SIT/OHI Conversion Update TMA Uniform Busines s Office

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

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

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

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

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

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

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

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 CertificationMB = Medicare Part B 11 = Other Non-Federal ProgramsOF = Other Federal Program 15 = Indemnity Insurance- Old Blue CrossTV= Title V- Maternal/Child program 16 = Health Maintenance Organization (HMO)Medicare RiskVA = Veteran’s Plan AM = Automobile MedicalWC= Worker’s Comp CH = CHAMPUS – (Tricare) Not supported by DEERSZZ = (defined as unknown) DS = Disability LI = Liability LM = Liability Medical

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

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

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

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