Tricare Insurance Identification for Medicaid Recipients in New Hampshire
Identifying Tricare Insurance for
Medicaid Recipients Using the
PARIS FEDERAL FILE
Presented by
Stefanie Johnson, MBA
Business Analyst
New Hampshire Department of Health & Human Services
603-271-4723
sjohnson@dhhs.state.nh.us
New Hampshire
Department of Health & Human Services
New Hampshire History with Paris
•
August 2009 New Hampshire submitted its first ever PARIS match file
for the State-to-State match only. Submission was done annually
•
August 2010 NH expanded its PARIS match with the addition of both
the Federal and VA match as well
•
Presently NH participates in all three PARIS matches on a quarterly
basis
•
By far, the Federal file has yielded the most valuable information for
NH Medicaid, Third Party Liability/Coordination of Benefits
New Hampshire Department of Health
Background of Federal File
The Federal match file is the data file returned to participating member
States that matches State enrollment data with information from the
Department of Defense and the Office of Personnel Management
The file identifies clients from Federal sources for active and retired
Federal civilian employees and active and retired military personnel
In addition, the file contains information that can be used to identify the
potential for third-party insurance coverage from Federal sources for
Medicaid clients
New Hampshire
Department of Health & Human Services
Determining Tricare Eligibility
•
Client records containing the following codes in the “Record Type”
field are eligible for Tricare health insurance
•
MA for Military Active Duty
•
MR for Military Retired
•
MV for Military Reserved
•
TRICARE is the health care program serving active duty service
members, National Guard and Reserve members, retirees, their
families, survivors and certain former spouses worldwide
•
Using the Defense Enrollment Eligibility Reporting System (DEERS)
an individual client’s (and their dependents) Tricare eligibility and
coverage type is verified with begin and end dates to be entered into
the Medicaid Management Information System
New Hampshire
Department of Health & Human Services
What is DEERS?
The Defense Enrollment Eligibility Reporting
System is a Central System which provides
a uniform means of determining the
eligibility for benefits (specifically Tricare)
of Uniformed Services personnel, retirees,
and family members.
New Hampshire
Department of Health & Human Services
Determining Federal Health Insurance
Coverage
•
Client records containing the following codes in the “Record Type”
field may be eligible for Federal health insurance coverage
•
CD for Civilian Department of Defense
•
CO for Civilian Office of Personnel Management
•
CR for Civilian Retired
•
The NH return file has only reported Civilian Retired personnel.
•
Policy information is not provided on the Federal Return file
•
NH Medicaid Third Party Liability sends each individual identified as
a Civilian Retiree a letter requesting health insurance information for
that recipient. This correspondence includes questionnaire and a return
address envelope.
New Hampshire
Department of Health & Human Services
Why is Tricare Insurance Data Important
to New Hampshire?
Military Installations Located in NH
Portsmouth Naval Shipyard in Portsmouth, NH
Pease Air National Guard Base in Portsmouth, NH
New Hampshire
Department of Health & Human Services
Benefits for Identifying Other Insurance
•
Compliance with Federal Law to assure Medicaid is Payor of Last
Resort
•
Tricare and other Federal health insurance must pay providers first and
Medicaid will pay up to but not more than the Medicaid allowed
amount for Medicaid covered services only
•
Reduces the State’s Medicaid costs by transferring eligible costs from
Medicaid to other insurance
•
Medicaid may recoup $$ paid to providers for services that should
have been covered by other insurance.
•
Note: Federal Military insurance regulations supersede State laws,
therefore the laws in place regarding TPL are not valid with Tricare.
Recouping funds is limited to 12 months (not 3 years) as per DRA
laws making it all the more important to identify Tricare coverage as
early as possible.
•
Recipients may receive covered benefits from other insurance that are
not included as a Medicaid covered service
New Hampshire
Department of Health & Human Services
1st Year Results (3 return files)
w/ PARIS Federal File
Using DEERS On-Line
•
Identified 100 Medicaid Recipients with Tricare Insurance
•
Medicaid Cost avoided over $82,000 in claims deferred to Tricare
•
Medicaid Saved $53,000 in claims paid in part or completely by
Tricare
•
Recouped more than $27,000 of Medicaid fund from Tricare for
claims previously paid
New Hampshire
Department of Health & Human Services
Access to DEERS On-Line
•
Web site provided by the Defense Manpower Data Center (DMDC)
•
MOU Agreement and Justification for Access Letter
Standard documents to which state must fill in site specific information
and which must be signed by a director level individual
•
Authority to Operate (ATO)
A letter which states your system has been properly tested and certified
•
Contact:
Althea.Frazier.ctr@ods.pentagon.mil
For documentation and submission process
New Hampshire
Department of Health & Human Services
New Hampshire Department of Health & Human Services utilizes the PARIS Federal File to identify Tricare insurance for Medicaid recipients, including information on the history, background of the Federal File, and determining Tricare eligibility through DEERS. By participating in quarterly matches, NH leverages Federal data to enhance Medicaid services efficiently.
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Presentation Transcript
New Hampshire Department of Health & Human Services Identifying Tricare Insurance for Medicaid Recipients Using the PARIS FEDERAL FILE Presented by Stefanie Johnson, MBA Business Analyst New Hampshire Department of Health & Human Services 603-271-4723 sjohnson@dhhs.state.nh.us
New Hampshire Department of Health New Hampshire History with Paris August 2009 New Hampshire submitted its first ever PARIS match file for the State-to-State match only. Submission was done annually August 2010 NH expanded its PARIS match with the addition of both the Federal and VA match as well Presently NH participates in all three PARIS matches on a quarterly basis By far, the Federal file has yielded the most valuable information for NH Medicaid, Third Party Liability/Coordination of Benefits
New Hampshire Department of Health & Human Services Background of Federal File The Federal match file is the data file returned to participating member States that matches State enrollment data with information from the Department of Defense and the Office of Personnel Management The file identifies clients from Federal sources for active and retired Federal civilian employees and active and retired military personnel In addition, the file contains information that can be used to identify the potential for third-party insurance coverage from Federal sources for Medicaid clients
New Hampshire Department of Health & Human Services Determining Tricare Eligibility Client records containing the following codes in the Record Type field are eligible for Tricare health insurance MA for Military Active Duty MR for Military Retired MV for Military Reserved TRICARE is the health care program serving active duty service members, National Guard and Reserve members, retirees, their families, survivors and certain former spouses worldwide Using the Defense Enrollment Eligibility Reporting System (DEERS) an individual client s (and their dependents) Tricare eligibility and coverage type is verified with begin and end dates to be entered into the Medicaid Management Information System
New Hampshire Department of Health & Human Services What is DEERS? The Defense Enrollment Eligibility Reporting System is a Central System which provides a uniform means of determining the eligibility for benefits (specifically Tricare) of Uniformed Services personnel, retirees, and family members.
New Hampshire Department of Health & Human Services Determining Federal Health Insurance Coverage Client records containing the following codes in the Record Type field may be eligible for Federal health insurance coverage CD for Civilian Department of Defense CO for Civilian Office of Personnel Management CR for Civilian Retired The NH return file has only reported Civilian Retired personnel. Policy information is not provided on the Federal Return file NH Medicaid Third Party Liability sends each individual identified as a Civilian Retiree a letter requesting health insurance information for that recipient. This correspondence includes questionnaire and a return address envelope.
New Hampshire Department of Health & Human Services Why is Tricare Insurance Data Important to New Hampshire? Military Installations Located in NH Portsmouth Naval Shipyard in Portsmouth, NH Pease Air National Guard Base in Portsmouth, NH
New Hampshire Department of Health & Human Services Benefits for Identifying Other Insurance Compliance with Federal Law to assure Medicaid is Payor of Last Resort Tricare and other Federal health insurance must pay providers first and Medicaid will pay up to but not more than the Medicaid allowed amount for Medicaid covered services only Reduces the State s Medicaid costs by transferring eligible costs from Medicaid to other insurance Medicaid may recoup $$ paid to providers for services that should have been covered by other insurance. Note: Federal Military insurance regulations supersede State laws, therefore the laws in place regarding TPL are not valid with Tricare. Recouping funds is limited to 12 months (not 3 years) as per DRA laws making it all the more important to identify Tricare coverage as early as possible. Recipients may receive covered benefits from other insurance that are not included as a Medicaid covered service
New Hampshire Department of Health & Human Services 1st Year Results (3 return files) w/ PARIS Federal File Using DEERS On-Line Identified 100 Medicaid Recipients with Tricare Insurance Medicaid Cost avoided over $82,000 in claims deferred to Tricare Medicaid Saved $53,000 in claims paid in part or completely by Tricare Recouped more than $27,000 of Medicaid fund from Tricare for claims previously paid
New Hampshire Department of Health & Human Services Access to DEERS On-Line Web site provided by the Defense Manpower Data Center (DMDC) MOU Agreement and Justification for Access Letter Standard documents to which state must fill in site specific information and which must be signed by a director level individual Authority to Operate (ATO) A letter which states your system has been properly tested and certified Contact: Althea.Frazier.ctr@ods.pentagon.mil For documentation and submission process
