     HCDP is sent and the enrollment     end date further in the future.
                                       start date is within 60 days of
                                       HCDP_end_date the user will
                                       receive a message.


Unknown HCDP Plan Coverage             Upon send to DEERS the HCDP         Internal System Error. Contact
Code or incorrect dates (00305)        plan code selected was either       DEERS Support Center to begin
                                       removed from the HCDP_PLN           research.
                                       table, or the HCDP Begin/End
                                       Date was incongruous with the
                                       plan code.
No Policy Enrollment Period for        For enrollment fee payment          Internal System Error. Contact
Fee Payment (00309)                    begin date and payment through      DEERS Support Center to begin
                                       date sent, there was no             research.
                                       corresponding policy or
                                       enrollment period.
Cannot update Medical data:            Beneficiary record locked during    Cancel action or make action
beneficiary locked (00310)             a concurrent or previous action     pending and re-send once 24 hour
                                       and lock not lifted yet.            lock is lifted.


Incorrect Enrollment End Reason        See Error Message                   Internal System Error. Contact


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    Code Description (Error                      Explanation                           Solution
          Number)

Code for transfer (00316)                                                   DEERS Support Center to begin
                                                                            research.
Non-contiguous HCDP_EMCs               Cannot be a break in enrollment      Internal System Error. Contact
under same HCDP (00317)                if the policy is under the same      DEERS Support Center to begin
                                       HCDP.                                research.
Adjacent HCDP_EMCs under same          Until policies are consolidated      Internal System Error. Contact
contractor and HCDP (00318)            across contracts, a family cannot    DEERS Support Center to begin
                                       have multiple enrollments of the     research.
                                       same plan type with the same
                                       contractor during the same time
                                       period.
Incorrect End Reason Code for that     See Error Message                    Internal System Error. Contact
plan (00319)                                                                DEERS Support Center to begin
                                                                            research
Policy or enrollment starting before   The enrollment or policy has a       Internal System Error. Contact
plan does (00325)                      begin date < the plan begin date     DEERS Support Center to begin
                                                                            research
Policy or enrollment ending after                                           Internal System Error. Contact
plan does (00326)                                                           DEERS Support Center to begin
                                       Enrollment or Policy is ending
                                                                            research
                                       after the hcdp_pln_end_dt
Policy lasting too many months for     For Plan Coverage Code, the          Internal System Error. Contact
that plan (00327)                      End Date is more than 12 months      DEERS Support Center to begin
                                       from Begin Date.                     research
Policy incompatible with Family        Enrollee/Plan type incongruence.     Internal System Error. Contact
Plan Code (00328)                                                           DEERS Support Center to begin
                                                                            research
PCM Selection invalid for that plan    Provider selection of Direct Care,   Internal System Error. Contact
(00330)                                Resource Sharing, Civilian or        DEERS Support Center to begin
                                       None is invalid for the plan         research
Enrollment Incompatibility with        If Beneficiary is enrolled in plan   Internal System Error. Contact
Contractor Capability (00331)          not authorized to contractor         DEERS Support Center to begin
                                       (CHCBP, North) for example,          research
                                       error returned.
PCM Error (000332)                     PCM data parameters are              Internal System Error. Contact
                                       incorrect.                           DEERS Support Center to begin
                                                                            research
Enrollment Dates outside of            See Error Message                    Internal System Error. Contact
Eligibility Dates (00502)                                                   DEERS Support Center to begin
                                                                            research
Enrollment Begin Date anterior to      See Error Message                    Internal System Error. Contact
                                                                            DEERS Support Center to begin

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    Code Description (Error                     Explanation                             Solution
          Number)

Eligibility (00503)                                                         research
Enrollment End Date posterior to       See Error Message                    Internal System Error. Contact
Eligibility (00504)                                                         DEERS Support Center to begin
                                                                            research
Update to a non-existing or            See Error Message                    Internal System Error. Contact
terminated Enrollment (00505)                                               DEERS Support Center to begin
                                                                            research
Duplicate or overlapping       See Error Message??                          Internal System Error. Contact
Enrollments (HCDP_EMC) (00506)                                              DEERS Support Center to begin
                                                                            research
Duplicate or overlapping Policies      See Error Message??                  Internal System Error. Contact
(HCDP_PEP) (00510)                                                          DEERS Support Center to begin
                                                                            research
Duplicate or overlapping PCM           See Error Message                    Internal System Error. Contact
Selections (PCM_SLCT) (00512)                                               DEERS Support Center to begin
                                                                            research
Incorrect Enrollment Begin / End       See Error Message                    Internal System Error. Contact
combination (00516)                                                         DEERS Support Center to begin
                                                                            research
Incorrect Policy Begin / End           See Error Message                    Internal System Error. Contact
combination (00517)                                                         DEERS Support Center to begin
                                                                            research
Incorrect PCM Selection Begin /        See Error Message                    Match the begin date with
End combination (00518)                                                     enrollment begin dates
Enrollment not matching HCDP           The beneficiary enrollment           Internal System Error. Contact
dates (00519)                          period (PEP) is outside the          DEERS Support Center to begin
                                       health care delivery program         research
                                       (HCDP) period.


PCM Selection not matching             The selected PCM begin/end           Select a different PCM whose
enrollment dates (00520)               dates are outside the range of the   begin/end date combination are
                                       EMC begin or end dates.              within the EMC begin/end date
                                                                            combination for the beneficiary.

                               Errors Not Common in Application Functionality
Invalid Person/Family Transaction      See Error Message                    Internal System Error. Contact
Type Code (00320)                                                           DEERS Support Center to begin
                                                                            research
Invalid Inquiry Person Identifier      See Error Message                    Internal System Error. Contact
(00321)                                                                     DEERS Support Center to begin
                                                                            research


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    Code Description (Error                  Explanation                           Solution
          Number)

Invalid Inquiry Person Identifier   See Error Message                  Check Person ID Type Code and
Type Code (00322)                                                      re-send to database.
Invalid Sponsor Inquiry Person      User attempted to search on        Check the ID and ID Type for the
Identifier (00324)                  Person ID and ID type not          Sponsor or the requested
                                    available or recognized in         beneficiary and re-send to
                                    DEERS.                             database.
Plan invalid for that type of       Check the compatibility of         Internal System Error. Contact
beneficiary (00329)                 beneficiary (individual, family,   DEERS Support Center to begin
                                    NAD, etc) with Plan (ADSM          research
                                    Prime. TPR, NAD, etc).
Invalid Inquiry Person Type Code    See Error Message                  Internal System Error. Contact
(00335)                                                                DEERS Support Center to begin
                                                                       research
Cannot process update: benefits     See Error Message                  Internal System Error. Contact
aren‘t up-to-date (00500)                                              DEERS Support Center to begin
                                                                       research
Cannot find Direct Care used for    Record is missing the              Internal System Error. Contact
Eligibility (00501)                 HCDP_PLN_CVG_CD which              DEERS Support Center to begin
                                    alerts DEERS to the beneficiary    research
                                    plan coverage within a health
                                    care delivery program.

Incorrect number of Subscribers     See Error Message                  Internal System Error. Contact
(00508)                                                                DEERS Support Center to begin
                                                                       research
Enrollment overlaps several         See Error Message                  Internal System Error. Contact
eligibility segments (00509)                                           DEERS Support Center to begin
                                                                       research
Duplicate or overlapping Programs   See Error Message                  Internal System Error. Contact
(HCDP) (00511)                                                         DEERS Support Center to begin
                                                                       research
Unknown End Reason Code             The enrollment ERC not defined     Internal System Error. Contact
(00513)                             in DEERS Data Dictionary.          DEERS Support Center to begin
                                                                       research
Incorrect End Reason Code / End     See Error Message                  Internal System Error. Contact
Date combination (00514)                                               DEERS Support Center to begin
                                                                       research
Incorrect Program (HCDP) Begin /    See Error Message                  Internal System Error. Contact
End combination (00515)                                                DEERS Support Center to begin
                                                                       research




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