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Briefing: CHCS PATCATs vs HCDPs Date: 21 March 2007 Time: 1610 - 1700

Briefing: CHCS PATCATs vs HCDPs Date: 21 March 2007 Time: 1610 - 1700. Objectives. Be aware that DEERS and CHCS count and categorize patients differently when it comes to status and eligibility Understand what Patient Categories (PATCATs) are, and how they are used within CHCS

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Briefing: CHCS PATCATs vs HCDPs Date: 21 March 2007 Time: 1610 - 1700

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  1. Briefing: CHCS PATCATs vs HCDPs Date: 21 March 2007 Time: 1610 - 1700

  2. Objectives • Be aware that DEERS and CHCS count and categorize patients differently when it comes to status and eligibility • Understand what Patient Categories (PATCATs) are, and how they are used within CHCS • Understand what HCDPs are, and how they represent a patients true eligibility within the MHS • Understand the relationship between the HCDP and the PATCAT, and how DEERS and CHCS communicate eligibility • Be able to identify/verify/correct mismatches between PATCAT/HCDP within the enrolled patient population

  3. PATCATs • PATCATs are used to categorize patients within CHCS by service and eligibility type (Active Duty, Retired, etc…) EXAMPLE: PATIENT CATEGORY CODE SUMMARY USAF ACTIVE DUTY F11 ACTIVE DUTY USAF RET LOS ENLISTED F31 DEPENDANT/RETIREE USAF FAMILY MBR RET F43 DEPENDANT/RETIREE

  4. PATCATS/HCDP • PATCATs are also key in separating out the enrolled population within the MCP file • The MTF’s enrolled population consists of the primary patients that visit the MTF, and that the MTF is responsible for • DEERS does not update a patients PATCAT as eligibility changes to reflect a change in overall eligibility, or a change in the sponsor’s service • Many mismatches exist that blur the true eligibility/status of the patient, and cause errors in placement within the enrolled population • These errors can affect billing and OHI collection

  5. ENROLLED POPULATION

  6. HCDPs • HCDPs are used to identify the patients true eligibility within DEERS/MHS EXAMPLE: 106 TRICARE Prime Individual Coverage for Active Duty Sponsors 107 TRICARE Prime Individual Coverage for Active Duty Family Members 117 TRICARE Prime Family Coverage for Retired and Medal of Honor Sponsors and Family Members

  7. PATCAT/HCDP • Become familiar with PATCAT/HCDP key to detect errors (see key for reference) • Types of possible errors: • PATCAT/HCDP • PATCAT/HCDP/sponsor/dependant service • Sponsor service/dependant service • Sponsor deceased/dependant retired family member • Query DEERS through BHCF (Healthcare Finder Booking) to verify patients status • DEERS check will display CHCS Patient Category as well as current HCDP

  8. PATCAT/HCDP • By running a CHCS adhoc against the enrolled population we can compare the patient HCDP/Sponsor PATCAT/Patient PATCAT to easily identify any potential errors that might exist • When running the adhoc sort by HCDP/PATCAT/SPON PATCAT and scroll through. Errors will be found where changes occur between any data elements

  9. ADHOC EXAMPLE OUTPUT

  10. DEERS CHECK DEERS ELIGIBILITY DATA Name: SMITH,MICHAEL M FMP/SSN: 20/800-09-0909 Patient Category: USAF ACTIVE DUTY SEX/DOB/AGE:M/27Oct1961/45Y ───────────────────────────────────────────────────────────────────── Eligibility Date: 22 Jan 2007 Name First: MICHAEL Sponsor SSN: 800-09-0909 Middle: M Branch of Service: AIR FORCE Last: SMITH Pay Grade: 07 Cadency: Sponsor Cat Code: Retired DOB: 27 Oct 1961 Sponsor Rank: SERGEANT Sex: MALE Sponsor UIC: Relationship: Self UIC Zip Code: HCDP Code: 117 Type: MEDICAL Enr DMIS ID: 0326 TRICARE PRIME FAMILY COVERAGE FOR RETIRED AND MEDAL OF HONOR SPONSORS AND FAMILY MEMBERS HCDP Start Date: 22 Jan 2007 Region Code: 17 HCDP End Date: 22 Jan 2007 Network Provider: Direct Care Net ECHO Code: ECHO Start Date: ECHO End Date: ─────────────────────────────────────────────────────────────────────eXit PCM HCDP Demographics prInt hElp

  11. PATCAT/HCDP • Reference PATCAT/HCDP key to make corrections after verifying through DEERS the patient’s actual status • Make corrections through Mini Registration • Many of these patients are really billable • Can now query for OHI or enter OHI • Patients will now fall into the correct categories within the MCP files • CHCS will also now count these patients and identify them as their DEERS status truly reflects • Would run this adhoc and perform this procedure once every two weeks

  12. PATCAT/HCDP • PATCAT/HCDP key and ADHOC are available for copying or can be requested through email • QUESTIONS???

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