Briefing: The Standard Insurance Table – Case Studies Date: 20 March 2007 Time: 1110 - 1200

1. Briefing: The Standard Insurance Table – Case Studies Date: 20 March 2007 Time: 1110 - 1200

2. Objectives • Understand the importance of the information entered into the SIT Table • Know the common data entry errors and how to avoid them • Learn basic rules through “hands on” sample screens

3. Outline • Brief review of the SIT Table • Review HIC Entry Fields • Review SIT Table Basic Business Rules • Identify common HIC Entry errors • Review sample HIC entries • Role of Verification Point of Contact (VPOC)

4. Standard Insurance Table Standard Insurance Table

5. Standard Insurance Table • SIT Important Facts: • List of Health Insurance Carriers (HIC) • Stored on Defense Eligibility and Enrollment Reporting System (DEERS) • Accessed via the local Composite Health Care System (CHCS) • Bi-directional flow of information • Contains the claims address of the HIC which is necessary for billing Other Health Insurance (OHI) • OHI is “pointed” to a corresponding HIC for the claims address • Bill is sent to insurance company requesting payment

6. Information Flow DEERS Master SIT OHI VPOC validates and approves all adds/updates to the Master SIT • Local Holders of the SIT: • Subscribe daily to DEERS for updates to the SIT Local SIT Local SIT Local SIT TDEFIC & MCSCs Claims DOES MCSCs & DP Local OHI PDTS Local OHI CHCS 1 Local OHI TPOCS

7. HIC Entry Fields Verification Point of Contact (VPOC) and Composite Health Care System (CHCS) Views

8. HIC Entry / VPOC View

9. HIC Add Screen CHCS View SIT ID: STANDARD INSURANCE TABLE ADD INS CO CHCS Insurance Company Name: Aetna Health Care Additional Description: State School System Carrier Website: www.aetna.com Customer Service Email: www.customer.aetna.com HIC Status Code: T (Temporary) HIC Verification Code: U (Unverified) Coverage/Payer Type: XM/B (Medical – Inst/Prof) HIC Loc Commt: Local MTF HIC Std Commt: VPOC (Verification POC)

10. Cov Add Screen CHCS View SIT ID: AETCA0034 STANDARD INSURANCE COMPANY ADD INS CO CHCS Insurance Company Name: AETNA HEALTH CARE Coverage Type: MEDICAL Payer Type Code: B (BOTH) INSTITUTIONAL AND PROFESSIONAL Coverage Status Code: T Coverage Verification Status: U ATTN: Medical Claims P.O. Box/St Address: PO BOX 246 Zip Code: 92121 Zip Ext: State/Country: CALIFORNIA City: SAN DIEGO Phone Number: 8581021928 Phone Ext: FAX Number:

11. Point of Contact CHCS Screen Last Update System Name: system name of current user defaults here Last Update User Name: current user name defaults here Last Update User Phone: 7035751710 Ext: Last Update User Email: theresa.boyd@altarum.org

12. Basic Rules/Data Quality Basic Business Rules And Data Quality

13. Basic Rules/Data Quality • Spell out entire name of insurance carrier • Avoid use of acronyms unless actual name • No punctuation, symbols, hyphens • Include Point of Contact (POC) name and commercial telephone number • Include valid insurance carrier telephone number • Be specific in the Attention Line • Limit adding any insurance carriers billed only under Medical Affirmative Claim (MAC) • Do not add any JAG offices • For “Out of State Claims” (Attn Line), use the state code where the services were rendered

14. Common HIC Entry Errors Identify Common HIC Entry Errors

15. Common HIC Entry Errors • Common HIC Entry Errors • Incomplete queries with duplicate HIC entries • Insurance carrier name is abbreviated • Use of “RX” prefix – RXAetna for insurance carrier • Use of commas, periods, symbols, 18002345678 • Use of DSN instead of commercial telephone number • Invalid insurance carrier telephone number • Incorrect Coverage Type - XM, MD entered and insurer is clearly Pharmacy • Failure to “cancel” an incorrect entry

16. Examples Sample HIC Entries for Review Using VPOC Screens

17. Examples

18. Examples

19. Examples

20. Examples

21. Examples

22. Examples

23. Examples

24. Examples

25. Examples

26. Examples

27. VPOC Queue

28. VPOC Queue

29. VPOC Queue

30. VPOC Verification Point of Contact (VPOC) Role

31. VPOC • VPOC Role • Verifies claims address, when possible • Ensures data quality prior to SIT Table entry • Contacts User POC for any questions • Provides insurer information in the Standard Comment field • Updates, Adds, Restores, Rejects an entry

32. New Plans • Proposed changes to SIT Table process: • When DEERS eligibility is completed, the OHI will automatically be searched and retrieved • Establish a VPOC to User communication system • Some field changes, etc • Education and training will be provided

33. TMA/UBO Web Site • The new TMA / UBO Web site • http://tricare.osd.mil/ocfo/mcfs/ubo/index.cfm

34. TMA/UBO Web Site

35. TMA/UBO Web Site

36. Helpful Tips • Remember to: • Query the SIT Table to avoid duplicates • Use the commercial telephone number for POC • Obtain a valid insurance carrier telephone number • Use local comment field for additional information • Cancel an entry when it is a mistake • Do not deactivate any Health Insurance Carriers (HICs) • Limit request for any updates • When in doubt, contact VPOC

37. Summary • Understand the importance of the information entered into the SIT Table • Know the common data entry errors and how to avoid them • Learn basic rules through “hands on” sample screens

38. Quiz True or False • Always use the commercial telephone number for POC • Use the Local Comment field for additional information and to communicate with the VPOC • Do not add Judge Advocate (JAG) offices