Defense health care: DOD expects new IT system capabilities to improve other health insurance processing : report to congressional committees
- Collection:
- Health Policy and Services Research
- Alternate Title(s):
- DOD expects new IT system capabilities to improve other health insurance processing: report to congressional committees
- Contributor(s):
- United States. Government Accountability Office, issuing body. United States. Congress, issuing body.
- Publication:
- Washington, DC : United States Government Accountability Office, March 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Government Regulation Military Health Services -- economics National Health Insurance, United States -- economics United States United States. Department of Defense
- Genre(s):
- Technical Report
- Abstract:
- Why GAO did this study. Through DOD’s TRICARE health plan, beneficiaries—including servicemembers and dependents— may receive care from the direct care system of military hospitals or clinics, or from the private sector care system of civilian providers administered by contractors. When non-active duty beneficiaries have OHI, DOD is authorized to recover the cost of providing their health care. Public Law 116-283 includes a provision for GAO to review DOD’s OHI billing practices for care received under the TRICARE program. This report (1) describes challenges MTFs may face when processing OHI third-party claims for TRICARE beneficiaries; and (2) examines OHI information contractors submit to DOD for beneficiaries who receive care from civilian providers. GAO examined relevant documentation for the collection and billing of OHI claims and interviewed DHA officials, including those responsible for MHS GENESIS and its new billing component; contractor officials; and officials from six MTFs selected for variety in military service, use of MHS GENESIS, and amount of OHI payment received in 2018 through 2020—the most recent data available. What GAO Recommends. GAO recommends that DHA phase out the OHI repository, including the requirement for contractors to submit OHI information to it. DOD concurred with GAO’s recommendation and stated that the implementation of MHS GENESIS and Rev-X will enable the department to phase out the OHI repository.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (ii, 24 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918434585006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918434585006676