1. 2010 UBO/UBU Conference Title: Foreign Military Billing Session: T-3-1430

2. Objectives Better understanding of billing foreign military members and their dependents – UBO MSA perspective Reciprocal Healthcare Agreements – DoD Reference page Invitational Travel Orders Identify and discuss some important issues Provide ideas for improved performance Share helpful references for future use 2

3. Foreign Military Programs The programs are numerous: – International Military Education and Training (IMET) – Foreign Military Sales (FMS) – TW-P-TAX FMS – Paid for by host country – NATO Status of Forces Agreements (NATO SOFA) – Partnership for Peace (PFP) with a Status Of Forces Agreement (PFP SOFA) – Reciprocal Health Care Agreements (RHCA) – Acquisition & Cross Servicing Agreements (ACSA) 3

4. Training Programs Counterterrorism Fellows Program (CTFP) – JO-B-B05 Counter-Narcotics – MX-B-INL or POT – IMET, CTFP, and Counter-Narcotics – Primarily funded by U.S. government – Only covers student’s care – Dependents should be covered by insurance or an international agreement 4

5. Non-Students Not issued an ITO – Embassy employees – Personnel Exchange Program (PEP) – Reciprocal – Liaison Officer program (LNO) – Country funds – Foreign Visitor Program – Coalition Exercises in CONUS – WHINSEC guest instructors 5

6. Process Changes Past – Foreign military were not enrolled in DEERS Present – Foreign Military Members and dependents automatically enrolled in DEERS on application and/or receipt of new ID Card – DEERS assigns Foreign Identification Number (FIN) in lieu of a Social Security Number – FIN used for foreign military, foreign nationals, and their eligible family members – Billing rules do not account for those with insurance – Foreign language documents Future – No idea, but the programs continue to evolve 6

7. Collection Process Coordinating with TRICARE Office or assigned office at your facility – Foreign Military Registration Card Verifying country of foreign military member Notation of country in CHCS Collecting Invitational Travel Orders (ITOs) – Tells you where they’re from, what they’re authorized, and financial responsibility for health care of family members Communicating with; – Schools – FLO Coordinators – Foreign Members 7

8. Foreign Military Registration Card DeWitt Health Care Network card Identification to billing office can come in various forms 8

9. Benefit Sheet Example of Beneficiaries Svs. sheet 9

10. Reciprocal Health Care Agreements Provide care at no charge for military members and dependents in DoD facilities only Each agreement is unique, and some have restrictions All expired agreements are under renewal (with the exception of Venezuela) https://fhp.osd.mil/portal/rhas.jsp 10

11. Reciprocal Health Care Agreements https://private.fhp.osd.mil/portal/rhas.jsp DoD Reference Sheets 11

12. DoD Reference Sheets 12

13. Reference Sheet Codes 13

14. Invitational Travel Order Important items on ITO – Home Country – Funding – Invitation – Authorized Training – Dependents – Medical Services – Special Conditions 14

15. Invitational Travel Order 15

16. Invitational Travel Order 16

17. Country Code, Case ID, and Case Line Important for deposits When using sales code 73 address cannot be built without country, case, and line. Reference DFAS—DE 7077.2-M 13.6 & 13.8 Country Code Criteria: Main country code (i.e., for Italy, use IT for the Country Code criteria) Case ID and Case Line: The Case ID and Case Line is a programmed number for the training – Example: Netherlands, Country Code: NZ Pseudo Country Code: S4 Case ID: NZS989 Case Line: D111158 The ITO number will have the 2-character main country code at the beginning of the ITO Number and the 2-character country code at the end of the ITO Number (i.e., ITO#: NZS989D111158S4) 17

18. Invitational Travel Order 18

19. Invitational Travel Orders ITO contains billing information 19

20. Example of Address Line Request Invalid charge//aar aar Country/Case/Line code is available on the ITO or is obtained from the Foreign Liaison Officer 20

21. Authorizations for Care ITOs for students and dependents ID card Invitational letter DEERS Agreements 21

22. Submitting Bills Documentation – SF 1080 – Bill (DD7, DD7A, etc…) – ITO/copy of ID card – Amendment to ITO (if applicable) – Insurance Info I&R: Invoice and Receipt – IMET Students – FMS – Dependents – Embassies UB-04: – Prepared for whomever requests billing on this form 22

23. Submitting Bills US Air Force AFSAT/FMF ATTN: FMS Claims 315 J Street West Randolph AFB, TX 78150 US Army USAMEDCOM ATTN: MCRM-F 2050 Worth Rd, Ste 9 Ft Sam Houston, TX 78324 US Navy Commanding Officer Naval Ed & Security Assistance Field Activity Code-N5 Naval Air Station Pensacola, FL 32508 23 Embassies in DC http://embassy.org/embassies References: Joint Security Assistance Training (JSAT) AR 12-15 SECNAVINST 4950.4A AFI 16-105 DoD 5105.38-M (Security Assistance Management Manual) Chapter 4 - FMS General Information Chapter 10 - International Training DFAS 37-100-2007

24. Contact Information Foreign Military Student (FMS) and IMET Billing Air Force Security Assistance Training (AFSAT) Mailing Address: AFSAT/FMF 315 J Street West Randolph AFB TX 78150-4349 24

25. Challenges Inconsistent training in Foreign Military Billing – No guidance on reading ITOs Billing for reimbursement of care provided difficult due to lack of appropriate PATCAT information – Often difficult in getting appropriate personnel to make appropriate PATCAT corrections Over 60 counties currently covered by some type of healthcare agreements with DoD – Agreements expiring and being renegotiated – The program is in constant motion 25

26. Lessons Learned Along the Way DoD Reference sheet and CHCS PATCATs not in alignment – CHCS does not always generate FRR bills and Ins co. does not accept DD7 billings More foreign military now carry health insurance – CHCS does not allow the input of insurance for this category of patient – Collect a DD2569 on patient regardless of duty status – Active Duty subsistence rate not updated since Congress stopped charges for U.S. active duty – Travelers Insurance – Patients do not understand medical billing in the U.S. – Embassies are moving away from paper checks 26

27. Daily Challenges – Make CHCS Work for You DEERS TRICARE Standard issues 27

28. Rates 28 http://www.tricare.mil/ocfo/_docs/FY_2011_DC_Inpt_Rate_dtd_9_28_10.pdf

29. Rates Know your rates 29

30. Rates International Military Education and Training (IMET) and Inter- Agency Outpatient Rate (IOR) rate tables 2010 Government Discount Calculation Rate Factor PATCAT IMET0.64 IOR0.94 IOR0.94K611 IOR0.90K612 http://www.tricare.mil/ocfo/mcfs/ubo/mhs_rates/imet_ior.cfm 30

31. Sample SF 1080 31

32. Helpful Hints Know who gets the bill and how you get your money – Air Force Security Assistance Center (AFSAC) (pays the MTF directly) – Air Force Security Training (AFSAT) (pays Air Staff…but does not notify MTF when they have processed the bill for payment) – Embassy (pays by check or electronic method) – Insurance company (how to get the bills to the Hub since encounters do not flow to TPOCS) Work with GSUs to obtain listing of their foreign military Keep track of when member is leaving the country Establish working relationship with FLO-Coordinators 32

33. Helpful Hints cont… Recommendation: Pull M2 query and perform 100% audit on foreign military being seen in your facility – Validate billing requirements Work with Beneficiary Services to clarify PATCATS and billable services (They are human too, and mistakes can happen) Identify billing issues to your service representative Audit at least quarterly! Work MSA accounts monthly to stay on top of open foreign military accounts 33

34. Web Sites https://fhp.osd.mil/portal/rhas/dependentsmatrix.jsp http://www.armymedicine.army.mil/hc/ip/medical- eligibility.htm#spain http://www.armymedicine.army.mil/hc/ip/medical- eligibility.htm#spain https://fhp.osd.mil/portal/rhas.jsp http://www.embassiesabroad.com/ International Military Students & Medical Care Desk Top Guide http://www.disam.dsca.mil/DR/14%20Chapter.pdf http://www.cs.amedd.army.mil/imso/Medical.htm (Ft. Sam Houston site, but good explanations) http://www.cs.amedd.army.mil/imso/Medical.htm 34

35. Summary Better understanding of billing foreign military members and their dependents – UBO MSA perspective Reciprocal Healthcare Agreements – DoD Reference page Invitational Travel Orders Identify and discuss some important issues Provide ideas for improved performance Share helpful references for future use 35

36. Questions 36