[Federal Register: March 29, 2006 (Volume 71, Number 60)]
[Notices]
[Page 15702-15704]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29mr06-56]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
[DoD-2006-OS-0047]
Privacy Act of 1974; System of Records
AGENCY: Office of the Secretary, DoD.
ACTION: Notice to amend systems of records.
-----------------------------------------------------------------------
SUMMARY: The Office of the Secretary of Defense is amending a system of
records notice in its existing inventory of record systems subject to
the Privacy Act of 1974, (5 U.S.C. 552a), as amended.
DATES: This proposed action will be effective without further notice on
April 28, 2006 unless comments are received which result in a contrary
determination.
ADDRESSES: Send comments to the OSD Privacy Act Coordinator, Records
Management Section, Washington Headquarters Services, 1155 Defense
Pentagon, Washington, DC 20301-1155.
FOR FURTHER INFORMATION CONTACT: Ms. Juanita Irvin at (703) 696-4940.
SUPPLEMENTARY INFORMATION: The Office of the Secretary of Defense
systems of records notices subject to the Privacy Act of 1974, (5
U.S.C. 552a), as amended, have been published in the Federal Register
and are available from the address above.
The specific changes to the record system being amended are set
forth below followed by the notice, as amended, published in its
entirety. The proposed amendments are not within the purview of
susection (r) of the Privacy Act of 1974, (5 U.S.C. 552a), as amended,
which requires the submission of a new or altered system report.
Dated: March 23, 2006.
L.M. Bynum,
OSD Federal Register Liaison Officer, Department of Defense.
DTMA 04
System name:
Medical/Dental Claim History Files (May 9, 2003, 68 FR 24938).
Changes:
Notification procedure:
Add the following to the end of the entry: ``or TRICARE Management
Activity Privacy Office, Skyline 5, Suite
[[Page 15703]]
810, 5111 Leesburg Pike, Falls Church, VA 22041-3201.''
Record access procedures:
Add the following to the end of the entry: ``or TRICARE Management
Activity Privacy Office, Skyline 5, Suite 810, 5111 Leesburg Pike,
Falls Church, VA 22041-3201.''
DTMA 04
System name:
Medical/Dental Claim History Files.
System location:
TRICARE Management Activity, Department of Defense, 16401 East
Centretech Parkway, Aurora, CO 80011-9066, and contractors under
contract to TRICARE. A listing of TRICARE contractors maintaining these
records is available from the system manager.
Categories of individuals covered by the system:
Eligible beneficiaries and all individuals who seek health care
(medical and dental) under TRICARE/CHAMPUS and CHAMPVA.
Categories of records in the system:
File contains claims, billings for services, applications or
approval forms, enrollment files, recoupment files, third-party
liability files, fraud and abuse files, case management files, resource
sharing files, utilization management/quality assurance files, payment
files, medical/dental records, family history files, records of
grievances with a medical/dental provider, appeals, hearings, or any
other correspondence, memoranda, or reports which are acquired or
utilized in the development and processing of TRICARE/CHAMPUS or
CHAMPVA claims. Records are also maintained on health care
demonstration projects, including enrollment and authorization
agreements, correspondence, memoranda, forms and reports, which are
acquired or utilized during the projects.
Authority for maintenance of the system:
41 CFR 101-11.000; chapter 55, 10 U.S.C. 613, chapter 17, 38
U.S.C.; 32 CFR part 199; and E.O. 9397 (SSN).
Purpose(s):
TRICARE Management Activity and its contractors, DoD staff
(including Military Treatment Facilities, clinics and Lead Agent Staff)
use the information to control and process health care benefits
available under TRICARE/CHAMPUS and CHAMPVA including the processing of
medical/dental claims, the control and approval of medical/dental
treatments, issuance of deductible certificates, and necessary
interface with providers of health care. The system also supports
audits of contractor-processed claims to determine payment and
occurrence accuracy of the contractor's adjudication process.
Routine uses of records maintained in the system, including categories
of users and purposes of such uses:
In addition to those disclosures generally permitted under 5 U.S.C.
552a(b) of the Privacy Act, these records or information contained
therein may specifically be disclosed outside the DoD as a routine use
pursuant to 5 U.S.C. 552a(b)(3) as follows:
To the Department of Health and Human Services and/or the
Department of Veterans Affairs consistent with their statutory
administrative responsibilities under TRICARE/CHAMPUS and CHAMPVA
pursuant to chapter 55, 10 U.S.C. and section 613, chapter 17, 38
U.S.C.
Referral to Federal, State, local, or foreign governmental
agencies, and to private business entities, including individual
providers of care (participating and non-participating), on matters
relating to eligibility, claims pricing and payment, fraud, program
abuse, utilization review, quality assurance, peer review, program
integrity, third-party liability, coordination of benefits, and civil
or criminal litigation related to the operation of TRICARE/CHAMPUS.
Disclosure to the Department of Justice and the United States
Attorneys in situations where the United States is an interested party.
Disclosure to third-party contacts in situations where the party to
be contacted has, or is expected to have, information necessary to
establish the validity of evidence or to verify the accuracy of
information presented by the individual concerning his or her
entitlement, the amount of benefit payments, any review of suspected
abuse or fraud, or any concern for program integrity or quality
appraisal.
The DoD `Blanket Routine Uses' set forth at the beginning of OSD's
compilation of systems of records notices apply to this system.
Note: This system of records contains individually identifiable
health information. The DoD Health Information Privacy Regulation
(DoD 6025.18-R) issued pursuant to the Health Insurance Portability
and Accountability Act of 1996, applies to most such health
information. DoD 6025.18-R may place additional procedural
requirements on the uses and disclosures of such information beyond
those found in the Privacy Act of 1974 or mentioned in this system
of records notice.
Disclosure to consumer reporting agencies:
Disclosures pursuant to 5 U.S.C. 552a(b)(12) may be made from this
system to consumer reporting agencies as defined in the Fair Credit
Reporting Act of 1966 (15 U.S.C. 1681a(f)) or the Federal Claims
Collections Act of 1966 (31 U.S.C. 3701(a)(3)). The purpose of the
disclosure is to aid in the collection of outstanding debts owed to the
Federal Government; typically, to provide an incentive for debtors to
repay delinquent Federal Government debts by making these debts part of
their credit records.
The disclosure is limited to information necessary to establish the
identity of the individual, including name, address, and taxpayer
identification number (Social Security Number); the amount, status, and
history of the claim; and the agency or program under which the claim
arose for the sole purpose of allowing the consumer reporting agency to
prepare a commercial credit report.
Policies and practices for storing, retrieving, accessing, retaining,
and disposing of records in the system:
Storage:
Records are maintained on paper, electronic, microfilm, imaging, or
optical formats.
Retrievability:
Information is retrieved by sponsor's name; sponsor's Social
Security Number; beneficiary's name; beneficiary's Social Security
Number; provider's name; provider's number (Tax Identification Number
or Social Security Number); internal control number; classification of
medical diagnosis; procedure code; geographical location of care
provided; and selected utilization limits.
Safeguards:
Records are maintained in areas accessible only to authorized
personnel who are properly screened, cleared and trained. Decentralized
automated segments within contractor's operations are accessible on-
line only to authorized persons possessing user identification codes.
The automated portion of the Primary System is accessible only through
TRICARE Management Activity on-line data systems. Security systems and/
or security guards protect buildings where records are maintained.
Retention and disposal:
Paper records are closed out at the end of the calendar year in
which finalized and held six additional years and then destroyed. Where
hard copy
[[Page 15704]]
records (except Claims History Files) have been converted to
electronic, microfilm, imaging, or optical formats, the hard copy
record is destroyed and the electronic, microfilm, imaging, or optical
format is kept by the contractor for six years after claim is processed
to completion and then destroyed. Claims History Files maintained in
electronic format are kept for ten years and are then destroyed or
deleted.
System manager(s) and address:
TRICARE Management Activity, Department of Defense, Administration
and Evaluation Directorate, 16501 East Centretech Parkway, Aurora, CO
80011-9066.
Notification procedure:
Individuals seeking to determine whether information about
themselves is contained in this system should address written inquiries
to the TRICARE Management Activity, Department of Defense, ATTN:
Privacy Act Officer, 16401 Centretech Parkway, Aurora, CO 80011-9066;
or TRICARE Management Activity Privacy Office, Skyline 5, Suite 810,
5111 Leesburg Pike, Falls Church, VA 22041-3201.
Record access procedures:
Individuals seeking access to information about themselves
contained in this system should address written inquiries to the
TRICARE Management Activity, Department of Defense, ATTN; Privacy Act
Officer, 16401 Centretech Parkway, Aurora, CO 80011-9066; or TRICARE
Management Activity Privacy Office, Skyline 5, Suite 810, 5111 Leesburg
Pike, Falls Church, VA 22041-3201.
Written request for information should include the full name of the
beneficiary, the full name of the sponsor and sponsor's Social Security
Number, current address and telephone number.
For personal visits to examine records, the individual should
provide some acceptable identification such as a driver's license or
other form of picture identification.
If it is determined that the release of medical information to the
requester could have an adverse effect upon the individual's physical
or mental health, the requester should be prepared to provide the name
and address of a physician who would be willing to receive the medical
record, and at the physician's discretion, inform the individual
covered by the system of the contents of that record. In the event the
physician does not agree to convey the information contained within the
record to the individual, TRICARE Management Activity will take
positive measures to ensure the individual is provided the requested
information.
Contesting record procedures:
The OSD rules for accessing records, for contesting contents and
appealing initial agency determinations are published in OSD
Administrative Instruction 81; 32 CFR part 311; or may be obtained from
the system manager.
Record source categories:
Contractors, Health Benefit Advisors; other Components of the
Department of Defense; all branches of the uniformed Services;
Congressional offices; providers of care; consultants; and individuals.
Exemptions claimed for the system:
None.
[FR Doc. 06-3001 Filed 3-28-06; 8:45 am]
BILLING CODE 5001-06-M