16_TCRS_Sec-J__J-6_Clm_Review_Schl.pdf

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TRICARE Claims Review Services
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HT9402-17-R-0002
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Section J Attachment J-6

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Attachment J-6 TCRS Compliance Review Schedule

TCRS HT9402-17-R-0002, Section J, Attachment J-6

TRICARE Claims Review Services (TCRS) Compliance Review Schedule

Option Period (OP) 1 Aug 1, 2017 – Jul 31, 2018

TRICARE

Purchased Care

Contractors (PCC)

Compliance Review Cycle

Estimated Claim

Volume

Estimated Date List of Claims Selected for

Review Issued by DHA

Estimated Date Claims Information from PCC Due to TCRS Contractor

T2017 Managed Care Support Contractors

East Region West Region

Apr-Jun-17 4,800 Jul-17 Aug-17 Jul-Sep-17 4,800 Oct-17 Nov-17 Oct-Dec-17 4,800 Jan-18 Feb-18 Jan-Mar-18 4,800 Apr-18 May-18

TRICARE Dual Eligible Fiscal

Intermediary Contract

(TDEFIC)

Apr-Jun-17 2,200 Jul-17 Aug-17 Jul-Sep-17 2,200 Oct-17 Nov-17 Oct-Dec-17 2,200 Jan-18 Feb-18 Jan-Mar-18 2,200 Apr-18 May-18

TRICARE Overseas Program (TOP)

Jun-Aug 17 1,875 Sep-17 Oct-17 Sep-Nov 17 1,875 Dec-17 Jan-18

Dec-17-Feb-18 1,875 Mar-18 Apr-18 Mar-May 18 1,875 Jun-18 Jul-18

TRICARE Pharmacy Program (TPharm)

May-Jul 17 2,800 Aug-17 Sep-17 Aug-Oct 17 2,800 Nov-17 Dec-17

Nov 17 - Jan 18 2,800 Feb-18 Mar-18 Feb-Apr 18 2,800 May-18 Jun-18

Active Duty Dental Program (ADDP)

Feb-Jul 17 1,250 Sep-17 Oct-17 Aug 17 - Jan 18 1,250 Mar-18 Apr-18

Total Estimated Claim Volume for

OP 1

49,200

Option Period (OP) 2 Aug 1, 2018 – Jul 31, 2019

TRICARE

Purchased Care

Contractors (PCC)

Compliance Review Cycle

Estimated Claim

Volume

Estimated Date List of Claims Selected for

Review Issued by DHA

Estimated Date Claims Information from PCC Due to TCRS Contractor

T2017 Managed Care Support Contractors

East Region West Region

Apr-Jun-18 4,800 Jul-18 Aug-18 Jul-Sep-18 4,800 Oct-18 Nov-18 Oct-Dec-18 4,800 Jan-19 Feb-19 Jan-Mar-19 4,800 Apr-19 May-19

TRICARE Dual Eligible Fiscal

Intermediary Contract

(TDEFIC)

Apr-Jun-18 2,200 Jul-18 Aug-18 Jul-Sep-18 2,200 Oct-18 Nov-18 Oct-Dec-18 2,200 Jan-19 Feb-19 Jan-Mar-19 2,200 Apr-19 May-19

TRICARE Overseas Program (TOP)

Jun-Aug 18 1,875 Sep-18 Oct-18 Sep-Nov 18 1,875 Dec-18 Jan-19

Dec-18-Feb-19 1,875 Mar-19 Apr-19 Mar-May 19 1,875 Jun-19 Jul-19

TRICARE Pharmacy Program (TPharm)

May-Jul 18 2,800 Aug-18 Sep-18 Aug-Oct 18 2,800 Nov-18 Dec-18

Nov18-Jan 19 2,800 Feb-19 Mar-19 Feb-Apr 18 2,800 May-19 Jun-19

Active Duty Dental Program (ADDP)

Feb-Jul 18 1,250 Sep-18 Oct-18 Aug 18 – Jan 19 1,250 Mar-19 Apr-19

MCSC AHCC

T-2017 - East

Apr 17 - Mar 18 7,500

Jun-18

Jul-18 T-2017 West 7,500 Total Estimated

OP 2

64,200

Option Period (OP) 3 Aug 1, 2019 – Jul 31, 2020

TRICARE

Purchased Care

Contractors (PCC)

Compliance Review Cycle

Estimated Claim

Volume

Estimated Date List of Claims Selected for

Review Issued by DHA

Estimated Date Claims Information from PCC Due to TCRS Contractor

T2017 Managed Care Support Contractors

East Region West Region

Apr-Jun-19 4,800 Jul-19 Aug-19 Jul-Sep-19 4,800 Oct-19 Nov-19 Oct-Dec-19 4,800 Jan-20 Feb-20 Jan-Mar-20 4,800 Apr-20 May-20

TRICARE Dual Eligible Fiscal

Intermediary Contract

(TDEFIC)

Apr-Jun-19 2,200 Jul-19 Aug-19 Jul-Sep-19 2,200 Oct-19 Nov-19 Oct-Dec-19 2,200 Jan-20 Feb-20 Jan-Mar-20 2,200 Apr-20 May-20

TRICARE Overseas Program (TOP)

Jun-Aug 19 1,875 Sep-19 Oct-19 Sep-Nov 19 1,875 Dec-19 Jan-20

Dec-19-Feb-20 1,875 Mar-20 Apr-20 Mar-May 20 1,875 Jun-20 Jul-20

TRICARE Pharmacy Program (TPharm)

May-Jul 19 2,800 Aug-19 Sep-19 Aug-Oct 19 2,800 Nov-19 Dec-19

Nov19-Jan 20 2,800 Feb-20 Mar-20 Feb-Apr 19 2,800 May-20 Jun-20

Active Duty Dental Program (ADDP)

Feb-Jul 19 1,250 Sep-19 Oct-19 Aug 19 – Jan 20 1,250 Mar-20 Apr-20

MCSC AHCC

T-2017 - East

Apr 18 - Mar 19

Jun-19

Jul-19 T-2017 West 7,500

OP 3

Option Period (OP) 4 Aug 1, 2020 – Jul 31, 2021

TRICARE

Purchased Care

Contractors (PCC)

Compliance Review Cycle

Estimated Claim

Volume

Estimated Date List of Claims Selected for

Review Issued by DHA

Estimated Date Claims Information from PCC Due to TCRS Contractor

T2017 Managed Care Support Contractors

East Region West Region

Apr-Jun-20 4,800 Jul-20 Aug-20 Jul-Sep-20 4,800 Oct-20 Nov-20 Oct-Dec-20 4,800 Jan-21 Feb-21 Jan-Mar-21 4,800 Apr-21 May-21

TRICARE Dual Eligible Fiscal

Intermediary Contract

(TDEFIC)

Apr-Jun-20 2,200 Jul-20 Aug-20 Jul-Sep-20 2,200 Oct-20 Nov-20 Oct-Dec-20 2,200 Jan-21 Feb-21 Jan-Mar-21 2,200 Apr-21 May-21

TRICARE Overseas Program (TOP)

Jun-Aug 20 1,875 Sep-20 Oct-20 Sep-Nov 20 1,875 Dec-20 Jan-21

Dec-20-Feb-21 1,875 Mar-21 Apr-21 Mar-May 21 1,875 Jun-21 Jul-21

TRICARE Pharmacy Program (TPharm)

May-Jul 20 2,800 Aug-20 Sep-20 Aug-Oct 20 2,800 Nov-20 Dec-20

Nov20-Jan 21 2,800 Feb-21 Mar-21 Feb-Apr 21 2,800 May-21 Jun-21

Active Duty Dental Program (ADDP)

Feb-Jul 20 1,250 Sep-20 Oct-20 Aug 20 – Jan 21 1,250 Mar-21 Apr-21

MCSC AHCC

T-2017 - East

Apr 19 - Mar 20

Jun-20

Jul-20 T-2017 West 7,500

OP 4

Option Period (OP) 5 Aug 1, 2021 – Jul 31, 2022

TRICARE

Purchased Care

Contractors (PCC)

Compliance Review Cycle

Estimated Claim

Volume

Estimated Date List of Claims Selected for

Review Issued by DHA

Estimated Date Claims Information from PCC Due to TCRS Contractor

T2017 Managed Care Support Contractors

East Region West Region

Apr-Jun-21 4,800 Jul-21 Aug-21 Jul-Sep-21 4,800 Oct-21 Nov-21 Oct-Dec-22 4,800 Jan-22 Feb-22 Jan-Mar-22 4,800 Apr-22 May-22

TRICARE Dual Eligible Fiscal

Intermediary Contract

(TDEFIC)

Apr-Jun-21 2,200 Jul-21 Aug-21 Jul-Sep-21 2,200 Oct-21 Nov-21 Oct-Dec-22 2,200 Jan-22 Feb-22 Jan-Mar-22 2,200 Apr-22 May-22

TRICARE Overseas Program (TOP)

Jun-Aug 21 1,875 Sep-21 Oct-21 Sep-Nov 21 1,875 Dec-21 Jan-22

Dec-21-Feb-22 1,875 Mar-22 Apr-22 Mar-May 22 1,875 Jun-22 Jul-22

TRICARE Pharmacy Program (TPharm)

May-Jul 21 2,800 Aug-21 Sep-21 Aug-Oct 21 2,800 Nov-21 Dec-21

Nov21-Jan 22 2,800 Feb-22 Mar-22 Feb-Apr 22 2,800 May-22 Jun-22

Active Duty Dental Program (ADDP)

Feb-Jul 21 1,250 Sep-21 Oct-21 Aug 21 – Jan 22 1,250 Mar-22 Apr-22

MCSC AHCC

T-2017 - East

Apr 20 - Mar 21

Jun-21

Jul-21 T-2017 West 7,500

OP 5

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