Department of Defense Cancer Prevention and Treatment

1
Department of Defense Cancer Prevention and
Treatment

• UAMS
• RIS Team
• November 2003

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Topics of Discussion

• General Information
• Coverage
• Provider Requirements
• Claim Submission
• Enrollment
• Additional Notes

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Whaddya Know?
4

• Who gets TRICARE?
• Military Members and their Families
• Who Administers TRICARE?
• Department of Defense (DoD)

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• In the Coordination of Benefits, TRICARE is a
  _____________ payor.
• Secondary

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• What is a Plan Code?
• Alpha numeric identifier for an insurance plan
• Why are plan codes important?
• Contract information
• Provider numbers
• Timely and accurate billing

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How many TRICARE regions are there?

• 12

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• Which region are we in?
• Region 6
• What states make up Region 6?
• Arkansas
• Louisiana
• Oklahoma
• Texas
• Except West Texas and New Orleans

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• What is a TPA?
• Third Party Administrator

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Introduction

• The Department of Defense Cancer Prevention and
  Treatment Clinical Trials Demonstration is being
  conducted wherein the DoD will participate in
  cancer prevention and treatment clinical trials
  under approved National Cancer Institute (NCI)
  protocols.
• TRICARE Policy Manual 6010.47-M 3/15/02

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General Information

• For TRICARE enrollees
• All types of cancer
• Cancer Prevention
• Cancer Treatment
• National Cancer Institute Studies Phases II and
  III

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What are Clinical Trials?

• Research studies that help find ways to prevent,
  diagnose or treat illnesses and improve health
  care. When enrolled in these studies, people
  receive care that is considered the latest
  medicine or therapy, but is not yet approved as
  standard care.
• www.tricare.osd.mil/cancertrials/whatare.html

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Cancer Prevention Trials

• 2 Types
• Action and Agent
• Action focuses on whether certain actions can
  prevent cancer such as more exercise or quitting
  smoking
• Agent (chemoprevention) focuses on things like
  medicines or vitamins to prevent cancer

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Cancer Treatment Trials

• Also called Research Studies
• Test new treatments on people diagnosed with
  cancer
• New drugs
• New approaches to surgery or radiation therapy
• Gene Therapy

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3 Phases

• The NCI and DoD focus on Phases II and III
• Phase II focuses on on whether a therapy has an
  anticancer effect
• Phase III compares new treatments to standard ones

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Coverage

• TRICARE co-pays and deductibles apply
• Pays for all medical care required as a result of
  the NCI study
• Inpatient
• Outpatient
• Purchase and administration of Chemotherapy
• Diagnostic and Lab services

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Provider Requirements

• Pre-Authorization/Pre-Certification required -
  before Initial Evaluation as well!
• Some Retro-Active auths are possible
• Non Availability Statements are required except
  for those enrolled in Prime as of 09/23/96 - Rare
  for Region 6 North
• COB Secondary to other health coverage

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Claim Submission

• Claims Processed Manually
• Submit a copy of authorization letter with claim
• Both institutional and professional claims are
  paid based on billed charges
• Cancer Center must submit charges fully itemized
• Must be eligible in DEERS

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Claim Address Regions 1-5

• Plan Code D03
• Regions 1-5
• PGBA/DOD
• PO BOX 100514
• Florence, SC 29501
• Rep Deborah Goodman 800-779-3060
• Fax [phone] or 843-650-1962

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Claim Address Regions 6-12

• Plan Code D04
• Regions 6-12
• PGBA/DOD
• PO BOX 870060
• Surfside Beach, SC 29587
• Rep Billie Madden 800-395-7821
• Fax [phone]

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Enrollment

• Contact DoD Cancer Trials Demonstration
  Coordinator
• Regions 6, 11, 9, 10, 12 and central region call
  800-395-7821
• For all other regions call 800-779-3060

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Additional Notes

• All Authorizations should be documented in
  Comments and filed in EPF

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Contact Information

• NCI Info Service 800-422-6237
• NCI Web Site
• http//cancertrials.nci.nih.gov
• DoD Demonstration Coordinator
• 800-779-3060
• Military Health System Web Site
• www.tricare.osd.mil/cancertrials/
• Case Management 800-977-2206 Option 2,1 Cheryl
  Box