TRICARE Operations Manual 6010.59-M, April 1, 2015
TRICARE Medicare Eligible Program (TMEP)
Chapter 20
Section 11
CommunicationsAnd Customer Service (C&CS)
Revision:C-108, May 18, 2022
TMEP contractor shall complywith all TRICARE requirements noted in Chapter11 regarding Communications and Customer Service unlessspecifically changed, waived, or superseded by this section (asindicated below), the TRICARE Policy Manual (TPM), TRICARE Reimbursem*ntManual (TRM), TRICARE Systems Manual (TSM) or TMEP contract.
1.0EducationRequirements
1.1The requirements in Chapter 11, Section 1, are superseded by thefollowing:
1.2A collaborative effort betweenDefense Health Agency (DHA) Communications and the contractor shalladdress the 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.
1.3The 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 4 meetings/year), as directed by the Government.The purpose of these meetings are to develop, review, or revisedcore educational materials for the following calendar year, discussobservations from the previous year and discuss possible changesin education and communication activities.
1.4The 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.
1.5The contractorshall work with DHA to ensure beneficiaries receive unified, timely,accurate, consistent, and effective products and tools.
1.6The Governmentwill furnish the TMEP contractor printed TMEP, beneficiary- focused educationalmaterials. The Government will develop materials based on recommendationsby contractors, program managers, the Uniformed Services, DHA leadershipand others with interests and concerns about information sharedwith TRICARE beneficiaries and other stakeholders. DHA Communicationswill review all recommendations and prioritize products in accordancewith funding availability. DHA Communications will have final approvalauthority for TMEP products. The contractor shall discuss orderingof initial and subsequent educational materials with the Government.The contractor shall ensure the Memorandum of Understanding (MOU)with DHA Communications Division outlines the procedures.
1.7The contractorshall provide staff to perform timely reviews and provide inputto content developed by DHA Communications on a regular basis. Reviewsshall include printed products, web content, responses to queryfor media requests, customer service scripts, senior leader talkingpoints, briefings, and other products identified by the DHA.
1.8The contractorshall distribute TRICARE information using industry best practices(for example, email, telephone, media, social media, text messaging,chat and other contemporary methods) to ensure timely delivery andreceipt to TMEP beneficiaries.
1.9Upon 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 establish andmaintain effective communications with all TRICARE/Medicare dualeligible beneficiaries.
1.10The contractor shall submitan education plan, outlining how it intends to conduct targeted-TMEPeducation for beneficiaries and providers. The Program Office andDHA 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, the contractor shallsubmit a yearly exhibition plan for approval as well.
1.11The 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 contract.
1.12DHA Communicationswill 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 the Government,for Government review for audience appropriateness, accuracy, timeliness,use of plain language, 508 compliance, and any other criteria identifiedby the Government. DHA Communications and the TMEP contractor shallwork closely to address completion of items with a short suspense.DHA Communications requires a two business day minimum to reviewand approve materials.
2.0GovernmentStaff And Beneficiary Education
2.1The requirements in Chapter 11, Section 2, are superseded by thefollowing:
2.2The contractor shall not maintainpublic web content about TRICARE benefits. The contractor may havea secure portal that contains transactional content (e.g., explanationof benefits, referrals, bill pay, provider education, and otheronline business items), but unsecured portions of their site shall containsimply the login page and a series of links to TRICARE.mil for theinformational content (e.g., costs, eligibility, covered services,qualifying life events, etc.).
2.3The contractorshall ensure the public login page and secure portal portions ofweb presence follow the TRICARE.mil look and feel as closely aspossible. DHA will provide Cascading Style Sheets (CSS) files onrequest to make the adoption of the TRICARE.mil look and feel easier.
2.4The contractorshall adopt a DHA approved TRICARE Uniform Resource Locator (URL)for proposed websites. DHA will own and manage the domain and licenseits 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.
2.5The contractor shall followDepartment of Defense (DoD) and Federal Government website rules,including guidance on 508 compliance, mobile responsiveness, NIST-compliance,and plain language writing.
2.6The Governmentwill not accept information contained on the contractor’s web siteas a substitute for written or telephonic communication with thebeneficiary if those communication tools are in the best interestof the beneficiary.
2.7The contractor shall recommendmessages and placement on Government managed platforms to reachthe target audience. Examples include social media posts, additionalweb content, recommendations for articles, and information for inclusionin press releases or media pitching.
2.8The contractorshall not use 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 beneficiaries.The contractor may state their TRICARE contractor status in companymarketing/promotional activities as long as U.S. Government, MHS,or DHA endorsem*nt of the contractor is not implied.
2.9The 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
3.1The requirementsin Chapter 11, Section 3, paragraph 3.1.2, specificto Market/Military Treatment Facility (MTF) Prime Service Areas(PSAs) do not apply to TMEP except the contractor shall providesufficient telephone lines addressed in that paragraph to meet therequirements in Chapter 20, Section 1.
3.2Media
The requirements in Chapter 11, Section 3, paragraphs 5.0 through 5.4, are superseded by the following:
3.2.1DHA 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 shall conduct a media-relations program in accordancewith the DoD guidelines and guidance provided by DHA Communications.The contractor shall provide regular feedback to DHA Communicationsregarding their media activities, including coordination of proposedresponses to media queries for sensitive and controversial issues.The contractor shall keep DHA Communications, the Contracting Officer,and the Program Office aware of public and beneficiary perceptionsregarding TRICARE policies and procedures, and advise DHA on proposedcommunication strategies for responding to these issues.
3.2.2All publishedmaterials will communicate consistent TRICARE program messages withone voice and tone. The contractor shall perform the following intheir media relations program, with approval from the Government,unless otherwise directed:
3.2.2.1Respond to media questionsabout contractor roles, responsibilities and actions on behalf ofthe Government in support of the TRICARE program.
3.2.2.2Follow-up media contacts bysending copies of information provided to the media and a summaryof any discussions to DHA Communications when immediate action wasrequired.
3.2.3The TMEP contractor shall speakonly on issues for which it has direct responsibility and shallnot speculate on issues beyond the scope of the support they areproviding to the Government.
3.2.4The TMEPcontractor shall 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 contractor shall identify one point of contact to support timelyawareness and interaction. The contractor shall obtain DHA Communicationsapproval for items posted in a public forum.
3.3SocialMedia
3.3.1The contractor shall solelyrely on DHA Communications social media platforms and leverage thosemediums of education and communication. The contractor shall provideappropriate content for posting in response to identified educationalopportunities on an ad hoc basis or as requested by the Government.
3.3.1.1The contractor shall identifya primary and an alternate contact in support of paragraph 3.3.1 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).
3.3.1.2The contractor shall 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.
3.3.2The contractorshall assist DHA Communications in planning, designing, and implementing acomprehensive communications program that incorporates diverse functionsand issues, serves numerous distinct and specialized audiences andresponds rapidly in crisis conditions to changing demands.
3.3.3The contractorshall submit information, including news releases, fact sheets,talking points, communications plans, and public affairs guidanceto DHA Communications for approval. The contractor’s timeline forsubmission of ongoing materials shall include sufficient time forgovernment review for accuracy, timeliness, use of plain language,508 compliance and any other criteria as determined by the government.The contractor shall work closely with DHA Communications to addresscompletion of items with a short suspense.
4.0InquiryService Department-General
4.1The TMEP contractor shall complywith the requirements in Chapter 11, Section 4,related to an Inquiry Service Department with the exception of paragraph 3.0.Instead, the contractor shall provide trained personnel to answerall TRICARE inquiries in accordance with Chapter 20, Section 1.
4.2The requirementsin Chapter 11, Section 4, paragraph 5.0 do notapply to the TMEP contractor.
5.0Correspondence Control, ProcessingAnd Appraisal
The requirementsin Chapter 11, Section 5, paragraph 5.3 regardingcopies of congressional inquiries and the contractor’s responsebeing sent to DHA do not apply to the TMEP contractor.
6.0TelephoneInquiries
6.1The TMEP contractor shall complywith the requirements in Chapter 11, Section 6,with the changes noted below.
6.2The requirementsin Chapter 11, Section 6, paragraph 1.1, aresuperseded by the following: The TMEP contractor shall provide atoll-free telephone inquiry system with 24-hour, seven days a week, nationallyaccessible service. The contractor shall fully and continuouslystaff the system and provide callers with the option to speak witha customer service representative between the hours of 6:00 am and11:00 pm EST (except weekends and federal holidays). The contractormay use an IVR unit to meet telephone access standards outside ofthese hours. The contractor shall furnish responses within the timeframes noted in Chapter 20, Section 1.
6.3The requirementsin Chapter 11, Section 6, paragraph 1.2, aresuperseded by the following: The contractor shall ensure that afterhours, the telephone system indicates the hours customer service representativesare available. The contractor shall handle calls in the order theyare received. The contractor shall advertise the toll-free serviceusing available media including the Explanation of Benefits (EOB)and other appropriate sources.
6.4The TMEPcontractor shall comply with the requirements in Chapter 11, Section 6, paragraph 2.0 withthe exception that the contractor shall meet the telephone requirementsand standards in Chapter 20, Section 1.
6.5The TMEPcontractor shall comply with the requirements in Chapter 11, Section 6, paragraph 3.0, withthe exception of the noted normal business hours and the requirementto be staffed and operational on Federal Holidays which fall duringopen season. Business hours for TMEP are noted in paragraph 6.2.
6.6The TMEPcontractor shall comply with the requirements in Chapter 11, Section 6, paragraph 3.2, withthe exception of providing network provider availability/assistance.
6.7The contractorshall refer to Chapter 20, Section 1,for the Telephone Standards instead of the requirements in Chapter 11, Section 6, paragraphs 3.10 and 3.12.
6.8The contractorshall follow Chapter 20, Section 1 and CDRL M010 insteadof the requirements in Chapter 11, Section 6, paragraphs 3.12.1 and 3.12.2.
6.9The requirementsin Chapter 11, Section 6, paragraph 6.0, aresuperseded by the following: the contractor shall collect and reportcustomer support data, operational data and analytics in accordance withDD Form 1423, CDRL, in section J of the contract.
6.10The TMEPcontractor shall comply with the requirements in Chapter 11, Section 6, paragraph 7.0, withthe exception of providing access to information for staff outsidethe Market/MTF.
7.0AllowableCharge Reviews
The TMEPcontractor shall comply with the requirements in requirements in Chapter 11, Section 7, in relation to AllowableCharge Reviews.
8.0GrievancesAnd Grievances Processing
8.1The TMEP contractor shall complywith the requirements in Chapter 11, Section 8,in relation to grievances and grievances processing.
8.2The TMEPcontractor shall comply with the requirements in Chapter 11, Section 8, paragraph 2.0, exceptthat the contractor shall report quality of care issues to CMS whenCMS is the primary payer.
9.0CollectionActions Against Beneficiaries
The TMEP contractor shall complywith the requirements in Chapter 11, Section 9,in relation to collection actions against beneficiaries.
10.0TRICARELogo
The TMEP contractor shall complywith the requirements in Chapter 11, Addendum A. The link to the TRICARELogo Style Guide is https://tricare.mil/trademark.
- END -
