1. www.altarum.org SIT/OHI Update Advisory Working Group TMA/UBO Program Support Contractor May 2007

2. 2 SIT/OHI Update Overview User Teleconferences SIT Table Clean-up Proposed SIT/OHI Changes SIT/OHI Management Reports with Demonstration

3. 3 User Teleconferences Total of 3 Teleconferences Attendance averaged about 14-16 per session (0800 and 1400) Issues: - TPC inpatient billing/printing (MSA module) CP 310 (released) - Expiration dates not being saved on policies CP 312 (2 wks) - Updated insurance information not crossing over to TPOCS (still outstanding – looking for examples to identify pattern) Reviewed Trouble Ticket procedure Next teleconference mid July

4. 4 SIT Table Clean-up Clean-up procedure –Identify duplicate insurance carriers –Opportunity to re-point OHI –Communication system with VPOC email Snag –MCSCs and Pharmacy only Cancel and Add OHI –No re-point capability Teleconference training sessions on 15 May 2007 –NOTE: Rescheduled to – 30 and 31 May Anticipate beginning the process in June/July 2007

5. 5 VPOC to User Email Purpose: Clean up the SIT Table Communicate potential changes for the SIT Table Plan : Notification process with a 60-day window to provide the MTFs the opportunity to: - Question the decision to change certain HICs - Respond via email to VPOChelpdesk@altarum.org - Adjust their business processes and re-point OHI

6. 6 Proposed SIT/OHI Changes DEERS, CHCS, and TPOCS have reviewed list of proposed changes MCSCs / TMA Aurora and Pharmacy to review SCRs to be written

7. 7 History of Management Reports There were NO reports requested in the original SIT/OHI requirements Current Reports by DMDC (Defense Manpower Data Center) Opportunity to develop additional reports

8. 8 OHI Management Reports Reports Menu OHI by System ID SIT by System ID OHI transactions by System ID SIT transactions by System ID OHI by Claim Filing Code and System ID OHI by HIPAA Insurance Type Code and System ID

9. 9 Insurance Type Code Selection CI = Commercial CP = Medicare Conditionally Primary GP = Group Policy (Self funded/employer based) HM = HMO AP = Auto Insurance Policy IP = Individual Policy LD = Long Term Policy LT = Litigation MB = Medicare Part B MC = Medicaid MI = Medigap Part B MP = Medicare Primary OT = Other PP = Personal Payment SP = Supplemental Policy The default Insurance Type Code is “ Commercial”

10. 10 Claim Filing Code Values 09 = Self-pay (default) 10 = Central Certification 11 = Other Non-Federal Programs (Self insured programs, etc.) 12 = Preferred Provider Organization (PPO) 13 = Point of Service (POS) 14 = Exclusive Provider Organization (EPO) 15 = Indemnity Insurance (Old traditional policies) 16 = Health Maintenance Organization (HMO)Medicare Risk AM = Automobile Medical BL = Blue Cross/Blue Shield CH = CHAMPUS CI = Commercial Insurance Co. (Aetna, Cigna, etc.) DS = Disability HM = Health Maintenance Organization LI = Liability LM = Liability Medical MB = Medicare Part B MC = Medicaid OF = Other Federal Program (use for Medicare) TV = Title V (Medicare Maternal Child program) VA = Veteran Administration Plan WC = Workers’ Compensation Health Claim ZZ = Mutually Defined Unknown The default Claim Filing Code is “Self-pay”

11. 11 OHI Management Reports Useful information for UBO Service Managers SIT and OHI productivity totals Which sites have most / least OHI Breakdown of Insurance Type Codes and Claim Filing Codes by sites and totals Access to OHI Management Reports Who/How? Altarum Site Security Manager (SSM)

12. 12 Quality Data will yield better reports Achieved by: Clean up of the SIT Table Clean up of the OHI policies Educate and Train staff Implement Insurance Type Code and Claim Filing Code field changes

13. 13 Action Plan May 15 Teleconference – Clean-up process Begin Clean-up of SIT Table – Anticipate 6 months to one year Coordination of Proposed changes/Management reports SCRs