36_TCRS_Sec_L_Exhibit_L-8_TCRS_Hist_Rebut__Rprt_11-7-16.pdf

Attachment L, Exhibit L-8, Historical TCRS Rebuttal Data (2010-2014)

TCRS HT9402-17-R-0002, Section L 1 of 3

TRICARE

Purchased Care

Contract

Compliance Review Cycle

Total # Claims

# of Rebuttals

% of Rebuttals

# of 2nd Rebuttals

% of 2nd Rebuttals

North Region T- Next

JULY - SEPT 10 1,528 106 6.94% 8 0.52%

OCT - DEC 10 1,614 90 5.58% 5 0.31%

JAN - MAR 11 1,678 89 5.30% 7 0.42%

Annual HHC -

APRIL 09 - MAR

4,000 136 3.40% 7 0.18%

Annual HCC -

APRIL 10 - MAR

4,000 180 4.50% 27 0.68%

South Region - T- Next

JULY - SEPT 10 1,713 90 5.25% 2 0.12%

OCT - DEC 10 1,665 60 3.60% 3 0.18%

JAN - MAR 11 1,686 61 3.62% 2 0.12%

APR - JUN 11 1,724 60 3.48% 3 0.17%

JUL 11 - SEPT 11 1,718 83 4.83% 10 0.58%

OCT - DEC 11 1,442 63 4.37% 3 0.21%

JAN - MAR 12 1,448 56 3.87% 5 0.35%

Annual HHC -

APRIL 09 - MAR

4,000 73 1.83% 5 0.13%

Annual HCC -

APRIL 10 - MAR

4,000 86 2.15% 3 0.08%

Annual HCC - APR

11 - MAR 12

4,000 111 2.78% 10 0.25%

West Region - T- Next MAR 11 - MAY 11

1,690 69 4.08% 16 0.95%

JUNE - AUG 11 1,817 80 4.40% 1 0.06%

SEP - NOV 11 1,432 40 2.79% 4 0.28%

DEC 11 - FEB 12 1,803 92 5.10% 8 0.44%

MAR 12 - MAY 12 1,766 81 4.59% 2 0.11%

JUN 12 - AUG 12 1,741 88 5.05% 8 0.46%

SEP - NOV 12 1,782 67 3.76% 0 0.00%

DEC 12 - FEB 13 1,507 105 6.97% 0 0.00%

Annual HHC -

APRIL 09 - MAR

4,000 102 2.55% 7 0.18%

Annual HCC -

APRIL 10 - MAR

4,000 100 2.50% 11 0.28%

Annual HCC - APR

11 - MAR 12

4,000 112 2.80% 0 0.00%

TDEFIC (T-3) JULY - SEPT 10 2,309 70 3.03% 4 0.17%

OCT - DEC 10 2,261 53 2.34% 0 0.00%

JAN - MAR 11 2,154 39 1.81% 6 0.28%

APR - JUN 11 2,204 58 2.63% 1 0.05%

JUL - SEP 11 2,179 67 3.07% 2 0.09%

OCT - DEC 11 1,811 12 0.66% 0 0.00%

JAN - MAR 12 2,180 73 3.35% 11 0.50%

APR - JUN 12 2,201 60 2.73% 0 0.00%

TCRS HT9402-17-R-0002, Section L 2 of 3

TRICARE

Purchased Care

Contract

Compliance Review Cycle

Total # Claims

# of Rebuttals

% of Rebuttals

# of 2nd Rebuttals

% of 2nd Rebuttals

JUL - SEP 12 2,196 54 2.46% 2 0.09%

OCT - DEC 12 2,055 47 2.29% 2 0.10%

JAN - MAR 13 2,069 28 1.35% 0 0.00%

APR - JUN 13 2,382 96 4.03% 4 0.17%

JUL - SEP 13 2,156 129 5.98% 27 1.25%

OCT - DEC 13 2,180 210 9.63% 3 0.14%

JAN - MAR 14 2,148 108 5.03% 12 0.56%

APR - JUN 14 2,135 125 5.85% 0 0.00%

JUL - SEP 14 2,020 70 3.47% 3 0.15%

OCT - DEC 14 2,049 453 22.11% 7 0.34%

TOP (T-3) SEP - NOV 10 979 132 13.48% 17 1.74%

DEC 10 - FEB 11 1,016 174 17.13% 84 8.27%

MAR - MAY 11 1,258 214 17.01% 9 0.72%

JUNE - AUG 11 1,264 87 6.88% 14 1.11%

SEP - NOV 11 1,219 156 12.80% 10 0.82%

DEC 11 - FEB 12 1,215 93 7.65% 14 1.15%

MAR - MAY 12 1,310 152 11.60% 5 0.38%

JUN - AUG 12 1,219 94 7.71% 12 0.98%

SEP - NOV 12 1,197 107 8.94% 5 0.42%

DEC 12 - FEB 13 1,218 94 7.72% 4 0.33%

MAR - MAY 13 1,315 77 5.86% 6 0.46%

JUN - AUG 13 1,617 139 8.60% 9 0.56%

SEP - NOV 13 1,609 132 8.20% 26 1.62%

DEC - FEB 14 1,402 129 9.20% 20 1.43%

MAR - MAY 14 1,443 106 7.35% 5 0.35%

JUN - AUG 14 1,457 85 5.83% 3 0.21%

SEP - NOV 14 1,406 172 12.23% 12 0.85%

TPharm (T-3) MAY - OCT 10 2,615 1878 71.82% 0 0.00%

NOV 10 - APR 11 2,646 762 28.80% 762 28.80%

MAY 11 - OCT 11 2,717 2670 98.27% 46 1.69%

NOV 11 - APR 12 2,630 321 12.21% 99 3.76%

MAY 12 - OCT 12 2,630 670 25.48% 322 12.24%

NOV 12 - APR 13 2,784 789 28.34% 0 0.00%

MAY 13 - OCT 13 2,610 470 18.01% 0 0.00%

NOV 13 - APR 14 2,631 362 13.76% 0 0.00%

MAY 14 - OCT 14 2,560 293 11.45% 7 0.27%

ADDP (T-3) FEB - JUL 10 2,478 389 15.70% 7 0.28%

AUG 10 - JAN 11 2,791 32 1.15% 0 0.00%

FEB 11 - JUL 11 2,791 13 0.47% 2 0.07%

AUG 11 - JAN 12 2,432 8 0.33% 0 0.00%

FEB 12 - JUL 12 1,242 9 0.72% 0 0.00%

AUG 12 - JAN 13 1,199 17 1.42% 0 0.00%

FEB 13 - JUL 13 1,350 19 1.41% 0 0.00%

TCRS HT9402-17-R-0002, Section L 3 of 3

TRICARE

Purchased Care

Contract

Compliance Review Cycle

Total # Claims

# of Rebuttals

% of Rebuttals

# of 2nd Rebuttals

% of 2nd Rebuttals

AUG 13 - JAN 14 1,269 52 4.10% 0 0.00%

FEB 14 - JUL 14 1,198 7 0.58% 0 0.00%

North Region T-3 JUL 11 - SEPT 11 1,617 129 7.98% 18 1.11%

OCT - DEC 11 1,700 113 6.65% 13 0.76%

JAN - MAR 12 1,661 92 5.54% 20 1.20%

APR - JUN 12 1,727 121 7.01% 47 2.72%

JUL 12 - SEP 12 1,649 135 8.19% 12 0.73%

OCT - DEC 12 1,537 31 2.02% 5 0.33%

JAN - MAR 13 1,604 66 4.11% 11 0.69%

APR - JUN 13 1,565 66 4.22% 7 0.45%

OCT - DEC 13 1,592 38 2.39% 3 0.19%

JAN - MAR 14 1,599 43 2.69% 7 0.44%

APR - JUN 14 1,581 55 3.48% 5 0.32%

JUL - SEP 14 1,563 36 2.30% 3 0.19%

OCT - DEC 14 1,614 65 4.03% 7 0.43%

Annual HHC -

APR 11 - MAR 12

4,000 123 3.08% 17 0.43%

South Region - T-3

APR - JUN 12 1,468 59

4.02%

1.16%

JUL - SEP 12 1,703 123 7.22% 11 0.65%

OCT - DEC 12 1,533 59 3.85% 8 0.52%

JAN - MAR 13 1,622 62 3.82% 7 0.43%

APR - JUN 13 1,563 87 5.57% 10 0.64%

JUL - SEP 13 1,588 139 8.75% 16 1.01%

OCT - DEC 13 1,605 77 4.80% 7 0.44%

JAN - MAR 14 1,590 59 3.71% 2 0.13%

APR - JUN 14 1,613 54 3.35% 2 0.12%

JUL - SEP 14 1,605 46 2.87% 3 0.19%

OCT - DEC 14 1,599 1 0.06% 2 0.13%

West Region - T-3

APR - JUN 13 1,606 59

3.67%

0.06%

JUL - SEP 13 1,622 107 6.60% 20 1.23%

OCT - DEC 13 1,618 130 8.03% 10 0.62%

JAN - MAR 14 1,615 143 8.85% 12 0.74%

APR - JUN 14 1,604 80 4.99% 9 0.56%

JUL - SEP 14 1,604 111 6.92% 8 0.50%

OCT - DEC 14 1,604 155 9.66% 56 3.49%

216,931 17,600 8.11% 2,117 0.98%Total Completed Audit Cycles

Sheet1