Issues Regarding the Billing of Foreign Military & Their Dependents

1. Issues Regarding the Billing of Foreign Military & Their Dependents [Name Redacted] UBO AWG 1 March 2006

2. Scope of Today’s Discussion • Limited to the billing of care provided to foreign military and their dependents at DoD military treatment facilities (MTFs) • Excludes the issue of access to care at MTFs • We assume they got in to the MTF • Does not include the issue of care provided at civilian treatment facilities

3. Challenges • Multitude of countries involved • More than 50 nations • Different levels of benefits authorized depending upon the country • Perceived lack of guidance & training • Invitational Travel Orders (ITOs) not always available nor correctly completed • Billing not a high priority • Focus on ensuring access to care and avoiding international incidents • Billing often an afterthought

4. Covered Countries • About 53 countries currently are covered by some sort of health care agreements with DoD • Programs Include: • NATO Status of Forces Agreements (SOFA) • Partnership for Peace (PFP) • Reciprocal Health Care Agreements (RHCAs) • Currently 18 are in effect • Includes several NATO SOFA countries such as Canada, Germany & the UK • Only cover care provided in MTFs

5. Recipe for Failure • No Visibility to Management • No one knows the true extent of care being rendered • No Management Oversight • Issue is “below the radar” since no or cost data are being reported upward • No Effective Performance • “Not important” so why bother improving our billing & collection

6. Success Factors • Having access to the Invitational Travel Order (ITO) is a key • Tells you where they’re from and what they’re authorized • Determines financial responsibility for health care of dependents • May not always be correct as to covered health care services • Verifying eligibility via DEERs

7. DEERS Improvements • In the past, foreign military were NOT enrolled in DEERS • New ID Card (DD Form 2765) automatically enrolls foreign military member and dependents (when applicable) into DEERS • DEERS assigns them a Foreign Identification Number (FIN) in lieu of an SSN • FIN used for foreign military, foreign nationals and their eligible family members • Numbered 900-00-0001 and up

8. PATCAT Table Issues • Are foreign military & their dependents being assigned to the correct PATCATs? • PATCAT Table has a column indicating “No DEERS Check” for foreign military PATCATs • Assumes they’re NOT in DEERS so why bother checking?

9. No TRICARE Eligibility • Only U.S. military and their families can enroll in TRICARE • Personnel from countries with agreements with the U.S. are entitled to the same access to care in MTFs as do TRICARE Prime enrollees • But their HCDP code shows them as “TRICARE Standard” which puts them low in priority so they never get an MTF appointment

10. Useful References • Security Assistance Health Affairs Handbook (Draft), November 2003 • http://www.disam.dsca.mil/itm/References/HAHB/Contents.htm • Reciprocal Health Care Agreements • https://fhp.osd.mil/portal/rhas.jsp • Requires a .mil address to access

11. Discussion on Foreign Military Billing • Is it really a problem? • Are there sufficient TMA and Service directives/policies regarding foreign military billing? • What more should be done than just having one foreign military billing class at the annual UBO Conference? • Who should be the Service champions for improving billing of foreign military? • Any changes needed to the PATCAT Table?