UPDATED_Section_F_-_T2017-02.04.2016.pdf

02.04.2016

F.3. REPORTS AND PLANS

F.3.1.

F.3.1.1. Daily Reports D010 Non-Financially Underwritten Contractor Payment/Check Issue Data D020 Financially Underwritten Contractor Payment/Check Issue Data

F.3.1.2. Weekly Reports W010 Integrated Master Plan (IMP) and Integrated Master Schedule (IMS) Status Report W020 Transition-Out (Phase-Out) Status Report W030 Weekly Claims Processing Statistics Report W040 Deferred Claims Report

F.3.1.3. Monthly Reports M010 Enrollment Plan Implementation Report M020 Customer Satisfaction Report M030 Education Presentation Report M040 Clinical Support Agreement (CSA) Report M050 HIPAA Privacy Complaint Report M060 TRICARE Reserve Select (TRS)/TRICARE Young Adult (TYA)/TRICARE Retired Reserve (TRR) Premium Activity Report M070 Beneficiary Services Report M080 Case Management (CM) and Chronic Care/Disease Management (DM) Report M090 Management Report M100 Medical Management Report M110 Network Adequacy Report (NAR) M120 Network Inadequacy Report M130 Non-Financially Underwritten Accounts Receivable Summary Report (Government) M140 Non-Financially Underwritten Accounts Receivable Summary Report (Non-Government) M150 Non-Financially Underwritten Bank Account Reconciliation Report M160 Non-Financially Underwritten Bank Cleared Payment Data M170 Financially Underwritten Bank Cleared Payment Data M180 Non-Financially Underwritten Bank Account Statement Report M190 Overpayment Cases Against VA Facilities M200 Customer Support Hours Used M210 Access Standards Report M220 Network Adequacy/Access - Referrals to MTF & Network Report M230 Continued Health Care Benefit Program (CHCBP) Adjusted Premiums Report (East Region) M240 Continued Health Care Benefit Program (CHCBP) Enrollment Premium Report (East Region) M250 Continued Health Care Benefit Program (CHCBP) Enrollment Report (East Region) M260 Continued Health Care Benefit Program (CHCBP) Premiums Summary Report (East Region) M270 Continued Health Care Benefit Program (CHCBP) Workload Report (East Region) M280 Right of First Refusal Referrals (ROFR) Report M290 Behavioral Health Un-activated Referrals M300 Comprehensive Autism Care Demonstration Report (M) M310 Employee Access to DoD IS/Networks Report M320 Directed Referrals Report M330 Clinical Quality Management (CQM) Quality Intervention Report M340 Contractor Records Accountability Report M350 ADSM Enrollment Report M360 DHA-GL Deferred Claims Report M370 OHI Discovery and Validation M380 Emergency Room (ER) Outliers Report M390 Preauthorizations/Authorizations and Referral Timeliness/Accuracy M400 Integrated Disability Evaluation System (IDES) Memorandum of Agreement (MOA) Claims Without Authorization M410 Adjudicated Referral/Claims Report

M420 TRICARE Prime Enrollment Fees Wire Transfers Report

F.3.1.4. Quarterly Reports Q010 Retrospective Review for Other than Diagnostic Related Group (DRG) Validation Report Q020 Claims Audit Report Q030 Beneficiary Access Assistance Report Q040 Fraud and Abuse Summary Report Q050 Referrals Received by Specialty Report Q060 Evolving Practices Report Q070 Quality Assessment Report Q080 Capital and Direct Medical Education Update Report (Quarterly) Q090 MTF Level Contingency Exercise Participation Q100 Comprehensive Autism Care Demonstration Report (Q) Q110 Mental Health Counselor Status Report Q120 Beneficiary Satisfaction Survey Report Q130 Predictive Modeling Report Q140 Listing of Prime Service Areas (PSA) Zip Codes Q150 Health System area Assessment Report Q160 TRICARE Quality Monitoring Contract (TQMC) Findings Response Report [Formerly R240]

F.3.1.5. Semiannual Reports SA010 Comprehensive Autism Care Demonstration Report (SA) SA020 Ambulatory Retrospective Review Report SA030 Agency for Healthcare Research and Quality Patient Safety Indicators Report

F.3.1.6. Annual Reports A010 Clinical Quality Management Program (CQMP) Report A020 Indirect Medical Education (IDME) Ratios for Children’s Hospitals Report A030 Third Party Recoveries for Fiscal Year Report A040 State Prevailing Annual Update Report A050 Statement on Standards for Attestation Engagements SSAE No. 16 (Prime) A060 Statement on Standards for Attestation Engagements SSAE No. 16 (Sub-Contractor) A070 Capital and Direct Medical Education Report (Annual) A080 National Institutes of Standards and Technology (NIST) Certification of Compliance Report A090 Disaster Recovery Test Results Report A100 Risk Assessment Letter of Assurance A110 Freedom of Information Act (FOIA) Releasable Contract A120 Memorandum of Understanding (MOU) with (MTF/eMSM Name) A130 Fraud Detection and Prevention Strategy and Internal Procedures A140 MOU with TRICARE Regional Office A150 MOU with (East/West Contractor Name) A160 MOU with (TPharm Contractor Name) A170 MOU with (TDEFIC Contractor Name) A180 MOU with (TOP Contractor Name) A190 MOU with US Coast Guard A191 MOU with (Nurse Advice Line Contractor Name) A192 MOU with (TRICARE Claims Review Services Contractor Name) A193 MOU with (Air Force Medical Service for Referral Management Suite Contractor Name) A194 MOU with (Active Duty Dental Program Contractor Name) A195 MOU with (TRICARE Dental Program Contractor Name) A196 MOU with (TRICARE Retiree Dental Program Contractor Name) A200 Provider Credentialing and Privileging File Audit Report A210 Affordable Care Act Information Reporting for CHCBP Enrollees (East Region)

F.3.1.7. Annual Plans AP010 Enrollment Plan AP020 Medical Management (MM)/Utilization Management (UM) Plan AP030 Clinical Quality Management Program (CQMP) Plan AP040 MTF/eMSM Optimization Support Plan [Formerly titled External Resource Sharing Plan] AP050 Contingency Program Plan AP060 Education Plan AP070 Chronic Care/Disease Management Program Plan AP080 Network Implementation Plan AP090 Continuity of Operation Plan (COOP) AP100 Internal Quality Management/Quality Improvement (QM/QI) Program Plan

F.3.1.8. As Required Plans/Reports R010 Integrated Master Plan (IMP) and Integrated Master Schedule (IMS) R020 Serious Reportable Events (SREs) R030 Accreditation and Certification Reports and Documentation R040 Service Assist Team (SAT) After-Action Report R050 Designated Standards Maintenance Organization (DSMO) Meeting Summary Report R060 DHA/MTF Fraud & Abuse Referral Cover Sheet R070 Fraud/Abuse Patient Harm-Initial Notification Checklist R080 Random Sample Audit Worksheet R090 Standard Operating Procedures (Desk Procedures) R100 Threats Report R110 Breach Report R120 Appeals, Processing Guidelines, Desk Instructions and Reference Materials R130 Purchased Care MTF Prime Enrollment Inpatient Report R140 Right of First Refusal (ROFR) Capability Report R150 Declaration of Transfer and Destruction of Records R160 MOU with DHA Communications R170 TPR Claims Processed to Completion R180 Inpatient Admission Notification Report R190 Special Programming Ad Hoc Reports R200 CHCBP Ad Hoc Reports (East Region) R210 Internal QM/QI Report R220 Systems Integration Test Plans R230 B2B Gateway Questionnaire

F.3.1.9 One Time OT010 Transition-Out (Phase-Out) Plan OT020 Access to Care Plan