[Federal Register: February 8, 2005 (Volume 70, Number 25)]
[Notices]
[Page 6634]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08fe05-38]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Proposed Collection; Comment Request
AGENCY: Office of the Assistant Secretary of Defense for Health
Affairs.
ACTION: Notice.
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In accordance with section 3506(c)(2)(A) of the Paperwork Reduction
Act of 1995, the Office of the Assistant Secretary of Defense for
Health Affairs announces the proposed extension of a public information
collection and seeks public comment on the provisions thereof. Comments
are invited on: (a) Whether the proposed extension of collection of
information is necessary for the proper performance of the functions of
the agency, including whether the information shall have practical
utility; (b) the accuracy of the agency's estimate of the burden of the
information collection; (c) ways to enhance the quality, utility, and
clarity of the information to be collected; and (d) ways to minimize
the burden of the information collection on respondents, including
through the use of automated collection techniques or other forms of
information technology.
DATES: Consideration will be given to all comments received April 11,
2005.
ADDRESSES: Written comments and recommendations on the information
collection should be sent to TRICARE Management Activity--Aurora,
Office of Program Requirement, 16401 E. Centretech Parkway, ATTN:
Graham Kolb, Aurora, CO 80011-9043.
FOR FURTHER INFORMATION CONTACT: To request more information on this
proposed information collection, please write to the above address or
call TRICARE Management Activity, Office of Program Requirements at
(303) 676-3580.
Title Associated With Form, and OMB Number: Health Insurance Claim
Form, UB 92, OMB Number 0720-0013.
Needs and Uses: The information collection requirement is necessary
for a medical institution to claim benefits under the Defense health
Program, TRICARE, which includes the Civilian Health and Medical
Program for the Uniform Services (CHAMPUS). The information collected
will be used by TRICARE/CHAMPUS to determine beneficiary eligibility,
other health insurance liability, certification that the beneficiary
received the care, and that the provider is authorized to receive
TRICARE/CHAMPUS payments. The form will be used by TRICARE/CHAMPUS and
it's contractors to determine the amount of benefits to be paid to
TRICARE/CHAMPUS institutional providers.
Affected Public: Business or other for-profit; not-for-profit
institutions.
Annual Burden Hours: 525,000.
Number of Respondents: 2,100,000 annually.
Responses Per Respondent: 1.
Average Burden Per Response: 15 minutes.
Frequency: On occasion.
SUPPLEMENTARY INFORMATION:
Summary of Information Collection
This collection instrument is for use by medical institutions
filing for reimbursement with the Defense Health Program, TRICARE,
which includes the Civilian Health and Medical Program of the Uniformed
Services (TRICARE/CHAMPUS). TRICARE/CHAMPUS is a health benefits
entitlement program for the dependent of active duty members of the
Uniformed Service, and deceased sponsors, retirees and their
dependents, dependents of department of transportation (Coast Guard)
sponsors, and certain North Atlantic treaty Organization, National
Oceanic and Atmospheric Administration, and Public Health Service
eligible beneficiaries. Use of the UB-92 (also known as the HCFA 1450)
continues TRICARE/CHAMPUS commitments to use the national standard
claim form for reimbursement of medical services/supplies provided by
institutional providers.
Dated: January 31, 2005.
Patricia L. Topplings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-2381 Filed 2-7-05; 8:45 am]
BILLING CODE 5001-06-M