PARIS FEDERAL FILE Presented by Stefanie Johnson MBA Business Analyst New Hampshire Department of Health amp Human Services 6032714723 sjohnsondhhsstatenhus New Hampshire Department of Health amp Human Services ID: 695575
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Identifying Tricare Insurance for Medicaid Recipients Using the PARIS FEDERAL FILE
Presented byStefanie Johnson, MBABusiness AnalystNew Hampshire Department of Health & Human Services603-271-4723sjohnson@dhhs.state.nh.us
New Hampshire
Department of Health & Human ServicesSlide2
New Hampshire History with ParisAugust 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 wellPresently NH participates in all three PARIS matches on a quarterly basisBy far, the Federal file has yielded the most valuable information for NH Medicaid, Third Party Liability/Coordination of Benefits
New Hampshire Department of Health Slide3
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 ServicesSlide4
Determining Tricare Eligibility
Client records containing the following codes in the “Record Type” field are eligible for Tricare health insuranceMA for Military Active DutyMR for Military RetiredMV for Military ReservedTRICARE 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 ServicesSlide5
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 HampshireDepartment of Health & Human ServicesSlide6
Determining Federal Health Insurance CoverageClient records containing the following codes in the “Record Type” field may be eligible for Federal health insurance coverage
CD for Civilian Department of DefenseCO for Civilian Office of Personnel ManagementCR for Civilian RetiredThe NH return file has only reported Civilian Retired personnel.Policy information is not provided on the Federal Return fileNH 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 ServicesSlide7
Why is Tricare Insurance Data Important to New Hampshire?
Military Installations Located in NHPortsmouth Naval Shipyard in Portsmouth, NHPease Air National Guard Base in Portsmouth, NH
New HampshireDepartment of Health & Human ServicesSlide8
Benefits for Identifying Other Insurance
Compliance with Federal Law to assure Medicaid is Payor of Last ResortTricare 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 onlyReduces the State’s Medicaid costs by transferring eligible costs from Medicaid to other insuranceMedicaid 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 ServicesSlide9
1st Year Results (3 return files)w/ PARIS Federal FileUsing DEERS On-Line
Identified 100 Medicaid Recipients with Tricare InsuranceMedicaid Cost avoided over $82,000 in claims deferred to TricareMedicaid 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 ServicesSlide10
Access to DEERS On-LineWeb site provided by the Defense Manpower Data Center (DMDC)
MOU Agreement and Justification for Access LetterStandard documents to which state must fill in site specific information and which must be signed by a director level individualAuthority 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