Administration. Figure l-l-a-2 Form to be Used by Contractor to Obtain Information

Transcription

1 Administration Figure l-l-a-2 Form to be Used by Contractor to Obtain Information I I, /name of Demon aivina consent), hereby authorize Iname of Demon, oraanization. or institution) to release to the Department of Defense, TRICARE ManagementActiuity (TMA) or their designee, lname of contmctorl information related to my medical treatment and, if necessary, photocopies of any medical records which may be required for adjudication of my claim for TRICK benefits. This consent will expire from the date shown below; however, I reserve the right to withdraw this authorization at anytime I I Date Signature of person giving consent l.l.a-3 C-139, May 19,1999

2 .:..:::.:..:.,..: :.:.:..:,.. Administration ::I,$:..:., :,,.).,:..:.. :.l...:.:..:. j;); ::::: :,,, :.::.j;.:..;,:,..:.::.:, :..:...i..:.>.; :I:;: :::.,,j. :::, ::.,..::::.:..: :.::.;: ::,,::..j. j:.:.,. ~~~~~~~~~i :..: :... _.:..:.,.. Figure 1-l-A-3 Authorization to Disclose Information I (FORM TO BE USED BY THE CONTRACTORS TO DISCLOSE INFORMATION) I, lname of person oivino consent], hereby authorize TRICARE Management I Activity (TWX) to release to [name of txzrtu information related to whom information is to be disclosed) information related to my medical treatment and, if necessary, photocopies of any medical records which may be required for adjudication of my claim I for TRICARE benefits. This consent will expire from the date shown below: however, 1 reserve the right to withdraw this authorization at any time Date Signature of person giving consent C-l 39, May 19,1999 l.l.a-4

3 Administration Figure 1-l-A-4 Return of Mail Order Pharmacy Prescription Dear TRICARE Beneficiary: Effective (date) the Department of Defense began offering a National Mail Order Pharmacy service to all kcare beneficiaries, regardless of whether they are enrolled in Prime or using Standard or Extra. This National Mail Order Pharmacy service is independent of all other TRICARE benefits and is no longer administered by lnwne of the TRICARE lklanaaed Care Sw~ort Contractor). Effective (date1, we discontinued all Mail Order Pharmacy operations which previously existed in TRICARE Region. Since we no longer provide a Mail Order Pharmacy service, we are returning your prescription to you. You may have the prescription filled by your local TRICARE pharmacy, or by the National Mail Order Pharmacy contractor. The contractor to whom the prescription must be sent for Mail Order Pharmacy service only is: [National Mail Order Pharmacy Contractor Name, Address and Toll-Free Number] Please send all future prescriptions for Mail Order Pharmacy service to the above address. The addresses for all other TRICARE claims and correspondence remain unchanged. If you have questions about the National Mail Order Pharmacy program, you may call the contractor s toll-free number listed above, or call your local TRICARE Service Center. [MCS Contractor Name] l.l.a-5 C-l 39, May 19,1999

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5 I. Records Management Table of Contents GENERAL I. Policy......; l ;.:::;\,)y+/ : ::,,; ::, j ;:,, :,,:,,,,..,...jl:~~l:ji~::::: :..:....:,.:.,. : ~;~~~~~~~~ ;:.::.:..,:.::..:..: >:..::.:::,..::.,.:::.,.:../.. ::.:.:... :.,:...,, :,I::.:!::.,:,::::: :.:,,:,::,::..> ~~~. ~~ :,:, :.)>,_:j::.. :,.::;.,....../..._,.. :::::..:.I: ;j. i., :.::i j :.,.. :..:: : j:.j. :+::.,,... ::...\... :i.:; ;;j:. :..: ::, : :.,2 lili.ii B. Applicability l C. Responsibility l 1. TREARE Management Actiuity (TSL4) l 2. Contractors l D. Definitions E. Availability and Accessibility of Records F. Establishing a Records Management Program G. Recordkeeping Requirements II. H. Records Maintained by Contractors..... l SUBJECT, DESCRIPTION, INDEXING, CATEGORY NUMBER, DISPOSITION AUTHORITY, AND STORAGE LOCATION OF GOVERNMENT RECORDS A. General l 1. Office General Management Files l 2. Record Locator Files Informational Records Files (Non-Record Material) Congressional Correspondence..... I.~.II Recoupment Administrative Files... Files... l Abortion Claim Files X-3 8. Adjusted Claims Beneficiary History and Deductible FiIes Preauthorlzation/Authorization Files TRICARE Contractor Claims Records Mental Health Case Files Provider File Reimbursement Elle Records Third Party Liability Case Records TRICARE Benefit Check Records X Explanation of Benefits Records (EOB) Grievance Case Records Managed Care and Records of Case Management (Medical C are Authorization Files) Appeals and Hearings Case Records - TRICARE Contractor and Subcontractor Files Fraud and Abuse Eiles S Health Care Service Record S Enrollment Files S Accounting Files X-8 B. Machine Readable Records g 1. Master Files g 2. Processing Files g 3. Documentation g i C-139, May 19,lQQQ

6 ;.,. ::..:..;;,..::.,.::..:...,:~.: III. Iv. Records Management Table of Contents J C. Disposition Instructions g MICROFILMING A. General _ I B. Standards., C. Procedures DIGITALIMAGING AND OPTICAL DIGITAL DATA DISK STORAGE Iv-1 A. General Iv-1 B. Standards v-1 C. Procedures Iv-2 D. Transition IV-3 V. E. Legal Admissability Iv-3 TRANSFERRING RECORDS (FEDERAL RECORDS CENTERS AND TRANSITIONS) V- 1 A. Federal Records Centers... I.2.v-1 1. FRC Relations V-1 2. Procedures for Transferring Records to FRC V-2 3. Retrieving Records V-4 B. Other Contractors v-5 VI. C. Requesting Forms v-6 DESTRUCTION OF RECORDS W1 A. Policy vI-1 B. Sale or Salvage of Records ~1-1 C. On-Site Destruction ~1 Addendum A figurc?s A- 1 Figure 1-2-A- 1 Figure 1-2-A-2 Figure l-2-a-3 Figure 1-2-A-4 Figure 1-2-A- 5 Marking and Packing Instructions A- 1 Records Transmittal and Receipt, SF Form A-2 Records Transmittal and Receipt (Continuation) - SF Form 135A A-4 Reference Request - Federal Records Center, OF Form A-5 Arrangement of Boxes on Pallets A-6 C-l 39, May 19,1999 ii

7 - Records Management I. GENERAL A. Policy 1. This chapter implements Department of Defense Administrative Instruction No. 15, Records Management, Administrative Procedures and Records Disposition Schedules (DOD AI 15). DOD AI 15, requires agencies to establish and maintain an active, continuing program for the economical and efficient management of agency records. It establishes procedures for the maintenance and disposition of records, and prescribes records disposition schedules. 2. The TRICARE Management Actiuity (TMA) Records Management Program is designed to preserve records of continuing value, systematically eliminate all other records, and remove less active current records from office areas to lower storage space costs. This ensures preservation of permanent records and reduces the cost and effort of record keeping. To achieve these objectives, standard procedures have been established for the disposition of all TRICARE records. 3. No record of the United States Government is to be alienated or destroyed except in accordance with the provisions of the Federal Records Act and applicable regulations. Unauthorized destruction of records is punishable by fine, imprisonment, or both. B. Applicability The provisions of this chapter apply to all TRICARE contractors. Where contractor is referred to within this chapter, the provisions shall apply, when appropriate, to subcontractors providing services under the contract. C. Responsibility 1. TIUCARE Management Activity (TnzA) TMA is responsible for: a. The development and implementation of standards and policies for the economical management of records for the TRICARE Program. b. Providing effective control over the creation, organization, maintenance, use, and disposition of records including records containing adequate and proper documentation of the contractor s administration and procedures. 2. Contractors Records related to beneficiary health care or claims which are received or developed under the TRICARE contracts are, by contract, the property of the U.S. Government unless specifically excluded. Contractors are required to: a. Establish, within their offices, a records management program to support the requirements outlined in this chapter. b. Institute measures to ensure records of continuing value are preserved and appropriate disposition is made of records no longer of current use C-139, May 19,1999

8 Records Management 1. c.2.c. C. Appoint an individual to perform the records management function in their offices and act in liaison with the TMA Records Management Officer. D. Definitions 1. Case Files. Records, regardless of media, documenting a specific action, event, person, place, project, or other matter. 2. Contractor Records. Data produced and/or maintained by a contractor for a Federal agency and required to provide adequate and proper documentation of that agency s programs and to manage them effectively. 3. Destruction. In records management, the major type of disposal action. Methods of destroying records include selling or salvaging the record medium and burning, pulping, shredding, macerating, or discarding with other waste materials. 4. Disposition Instructions. a. Directions for cutting off records and carrying out their disposition in compliance with National Archives and Records Administration s (NARA) regulations. b. Directions for screening nonrecord materials and carrying out their disposal when no longer needed by the agency. 5. Nonrecord Correspondence. Correspondence which is not included in any of the record categories discussed elsewhere in this chapter and which is of shortterm value such that, after action has been taken, the correspondence has no evidential, administrative, or informational value. This category includes requests for claim forms and informational pamphlets, requests for general benefit and other program information, claim status inquiries and tracer claims which do not result in claim action, and the types of inquiries requiring explanations of general policies and procedures rather than 1 determinations of specific issues. This category does not include congressional or TiUA (priority1 correspondence regardless of the subject matter. Nonrecord correspondence shall be controlled and counted as routine correspondence for workload, aging and cycle time purposes. Nonrecord correspondence shall be cutoff at the end of the month in which the following has been completed: required administrative action, required monthly I correspondence quality control review, and the Monthly Workload and Cycle Time/Aging Reports. The records will be held for one month in the current files area, and then destroyed. 6. Vital Records. (Sometimes called essential records.) Records essential to the continued functioning or reconstitution of an organization during and after an emergency and also those records essential to protecting the rights and interests of that organization and of the individuals directly affected by its activities (includes both emergency-operating and rights-and-interests records). Vital records considerations are part of an agency s records disaster prevention and recovery program. 7. Electronic Records. Records stored in a form that only a computer can process (also called machine-readable records or ADP records). C-l 39, May 19,

9 I.E. Records Management E. Availability and Accessibility of Records 1. TMA, its delegated audit agencies and the Comptroller General of the United States, shall have access to and the right to examine those books, records, documents, and other supporting data which will permit adequate evaluation of the cost or pricing data submitted by the contractor, along with the computations and projections used. The purpose of the examination shall be to verify that cost or pricing data submitted in conjunction with the negotiation of the agreement, including changes, and any fiscal report of settlement is accurate, complete, and current. The right to examination of records shall continue for six 16) years and three (31 months after final payment to the contractor has been made or until such time as the final audit is completed. 2. It is the responsibility of the contractor to ensure that records in its jurisdiction are retrievable within five (51 working days of request by the government. I Adequate management controls and procedures to ensure timely retrieval of federally stored records shall be established. 3. The government s right of access to these records shall not interfere with the contractors ability to maintain an effective records management program. However, the contractors records management program shall make allowance for the government s right of access to records. F. Establishing a Records Management Program The following elements are basic to a records management program. Each contractor shall establish, maintain and assure: 1. A standard classification and filing system achieving maximum uniformity and ease in maintaining and using records and facilitating the locating, chargeout, refiling, and disposing of records. 2. All records are maintained in a current and easily retrievable manner. 3. Formal authorized file locations for active, inactive, and retired files. 4. Standards, guides, and instructions developed for the records management program are documented and accessible to all employees concerned with the records operations. disaster. 5. A vital records program is developed and implemented in case of 6. All records shall be filed within five (5) days after final disposition. 7. An effective quality control system for periodically auditing a representative sampling of the records for duplications, misclassifications, misfiles, etc. G. Recordkeeping Requirements 1. The same records management principles that apply to paper records also apply to records. 2. Contractors shall, at a minimum: C-139, May 19,1999

10 Records Management I.G.2.U.. a. Write and implement contractor instruction on . Instructions at a minimum shall address: what is a record vs. a nonrecord, how the contractor will preserve the data, the names on distribution lists or directories, when to request receipts and how to preserve the receipts, external systems, and circulated drafts. The contractor must minimize the risk of unauthorized additions, deletions, or alterations to records (integrity). b. Assign an individual to be responsible for the maintenance of the recordkeeping system. This individual is also required to annually monitor the use of the system to assure recordkeeping instructions are being followed. C. Train all present users and provide on-going training for any new users on recordkeeping requirements. This training shall include: defining what is a record vs. a nonrecord; how to put records into recordkeeping systems; preserving data; preserving names on distribution lists or directories, when to request receipts and how to preserve the receipts: how to deal with circulated drafts; and external systems. H. Records Maintained by Contractors The records in Section II. shall be maintained by all contractors. In the event of a contract transition, the outgoing contractor shall transfer either a microfilm or imaged copy of the following records for the full retention time required in the Disposition Instructions of this section to an incoming contractor: either supports 1. TRICARE Claims 2. Claims Supporting Documentation (including any documentation that or denies payment of a claim) 3. Adjustment Records 4. Adjustment Supporting Documentation (including any documentation that either supports or denies payment of the adjustment1 5. Checks 6. Explanation of Benefits Forms and Summary Payment Vouchers C-l 39, May 19,