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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.

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TMA Uniform Business Office

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  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

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