TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Medicare Eligible Program (TMEP)
Chapter 20
Section 11
Communicationsand Customer Service (C&CS)
Revision:
All TRICARE requirements notedin Chapter 11 regardingCommunications and Customer Service (C&CS) shall apply to theTMEP unless specifically changed, waived, or superseded by thissection (as indicated below), the TRICARE Policy Manual (TPM), TRICAREReimbursem*nt Manual (TRM), TRICARE Systems Manual (TSM), or TMEPcontract.
1.0Education Requirements
The provisions of Chapter 11, Section 1, are superseded by thefollowing:
1.1A collaborative effort betweenDefense Health Agency (DHA) Communications and the contractor shall addressthe communication and education requirement of TMEP beneficiariesand associated providers. The intent is to make sure TRICARE benefitinformation is effectively communicated. TMEP educational activitiesinclude targeted beneficiary and provider education related to specificissues. Issues may be identified by the Government or the contractor.
1.2The contractorshall participate in various work group meeting(s) to be held inthe Washington, DC area. The contractor shall also participate inother meetings to address communication and education activitiesin support of the TRICARE benefit, to include print and web content.Meetings may be attended via teleconference, video telecommunicationsor in person (for up to four meetings/year), as directed by theGovernment. The purpose of these meetings are to develop, review,or revised core educational materials for the following calendaryear, discuss observations from the previous year and discuss possiblechanges in education and communication activities.
1.3The contractorshall coordinate with DHA communications on development of contentthat addresses how individuals may identify and report fraudulentpractices and to develop messaging and content for use in beneficiaryand provider education products.
1.4The contractorshall work with DHA to ensure beneficiaries receive unified, timely,accurate, consistent, and effective products and tools.
1.5The Governmentshall furnish the TMEP contractor printed TMEP, beneficiary-focusededucational materials. The Government shall develop materials basedon recommendations by contractors, program managers, the Services,DHA leadership and others with interests and concerns about informationshared with TRICARE beneficiaries and other stakeholders. DHA Communicationsshall review all recommendations and prioritize products in accordancewith funding availability. DHA Communications shall have final approvalauthority for TMEP products. Ordering of initial and subsequenteducational materials shall be discussed with the Government andoutlined in the Memorandum of Understanding (MOU) with DHA CommunicationsDivision.
1.6The contractor shall providestaff to perform timely reviews and provide input to content developedby DHA Communications on a regular basis. Reviews shall includeprinted products, web content, responses to query for media requests,customer service scripts, senior leader talking points, briefings,and other products identified by the DHA.
1.7The contractorshall be responsible for distribution of TRICARE information usingindustry best practices (for example, email, telephone, media, socialmedia, text messaging, chat and other contemporary methods) to ensuretimely delivery and receipt to TMEP beneficiaries.
1.8Upon request,the contractor shall furnish claim forms, claim completion instructions,the TRICARE materials, Defense Enrollment Eligibility ReportingSystem (DEERS) information and other TMEP related materials to beneficiary,provider and Congressional offices. The contractor will establishand maintain effective communications with all TRICARE/Medicaredual eligible beneficiaries.
1.9The contractorshall submit an education plan, outlining how it intends to conducttargeted-TMEP education for beneficiaries and providers. The ProgramOffice and DHA Communications will review the plan and provide appropriatefeedback for recommended changes. Details for submission of theEducation Plan are identified by DD Form 1423, Contract Data RequirementsList (CDRL), located in Section J of the applicable contract. Ifthe contractor intends to exhibit at conferences, a yearly exhibitionplan should be submitted for approval as well.
1.10The contractorshall provide a quarterly report outlining provided and plannedtargeted beneficiary and provider education in accordance with DDForm 1423, CDRL, located in Section J of the applicable contract.
1.11DHA Communicationsshall review and approve education or communication materials developedby the contractor (for example; facts sheets, news releases, talkingpoints, and public affairs guidance). The contractor’s timelinefor submission shall include sufficient time, as determined by theGovernment, for Government review for audience appropriateness,accuracy, timeliness, use of plain language, 508 compliance, and anyother criteria identified by the Government. DHA Communicationsand the TMEP contractor shall work closely to address completionof items with a short suspense.
2.0Government Staff and BeneficiaryEducation
The provisionsof Chapter 11, Section 2, are superseded by thefollowing:
2.1The contractor shall not maintainpublic web content about TRICARE benefits. They may have a secure portalthat contains transactional content (e.g., explanation of benefits,referrals, bill pay, provider education, and other online businessitems), but unsecured portions of their site shall contain simplythe login page and a series of links to TRICARE.mil for the informationalcontent (e.g., costs, eligibility, covered services, qualifyinglife events, etc.).
2.2The public login page and secureportal portions of web presence shall follow the TRICARE.mil lookand feel as closely as possible. DHA will provide Cascading StyleSheets (CSS) files on request to make the adoption of the TRICARE.millook and feel easier.
2.3The contractor shall adopta DHA approved TRICARE Uniform Resource Locator (URL) for proposed websites.DHA will own and manage the domain and license its use to the contractor.TRICARE URL examples are www.TRICARE-West.com, www.TRICARE-East.com, www.TRICARE-overseas.com.The contractor shall not use corporate URLs for TRICARE customerwebsites.
2.4The contractor shall followDepartment of Defense (DoD) and Federal Government website rules, includingguidance on 508 compliance, mobile responsiveness, National Instituteof Standards and Technology (NIST)-compliance, and plain languagewriting.
2.5Information contained on thecontractor’s website will not substitute for written or telephonic communicationwith the beneficiary if those communication tools are in the bestinterest of the beneficiary.
2.6The contractorshall recommend messages and placement on government managed platformsto reach the target audience. Examples include social media posts,additional web content, recommendations for articles, and informationfor inclusion in press releases or media pitching.
2.7Use ofthe TRICARE trademarks, logo, brand, name, or any aggregate Governmentor personal TRICARE data collected as a TRICARE contractor to explicitlypromote non-TRICARE related products and services to TRICARE beneficiariesis prohibited. The contractor may state their TRICARE contractorstatus in company marketing/promotional activities as long as UnitesStates Government, Military Health System (MHS), or DHA endorsem*ntof the contractor is not implied.
2.8The contractorshall monitor and report on customer access assistance, customersupport hour usage and web analytics in accordance with DD Form1423, CDRL, located in Section J of the applicable contract.
3.0Beneficiary,Congressional, Media, Beneficiary Counseling and Assistance Coordinator(BCAC), and Debt Collection Assistance Officer (DCAO) Relations
The provisions of Chapter 11, Section 3, paragraph 3.0, specificto Market/Military Medical Treatment Facilities (MTFs) Prime ServiceAreas (PSAs) are not applicable to TMEP except the contractor willprovide sufficient telephone lines addressed in this paragraph tomeet the requirements in Section 1.
3.1Media
The provisions of Chapter 11, Section 6, paragraph 9.0 are supersededby the following:
3.1.1DHA Communicationsand the TMEP contractor will work together to support media-relatedactivities. Media relations programs implemented by the Governmentand the contractor on behalf of the Government will have three objectives:educate beneficiaries about changes to their TRICARE benefit, respondto media queries quickly and accurately and inform the Americanpublic about Government activities related to the TRICARE program.The contractor will conduct a media-relations program in accordancewith DoD guidelines and guidance provided by DHA Communications.The contractor shall provide regular feedback to DHA Communications regardingtheir media activities, including coordination of proposed responsesto media queries for sensitive and controversial issues. The contractorwill keep DHA Communications, the Contracting Officer (CO), andthe Program Office aware of public and beneficiary perceptions regardingTRICARE policies and procedures, and advise DHA on proposed communicationstrategies for responding to these issues.
3.1.2All publishedmaterials will communicate consistent TRICARE program messages withone voice and tone. Contractors will perform the following in theirmedia relations program, with approval from the Government, unlessotherwise directed:
•Respond to media questionsabout contractor roles, responsibilities and actions on behalf ofthe Government in support of the TRICARE program.
•Follow-up media contacts bysending copies of information provided to the media and a summaryof any discussions to DHA Communications when immediate action wasrequired.
3.1.3The TMEPcontractor will speak only on issues for which it has direct responsibilityand will not speculate on issues beyond the scope of the supportthey are providing to the Government.
3.1.4The TMEPcontractor will alert the Contracting Officer Representative (COR),Program Office, and DHA Communications on any situations that haveor may be likely to result in heightened or public media visibility.The contract will identify one point of contact to support timelyawareness and interaction. Items to be posted in a public forumhave to be approved by DHA Communications.
3.2SocialMedia
The followingadditional provisions are applicable to TMEP.
3.2.1The contractor will rely onDHA Communications social media to leverage those means of education andcommunication. The contractor will provide appropriate content forposting in response to identified educational opportunities on anad hoc basis or as requested by the Government.
3.2.1.1The contractor will identifya primary and an alternate contact in support of paragraph 3.2.1 tocreate written input for social media messaging and craft responsesto social media inquiries within a defined period of time (usuallynot to exceed one business day).
3.2.1.2The contractor will identifya primary and at least one alternate customer service support staffto contact beneficiaries and providers identifying specific issues/concernson the social media platform to assist with resolution. The Governmentwill provide the inquiry to the contractor via the Government designatedweb-based customer relations management system.
3.2.2The contractorwill assist DHA Communications in planning, designing, and implementinga comprehensive communications program that incorporates diversefunctions and issues, serves numerous distinct and specialized audiencesand responds rapidly, in crisis conditions to changing demands.
3.2.3The contractorwill submit information, including news releases, fact sheets, talkingpoints, communications plans, and public affairs guidance to DHACommunications for approval. The contractor’s timeline for submissionof ongoing materials will include sufficient time for governmentreview for accuracy, timeliness, use of plain language, 508 complianceand any other criteria as determined by the government. DHA Communications andthe contractor will work closely to address completion of itemswith a short suspense.
4.0InquiryService Department - General
The TMEP shall follow the provisionsof Chapter 11, Section 4, related to an inquiryservice department. The provision of paragraph 2.0 are replacedwith the contractor shall provide trained personnel to answer allTRICARE inquiries in accordance with Section 1.
5.0TelephoneInquiries
5.1The provisions of Chapter 11, Section 7, are applicable to TMEPwith the below noted changes.
5.2The provisionsof Chapter 11, Section 7, paragraphs 1.1 through 1.5, are superseded by the following: The TMEPcontractor shall provide a toll-free telephone inquiry system. Thetoll-free telephone inquiry system shall provide 24-hour, sevendays a week, nationally accessible service. The system shall befully staffed, continuous with callers having the option of speakingwith a customer service representative between the hours of 6:00am and 11:00 pm EST (except weekends and federal holidays). Telephoneaccess outside of these hours may be accomplished through an IVRunit. Responses shall be furnished within the time frames notedin Section 1.
5.3The provisionsof Chapter 11, Section 7, paragraph 1.6, aresuperseded by the following: after hours, the telephone system shallindicate the hours customer service representatives are available.Calls shall be handled in the order they are received. The contractorshall advertise the toll-free service using available media includingthe Explanation of Benefits (EOB) and other appropriate sources.
5.4The provisionsof Chapter 11, Section 7, paragraphs 2.0 through 2.2, are applicable to TMEP with the exceptionthat the contractor shall meet the telephone requirements and standardsin Section 1.
5.5The provisionsof Chapter 11, Section 7, paragraph 3.0, areapplicable to TMEP with the exception of the noted normal businesshours. Business hours for TMEP are noted in paragraph 3.1.1.
5.6The provisionsof Chapter 11, Section 7, paragraphs 3.2.1.2.2 through 3.2.1.2.4,are applicable to TMEP with the exception of providing network provideravailability/assistance.
5.7The contractor shall referto Section 1, for the Telephone Standards insteadof the provisions of Section 1, paragraphs 3.5 through 3.7.
5.8The contractorshall follow Section 1 and DD Form 1423, CDRL, locatedin Section J of the applicable contract instead of the provisionsof Section 1, paragraphs 3.7.1 through 3.7.2.1.
5.9The provisionsof Chapter 11, Section 7, paragraph 6.0, aresuperseded by the following: the contractor shall collect and reportcustomer support data, operational data and analytics in accordancewith DD Form 1423, CDRL, located in Section J of the applicablecontract.
5.10The provisions of Chapter11, Section 7, paragraph 7.0, are applicable to TMEPwith the exception of providing access to information for staffoutside the Market/MTF.
6.0Grievancesand Grievances Processing
6.1The provisions of Chapter 11, Section 8, in relation to grievancesand grievances processing are applicable to TMEP.
6.2The provisionsof Chapter 11, Section 8, paragraph 2.0, areapplicable with the exception that the contractor shall report qualityof care issues to CMS when CMS is the primary payer.
7.0CollectionActions against Beneficiaries
The provisions of Chapter 11, Section 9, in relation to collectionactions against beneficiaries are applicable to TMEP.
•TRICARE Logo.
•The provisions of Chapter 11, Addendum A are applicable to TMEP.The link to the TRICARE Logo Style Guide is https://tricare.mil/trademark.
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