1 / 13

TMA Uniform Business Office

TMA Uniform Business Office. SIT/OHI Conversion Update. Madigan. Pharmacy SITs with RX and OHI XM Standard SITs on CHCS did not match those on DEERS Few Priority 4 & 3s SIRs Manually track accounting/MSA, expect to be fixed prior to going global TPOCS Exit Criteria.

ceri
Download Presentation

TMA Uniform Business Office

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TMA UniformBusiness Office SIT/OHI Conversion Update

  2. Madigan • Pharmacy SITs with RX and OHI XM • Standard SITs on CHCS did not match those on DEERS • Few Priority 4 & 3s SIRs • Manually track accounting/MSA, expect to be fixed prior to going global • TPOCS • Exit Criteria

  3. Pre-Conversion Activities Current Status of MTFs utilizing the web application: 22 Hubs = 74 MTF sites

  4. Need to Update/Educate • Business Rules • Pre-Conversion Guide • Post-Conversion • TPOCS

  5. Business Rules • Insurance Company Report • No Changes allowed on the SIT • Coverage Type general rules • Communication with VPOC • OHI Claim Filing Code

  6. Insurance Company Report • Run for Standard, Temporary and Inactive SIT • Query Standard and Temporary SIT • If not on the SIT Table, ADD • Make a note on Report to re-point post conversion • If Pharmacy SIT (RX) ADD XM, RX Coverage Types

  7. Special Procedure For Pharmacy Benefit Manager (PBM) • All PBMs will be entered into the SIT table as a separate HIC rather than as a coverage type under another HIC Carrier • The HIC (insurer) under which the PBM operates must be added to the PBM HIC Name field • Example: HIC Name field: Caremark Aetna HIC_ID CARPA0001 Coverage type RX

  8. Special Procedure For Pharmacy Benefit Manager (PBM) • All PBMs will be entered into the SIT table as a separate HIC rather than as a coverage type under another HIC Carrier • Example: HIC Name field: Caremark HIC_ID CARPA0001 Coverage type RX

  9. More OHI Details Claim Filing Code (Select one) (drop down) (09) 09 = self pay (default) 12 = Preferred Provider Organization (PPO) 13 = Point of Service (POS) 14 = Exclusive Provider Organization (EPO) BL = Blue Cross/Blue Shield CI = Commercial Insurance Co. HM = Health Maintenance Organization MC = Medicaid 10 = Central Certification MB = Medicare Part B 11 = Other Non-Federal Programs OF = Other Federal Program 15 = Indemnity Insurance- Old Blue Cross TV= Title V- Maternal/Child program 16 = Health Maintenance Organization (HMO)Medicare Risk VA = Veteran’s Plan AM = Automobile Medical WC= Worker’s Comp CH = CHAMPUS – (Tricare) Not supported by DEERS ZZ = (defined as unknown) DS = Disability LI = Liability LM = Liability Medical

  10. New Timeline • March 24 next Limited Active Site • Grotten, possibly Vance and Elmendorf • Then roll – out every two weeks in groups of 10-15 sites

  11. DMDC Changes • POC – now blank with required fields • Display of Attention Line • Able to add multiple SIT Carrier Coverages in one transaction • No updates to a HIC_ID that has an assigned Cross Reference ID

  12. SIT Issues in future Clean up of SIT Table • Automated as much as possible • Duplicates • Old, unused SITs • Re-structure coverage types for Pharmacy Clean up of OHI • Open all OHI over time and change coverage type

  13. VPOC and Other Suggested Changes • Functional Reject Option • Automated Communication • Ability to do Updates for a SIT • Change Claim Filing Code field

More Related