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Health IT Innovation and Research

Questions and Answers about Health IT Innovation and Research

Recommended Content:

Architecture, Advanced Concepts, and Engineering (AACE)
Q1:

What does AACE stand for?

A:

Architecture, Advanced Concepts and Engineering (The AACE Division replaces the former Innovation and Advanced Technology Development Division)

Q2:

How is the DHA/AACE working to increase transparency of HIT research initiatives across the enterprise?

A:

The AACE Division is committed to ensuring a consistent and centrally managed approach of HIT research initiatives. AACE has developed a process to identify, research, develop, test and evaluate innovative solutions that benefit the MHS enterprise. This streamlined evaluation process will increase transparency into HIT research initiatives and reduce parallel efforts underway. Be sure to view the latest snapshot of HIT R&D projects by checking out our HIT R&D Directory.

Q3:

How can I have my ideas heard by the DHA/ACCE?

A:

To have your ideas heard by us, visit our Health IT Research and Innovation page to explore your options or email us.

Frequently Asked Questions for Transactions

View questions and answers about the nationwide standards for HIPAA compliant electronic administrative health care transactions.

Recommended Content:

Transactions | Table of HIPAA Adopted Transactions Used by MHS
Q1:

Has the MHS provided Companion Guides for HIPAA Transactions?

A:

The TRICARE Managed Care Support Contractors (MCSCs) have provided companion guides for some of the HIPAA transactions they perform. Please contact the MCSC point of contact for your region to obtain the latest information.

Q2:

What is the General Inquiry for Defense Enrollment Eligibility Reporting System (DEERS) (GIQD), and who is able to access this system?

A:

The GIQD is a web-based, direct data entry system which allows authorized users to make eligibility inquiries. The GIQD has been updated to include HIPAA-compliant data elements and can be used in lieu of a direct Electronic Data Interchange (EDI) with DEERS.

Q3:

Is the Defense Online Enrollment System (DOES) enrollment application HIPAA compliant?

A:

The DOES application is a web-based, direct data entry system which can be utilized by Managed Care Support Contractors (MCSCs) to enroll TRICARE beneficiaries into TRICARE programs in the Defense Enrollment Eligibility Reporting System (DEERS). DOES has been updated to include HIPAA-compliant data elements. The system includes upgraded security features and was deployed to all users as of May 2003. All TRICARE enrollments are performed using the HIPAA-compliant DOES application.

Q4:

When will the Claims/Clinical Attachments Final Rule be published?

A:

The Centers for Medicare and Medicaid Services (CMS) published a Claims Attachments Notice of Proposed Rulemaking (NPRM) (CMS-005-0-F) in the Federal Register in September 2005. However, that NPRM was withdrawn in 2010 because of technology and business need changes. The Patient Protection and Affordable Care Act of 2010 (also known as ACA) requires the Department of Health and Human Services (HHS) to publish a Final Rule to adopt a Claims Attachment Standard and Operating Rules by January 2014 with an effective date not later than January 2016. Please note, while originally called "Claims Attachments" the health care industry has shifted toward the phrase "Clinical Attachments" to reflect the broader usage of the standard for purposes including but not limited to claims, referrals, and requests for pre-authorization. On 5 July 2016, National Committee on Vital and Health Services (NCVHS), the statutory advisory committee responsible for providing recommendations on health information policy and standards to HHS, recommended HHS publish a Final Rule to adopt a Clinical Attachment standard. As of January 2017, a Final Rule to adopt a Clinical Attachments Standard and Operating Rules had not been published.

Q5:

When was the industry required to use ASC X12 Version 5010 of the X12 HIPAA Electronic Data Interchange (EDI) standards?

A:

In a Final Rule published by the Department of Health and Human Services (HHS) in January 2009, covered entities were mandated to be in full compliance with Version 5010 and NCPDP Version D.0 by January 1, 2012. The Military Health System (MHS) successfully implemented the EDI standards and is in compliance with the Final Rule.

Frequently Asked Questions for Code Sets

View questions and answers about the nationwide standards for code sets used in the HIPAA compliant electronic health care transactions.

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Code Sets
Q1:

How do I know how to correctly code my claim?

A:

Q2:

What organization developed the ICD-10 code set?

A:

The World Health Organization (WHO), a specialized agency of the United Nations, owns and publishes the ICD code sets (including ICD-10).

Q4:

Why are code sets used in nationwide electronic health care transactions?

A:

By using standardized code sets, providers across the nation can easily and efficiently communicate with one another in order to serve patients and conduct administrative transactions.  In other words, the use of standardized code sets improves the interoperability of health care payers and providers by normalizing the “language” that is used.

Frequently Asked Questions for Identifiers

View questions and answers about the nationwide standards for identifiers used in HIPAA compliant electronic health care transactions.

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Health Plan Identifier and Other Entity Identifier | Identifiers | National Provider Identifier | Employer Identification Number
Q1:

What is the National Provider Identifier (NPI)?

A:

The NPI is a unique identification number for health care providers. Health care providers, health plans and health care clearinghouses use NPIs in the administrative and financial transactions specified by HIPAA. The NPI is a 10-position numeric identifier with a check digit in the last position to help detect invalid NPIs. The NPI contains no embedded intelligence; that is, it contains no information about the health care provider such as the type of health care provider or state where the health care provider is located.

Q2:

Which entities within and external to the MHS are required to get a National Provider Identifier (NPI)?

A:

There are two Health Affairs (HA) Policies and one HA Guideline that describe the types of providers in the MHS that require NPIs. These include: HA Policy 05-002 (NPI Enumeration of MHS Individual (Type 1) Health Care Providers), HA Policy 05-012 (NPI Enumeration of MHS Organizational (Type 2) Health Care Providers) and HA Guideline dated May 2007. According to these policies and guideline the following MHS providers are required to obtain and use an NPI: 

Individual (Type 1) Health Care Providers

Providers who furnish billable services or those that may initiate and/or receive referrals. In the MHS, this affects the following types of providers: All privileged providers, residents, and certain non-privileged providers such as Independent Duty Corpsmen who request referrals, Independent Duty Medical Technicians working in the cast clinic, or a nurse giving Depo-Provera injections when the patient has not seen the physician. These provider types need to be identified with an NPI in certain HIPAA electronic transactions.

Organizational (Type 2) Health Care Providers

  • Military Treatment Facilities (MTFs) with legislative authority to bill, including Defense Health Program (DHP) funded facilities and air evacuation facilities
  • MTFs that generate ambulatory data records, third party bills, Standard Inpatient Data Records and Standard Ambulatory Data Records
  • MTF pharmacy dispensing locations that currently have an NCPDP provider identification number
  • MTFs that generate or perform referrals
  • MTFs that provide health care services

Q3:

When are MHS providers required to use the National Provider Identifier (NPI)?

A:

MHS providers have been required to obtain and use the NPI since 2007.

Q4:

How are National Provider Identifiers (NPIs) issued?

A:

Health care providers can obtain NPIs by submitting an application to the National Plan and Provider Enumeration System (NPPES). The NPPES was developed by the Centers for Medicare and Medicaid Services (CMS) to process NPI applications. Providers have two options when applying for their NPIs:

After an application is successfully processed, health care providers will be notified of their NPIs. HHS has contracted with an organization, known as the enumerator, to process NPI applications. In addition to receiving and processing NPI applications and notifying health care providers of their NPIs, the enumerator uses the NPPES to perform the following functions: ensure the unique identification of a health care provider; answer questions about the processes of applying for and obtaining NPIs and furnishing updates; collect information via the applications and updates, maintain the NPPES database containing NPIs and information about the health care providers to which they are assigned; and furnish information upon request and in accordance with established guidelines.

Q5:

What should you do now as a MHS provider?

A:

Ensure the MHS has your National Provider Identifier (NPI) on file. MHS providers who furnish billable health care services, write prescriptions, initiate and/or receive referrals should have obtained, submitted and began using an NPI effective May 2007. This includes all privileged providers, residents, and certain non-privileged providers. Non-privileged providers are required to obtain an NPI if they request referrals, request consults, write prescriptions or provide billable services. For example, Independent Duty Corpsmen who request referrals, Independent Duty Medical Technicians working in the cast clinic or a nurse giving Depo-Provera injections when the patient has not seen the physician would need to be identified in certain HIPAA electronic transactions.

  1. Active Duty providers in any of the Services should submit their NPI to their Military Treatment Facility (MTF) Credentialing Office.
  2. Army Reserve providers should submit their NPI to the Army Reserve Centralized Credentialing Affairs (ARCCA), excluding the Individual Mobilization Augmentee (IMA) who will turn it into their MTF of assignment.
  3. Army National Guard providers should submit their NPI into the State Surgeons Office where their credentialing office is located.
  4. Navy Reserve Independent Practitioners should provide their NPI during the normal privileging application process. The Centralized Credentials and Privileging Department, NHSO Jacksonville began collecting NPIs effective June 15, 2005.
  5. Air Force Reserve and Guard providers should submit a copy of their NPI letter to their local reserve or guard unit Credentials Manager.

Once an MHS provider has an NPI, these offices will forward a copy of the NPI letter to the appropriate support office for entry of the NPI information into the Defense Manpower Human Resource System internet (DMHRSi), which is the MHS repository for the NPI. If you are a new MHS provider, refer to the question, "How are NPIs issued?"

Q6:

Are there any special instructions for Physician Assistants (PAs)?

A:

Due to the inconsistency between state licensure requirements for PAs, they are allowed to obtain an NPI without having to furnish a license number and/or state of license.

Q7:

Will I use the same National Provider Identifier (NPI) that I have for my civilian practice?

A:

Yes, you have just one NPI for life; no matter where you are working or what specialty you are practicing.

Q8:

How are National Provider Identifiers (NPIs) used in the MHS?

A:

The NPI is used as a means of communicating the identity of providers in HIPAA electronic transactions (e.g., billing and referral purposes) both within and external to the MHS. NPIs are also used for non-HIPAA purposes where a provider identifier is needed, such as on paper claim forms (e.g., CMS-1500 and UB-04 claims), referral forms and on prescriptions.

Q9:

What are the uses of the National Provider Identifier (NPI)?

A:

The NPI must be used to identify providers in standard electronic transactions identified by HIPAA. In addition, the NPI may be used in several other ways:

  1. By health care providers to identify themselves in health care transactions identified in HIPAA or on related correspondence;
  2. By health care providers to identify other health care providers in health care transactions or on related correspondence;
  3. By health care providers on prescriptions (however, the NPI could not replace requirements for the Drug Enforcement Administration number or State license number);
  4. By health plans in their internal provider files to process transactions and communicate with health care providers;
  5. By health plans to coordinate benefits with other health plans;
  6. By health care clearinghouses in their internal files to create and process standard transactions and to communicate with health care providers and health plans;
  7. By electronic patient record systems to identify treating health care providers in patient medical records;
  8. By Health and Human Services (HHS) to cross reference health care providers in fraud and abuse files and other program integrity files;
  9. For any other lawful activity requiring individual identification of health care providers, including activities related to the Debt Collection Improvement Act of 1996 and the Balanced Budget Act of 1997.

Q10:

Can health care providers use other numbers besides the National Provider Identifier (NPI) to identify themselves in standard transactions?

A:

As of May 23, 2008, the NPI is the only identifier that can be used to identify a health care provider in standard transactions. Use of legacy identifiers (such as the Unique Physician Identification Number (UPIN), Medicaid Provider Number, Medicare Provider Number, and others) were discontinued on May 23, 2008. Where a health care provider must be identified in standard transactions for tax purposes, it would use its Taxpayer identification as required by the implementation specifications. Health care provider identifiers other than the NPI may continue to be used in the internal processes and files of health plans or health care clearinghouses if they wish to continue to use those identification numbers in those internal processes and files.

Q11:

Can a health plan require its enrolled health care providers who are not covered entities to obtain and use National Provider Identifiers (NPIs)?

A:

Yes, although the NPI Final Rule does not require that health care providers who are not covered entities under HIPAA obtain or use an NPI, the Rule also does not prohibit health plans from requiring their enrolled health care providers that are eligible for an NPI to obtain one.

Note: The NPI Final Rule does prohibit health plans from requiring a health care provider with an NPI to obtain additional NPIs.

Q12:

What if I am a provider who does not use HIPAA electronic transactions for billing or other administrative aspects of providing healthcare? Is there any reason why I should get a National Provider Identifier (NPI)?

A:

While the NPI Final Rule does not require providers who do not conduct HIPAA electronic transactions to obtain an NPI, all eligible providers are encouraged to obtain an NPI. One reason is that the CMS-1500 and UB-04 paper claim forms were updated to accommodate the NPI and health plans have the option to require the NPI be used on these paper forms. Another reason for eligible providers to get an NPI is that there may still be other instances where providers who do not conduct HIPAA standard electronic transactions would need to be identified in standard transactions conducted by other providers. For example, a physician who writes a prescription (electronic or paper) but does not bill health plans directly is not required by the NPI Final Rule to obtain an NPI; however, there are transactions that will be generated after the prescription is written, and some of those are standard electronic transactions. The pharmacy that fills the prescription will most likely bill for the prescription claim electronically (a HIPAA standard electronic transaction). If the physician who wrote the prescription does not have an NPI, the pharmacy is left with the problem of how to identify the prescriber on this billing transaction.

Q13:

Will a health care provider's National Provider Identifier (NPI) ever change?

A:

The NPI is meant to be a lasting identifier, and does not change based on changes in a health care provider's name, address, ownership, membership in health plans, or Healthcare Provider Taxonomy classification. There may be situations where use of an NPI for fraudulent purposes results in a health care provider requesting a different NPI. Such situations will be investigated and a different NPI may be assigned to the requesting health care provider.

Q14:

Are health care providers required to renew their National Provider Identifier (NPI)?

A:

Health care providers are not required to renew their NPI once issued.

Q15:

If a health care provider with a National Provider Identifier (NPI) moves to a new location, must the health care provider notify the enumerator of its new address?

A:

A covered health care provider must notify the enumerator of changes in any of the information that it furnished on its application for an NPI, and must do so within 30 days of the change. Health care providers who have been assigned NPIs, but are not covered entities, should do the same.

Q16:

How long does it take to get a National Provider Identifier (NPI)?

A:

According to the enumerator, it is difficult to predict the amount of time it takes to obtain an NPI because several factors come into play. Such factors include the volume of applications being processed at a given time, whether the application was submitted electronically or on paper, and whether the application was complete and passed all edits. It is expected that a health care provider who submits a properly completed electronic application could have their NPI within 10 days.

Q17:

Does a health care provider have to pay for a National Provider Identifier (NPI)?

A:

No, a health care provider is not charged, and does not have to pay a fee in order to obtain an NPI.

Q18:

Will there be enough National Provider Identifiers (NPIs) to enumerate all health care providers? Will we ever run out?

A:

Yes, there will be enough NPIs. The format of the NPI and the assignment strategy will enable the enumeration of over 200 million health care providers. Yes, the availability of NPIs will eventually run out. At the current rate of increase in the number of providers in the United States, this should enable HHS to enumerate health care providers for 200 years.

Q19:

Can National Provider Identifiers (NPIs) be used on paper claims transactions?

A:

The use of NPIs on paper claims transactions is allowed. The health plan receiving the claim may make the determination on the use of NPIs on paper claims transactions. HIPAA regulations adopt standards for format and content of certain electronic health transactions; they do not address the content of paper claims transactions.

Q20:

Does the National Provider Identifier (NPI) replace the use of provider Social Security Numbers (SSNs) in medical records and on other medical administrative paperwork?

A:

In some cases, an SSN may be the most appropriate identifier (e.g., in uses where there are tax implications). Over time, users of the NPI will likely find places where the NPI can take the place of other identifiers (possibly including some places where the SSN is currently used). HIPAA only requires the use of NPI for HIPAA-covered electronic transactions, but the MHS and other health care organizations may decide to use the NPI to improve or simplify other healthcare business processes.

Q21:

How do I update information on my National Provider Identifier (NPI)?

A:

To update information associated with your NPI, such as a tax ID and Provider name, or to apply for an NPI, contact the NPI Enumerator. The NPI Enumerator is responsible for assisting health care providers in applying for their NPIs and updating information in the National Plan and Provider Enumeration System (NPPES). For more information, visit the NPPES Website.

Q22:

How do I submit my National Provider Identifier (NPI) to TRICARE?

A:

NPI submission is based on region. Please choose the appropriate region from the following links: 

Q23:

Where can I find National Provider Identifiers (NPIs) for the MHS' providers or facilities? Is there a list of providers at each Military Treatment Facility (MTF)?

A:

MTFs are not providing lists of individual providers' NPIs; however, a list of MHS organizational provider NPIs is available on the Defense Medical Information Systems Identifier (DMIS ID) table.

NPIs of individual providers and organizational providers are included as required on referrals, and HIPAA transactions such as electronic claims, etc. 

In addition, the CMS/NPI Enumerator made an online search Registry available to the public. The NPIs of all providers and facilities that have obtained NPIs are available via this query only database known as the NPI Registry.

UserIDs and passwords are not needed to use the NPI Registry and there is no charge to use it. The NPI Registry enables users to query using the NPI or the name of the provider. The NPI Registry will return the results of the query to the user, and the user will click on the record(s) he/she wants to see. The NPI Registry will then display the Freedom of Information Act (FOIA)-disclosable data for those records. 

NPI data is also available in monthly downloadable files at no charge or need for UserIDs and passwords. Just like the search registry, the file will contain the FOIA-disclosable NPI data for health care providers who have been assigned NPIs.  

Each month CMS makes a file available that replaces the previous month's file. This is a full replacement, not an update file. It reflects updates and changes that were applied to the NPPES records of enumerated health care providers between the date the previous file was created and the date the full replacement file is created.

HIV/AIDS Prevention and Treatment

Questions and answers about HIV prevention and treatment

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HIV/AIDS Prevention and Treatment
Q1:

How is HIV transmitted?

A:

HIV can be transmitted through sexual contact, by sharing needles (to inject drugs), and from the mother to a baby during pregnancy, birth, or breastfeeding. To learn more specific information about how HIV is transmitted, visit the CDC Website.

Q2:

How can the spread of HIV be prevented?

A:

Abstinence (not having sex of any kind), is the only way to prevent the spread of HIV 100%. Other effective ways to reduce the risk include:

  • Limiting your number of sexual partners
  • Use condoms correctly every time you have sex
  • Never share needles

If you're already living with HIV or if you have a high risk for HIV, there are other options. Visit the CDC website to learn more about how to prevent the spread of HIV.

Q3:

How can I know if I have HIV?

A:

The only way to know for sure whether you have HIV is to get tested. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. To learn more about HIV testing, and to find a test center near you, visit the CDC website.

Q4:

Does TRICARE cover HIV testing?

A:

Yes. TRICARE covers HIV testing as part of the annual Health Promotion and Disease Prevention exam.

Human Subject Research at Fort Detrick

Questions and answers about Human Subject Research at Ft. Detrick

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Health Readiness | Biological Surveillance Tools | Environmental Exposures | Cold War | Chemical and Biological Exposures
Q1:

How were soldiers selected for Operation Whitecoat at Fort Detrick?

A:

Volunteering for Operation Whitecoat basically resulted in the Service member assignment to Fort Detrick. Assignment to Fort Detrick did not mean that the volunteer automatically participated in human experimentation. There was a distinct process used for each experiment.

Each medical investigator prepared a protocol that was extensively reviewed and modified to comply with the twelve ethical principles of the Nuremberg Code. (The Nuremberg war crimes trials convicted 23 Nazi doctors of murder. In 1946, Andrew Ivey released his list of ten conditions required for "permissible medical experiments" in healthy subjects, which became known as the Nuremberg Code. These twelve conditions are embodied in the Wilson Memorandum described above.) When a review validated the ethical requirement and scientific validity of an experiment, it was forwarded to Army officials for approval.

It was at this point that potential volunteers were briefed as a group on the approved protocol. During this briefing, they became familiar with the purpose of the study and the risks and benefits involved. They also attended an interview with a scientist where they could ask questions about the research. Volunteers were encouraged to discuss the study with family members, clergy and personal physicians. After an obligatory waiting period of 24 hours to four weeks (the length depended on the presumed risks of the study), informed consent documents would be signed.

It must be stressed that Operation Whitecoat soldiers were not required to participate in any study, only to be present for the protocol briefings by principal investigators seeking volunteers. About 20 percent of Operation
Whitecoat volunteers did not participate in any study during their tenure at Fort Detrick.

Q2:

If I think I was involved in a test what should I do next?

A:

If you need help verifying your possible participation in any of the tests or have information about the testing, please call the Department of Defense's (DoD) contact managers at 1-800-497-6261, Monday through Friday, 7:30 a.m. to 4 p.m. EST.

Alternatively, you may write to us at:

Force Health Protection and Readiness
ATTN: CB Exposures Manager
7700 Arlington Blvd.
Falls Church, VA 22042

If you'd like to speak with a Veterans Affairs (VA) representative, call the Special Issues Helpline at 1-800-749-8387. Many states offer services and benefits to veterans. To find out more about a particular state, please visit http://www.va.gov/statedva.htm.

Q3:

Was all Whitecoat Testing conducted at Fort Detrick?

A:

No. While most of the testing was conducted at Fort Detrick, limited testing was conducted at the Dugway Proving Ground.

Q4:

Were there any fatalities at Fort Detrick among volunteers?

A:

There were no deaths or serious injuries among any of the human experiment volunteers.

Q5:

To what diseases or biological agents were Operation Whitecoat volunteers exposed?

A:

Volunteers were exposed to Q fever, tularemia, staphylococcal enterotoxins and sand fly fever.

Q6:

What safeguards were in place to protect the volunteers at Fort Detrick?

A:

The basic safeguards are contained in the Wilson Memorandum, which was issued by the Secretary of Defense in February 1953. It specified that human research would be subject to the following conditions:

  1. The voluntary consent of the human subject is absolutely essential and the consent shall be in writing.
  2. The experiment should produce results for the good of society that can not be gotten by other means.
  3. The number of volunteers shall be kept to a minimum.
  4. The experiment should be designed and based on animal experimentation.
  5. The experiment should be conducted to avoid all unnecessary physical and mental suffering and injury.
  6. No experiment should be conducted where there is a prior reason to believe that death or disabling injury will occur.
  7. The degree of risk should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.
  8. Proper preparation should be made and adequate facilities provided to protect the subject.
  9. The experiment should be conducted only by scientifically qualified personnel.
  10. During the course of the experiment, the subject should be allowed to bring the experiment to an end if he has reached a physical or mental state where the continuation of the experiment seems to him to be impossible.
  11. During the course of the experiment, the scientist in charge must be prepared to terminate the experiment at any stage.
  12. Prisoners of war may not be used in any experiments.

Malaria

Questions and answers about malaria

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Malaria
Q1:

What is malaria?

A:

Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. 

Four kinds of malaria parasites infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae.  In addition, P. knowlesi, a type of malaria that naturally infects macaques in Southeast Asia, also infects humans, causing malaria that is transmitted from animal to human ("zoonotic" malaria). 

Q2:

How is malaria transmitted?

A:

Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken from an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten.

Q3:

What are symptoms of malaria?

A:

The symptoms will vary depending on the type of malarial infection.

Uncomplicated Malaria

The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of:

  • a cold stage (sensation of cold, shivering)
  • a hot stage (fever, headaches, vomiting; seizures in young children)
  • and finally a sweating stage (sweats, return to normal temperature, tiredness).

More commonly, the patient presents with a combination of the following symptoms:

  • Fever
  • Chills
  • Sweats
  • Headaches
  • Nausea and vomiting
  • Body aches
  • General malaise

Severe Malaria

Severe malaria occurs when infections are complicated by serious organ failures or abnormalities in the patient's blood or metabolism. The manifestations of severe malaria include:

  • Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
  • Severe anemia due to hemolysis (destruction of the red blood cells)
  • Hemoglobinuria (hemoglobin in the urine) due to hemolysis
  • Acute respiratory distress syndrome (ARDS), an inflammatory reaction in the lungs that inhibits oxygen exchange, which may occur even after the parasite counts have decreased in response to treatment
  • Abnormalities in blood coagulation
  • Low blood pressure caused by cardiovascular collapse
  • Acute kidney failure
  • Hyperparasitemia, where more than 5% of the red blood cells are infected by malaria parasites
  • Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia
  • Hypoglycemia (low blood glucose). Hypoglycemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.

Severe malaria is a medical emergency and should be treated urgently and aggressively.

Q4:

Is malaria a contagious disease?

A:

No. Malaria is not spread from person to person like a cold or the flu, and it cannot be sexually transmitted. You cannot get malaria from casual contact with malaria-infected people, such as sitting next to someone who has malaria.

Q5:

Where does malaria occur?

A:

Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfall. Malaria is transmitted in tropical and subtropical areas, where:

  • Anopheles mosquitoes can survive and multiply
  • Malaria parasites can complete their growth cycle in the mosquitoes ("extrinsic incubation period").

Q6:

Who is at risk of being infected?

A:

Anyone can get malaria. Most cases occur in people who live in countries with malaria transmission. People from countries with no malaria can become infected when they travel to countries with malaria or through a blood transfusion (although this is very rare). Also, an infected mother can transmit malaria to her infant before or during delivery.

Q7:

What is the treatment for malaria?

A:

Treatment of malaria depends on many factors including disease severity, the species of malaria parasite causing the infection and the part of the world in which the infection was acquired. The latter 2 characteristics help determine the probability that the organism is resistant to certain antimalarial drugs. Additional factors such as age, weight, and pregnancy status may limit the available options for malaria treatment.

CDC provides, on a 24-hour basis, consultations for clinicians needing guidance on diagnosis, management of malaria cases, access to antimalarial medication, or urgent issues related to adverse antimalarial drug reactions.

Assistance can be provided through the CDC Malaria Hotline (770-488-7788) from 9:00 am to 5:00 pm Eastern Time. After hours or on weekends and holidays, call the CDC Emergency Operation Center at 770-488-7100 and ask to page the person on call for the Malaria Branch. Do not use email to ask for clinical advice; email is not constantly monitored and there may be delays in answering.

Q8:

What can I do to prevent malaria infection?

A:

You and your family can most effectively prevent malaria by taking all three of these important measures:

  • Taking antimalarial medication to kill the parasites and prevent becoming ill
  • Keeping mosquitoes from biting you, especially at night
  • Sleeping under insecticide-treated bed nets, using insect repellent, and wearing long-sleeved clothing if out of doors at night.

Any traveler who becomes ill with a fever or flu-like illness while traveling, and up to 1 year after returning home, should immediately seek professional medical care. You should tell your health-care provider that you have been traveling in an area where malaria transmission occurs and ask to be tested for malaria infection.

Q9:

Should we be concerned with malaria in the United States?

A:

Outbreaks of locally transmitted cases of malaria in the United States have been small and relatively isolated, but the potential risk for the disease to re-emerge is present due to the abundance of competent vectors, especially in the southern states. At the request of the states, CDC assists in these investigations of locally transmitted mosquito-borne malaria.

Office of General Counsel

Questions and answers about the Office of General Counsel

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Office of General Counsel
Q1:

Can the Office of General Counsel give me legal advice about my appeals?

A:

Our policy prevents us from providing legal advice regarding appeals.

Q2:

How can I file an appeal?

A:

Please refer to the TRICARE Appeals Fact Sheet on the TRICARE Website for information about how to file an appeal.

Q3:

What is the email address of the Office of the General Counsel?

A:

Due the limited resources available to our organization we only take inquires sent through the regular mail. 

For general inquiries, send your request to:

Defense Health Agency
7700 Arlington Boulevard, Suite 5101
Falls Church, VA 22042-5101

For Appeals & Hearings or Claims Collection, send your request to:

Defense Health Agency
16401 E. Centretech Parkway
Aurora, CO 80011-9043

Patient Safety Order Materials

This outlines the frequently asked questions in reference to ordering patient safety materials. This includes vital contact information for assistance and account registration information.

Recommended Content:

Patient Safety
Q1:

Who is eligible to order patient safety materials?

A:

Any Government Civilian, Military, or Contractor staff that is employed at a Military Treatment Facility (MTF) and has a “.mil” email address. Individuals must register with a “.mil” email address.

Q2:

What types of patient safety products are available?

A:

  • Badge Cards (NPSGs, I PASS THE BATON, SBAR, TeamSTEPPS)
  • Posters (Ask ME, I PASS THE BATON, PfP, SBAR, TeamSTEPPS)
  • Buttons (Ask ME)
  • Pamphlets and brochures (Ask Me 3, My Medicines, PSR, TEAM UP)

*NOTE: TeamSTEPPS materials are ordered by emailing TeamSTEPPS.

Q3:

How do I get an account to order patient safety materials?

A:

Follow these steps:

  1. Go to the Patient Safety Program web page
  2. Click “Products and Services” on the left column of the page
  3. Click “Order Patient Safety Materials Page” in the middle of the page
  4. Click “Order your Patient Safety Program Products Now!” at the top middle of the page to access the external registration page
  5. A pop-up will come up; Press “Ok”
  6. Enter your email
  7. Click “Submit”
  8. Enter your information. Please make sure to include your MTF name in your address
  9. Click “Submit”
  10. You will receive an email notifying you of the creation of your account

Q4:

How do I place an order for patient safety materials?

A:

Follow these steps:

  1. Go to the Patient Safety Program Web page
  2. Click “Products and Services” on the left column of the page
  3. Click “Order Patient Safety Materials Page” in the middle of the page
  4. Click “Order your Patient Safety Program Products Now!” at the top middle of the page to access the external registration page
  5. Enter your email to login
  6. Locate your item(s) and enter the amount of the particular material you wish to order
  7. Click “Add to Order”
  8. Click “Continue Order”
  9. Review your information and confirm it is correct; Click “Continue”
  10. Review your order; Click “Process Order”

Q5:

What if my contact information changes and I need to order additional patient safety materials?

A:

If any of your contact information (address/duty station, email, or phone number) changes please send us an email message with the changes and we can update it in the ordering system. Because accounts are organized by email address, if your email changes, a new account will need to be created.

Email us if you need help with this process.

Q6:

How are patient safety products distributed?

A:

Patient safety materials are packaged in sets of various quantities. For example, all badge cards are organized in packs of 200; therefore when you request badge cards it must be in increments of 200 (200, 400, 600, etc.). Please be aware that each product has a maximum order quantity assigned to it, which you cannot exceed in an individual order.

Q7:

What if I need more patient safety materials than the maximum quantity allowed?

A:

Please continue to make your order and choose the max quantity allowed; then email us and explain why the extra materials are needed. Based on inventory levels, we can then consider an exception for your additional requested materials.

Pharmaceutical Manufacturers: Contact Us - Questionnaire

Questions and answers about the TRICARE Retail Pharmacy Refund Questionnaire

Recommended Content:

Contact the TRICARE Retail Refund Team and FAQs
Q1:

When do I have to fill out a Questionnaire?

A:

If you are a new Manufacturer to the TRICARE Retail Refund Program and/or if there are any changes in POC or address for your company you must complete a TRICARE Retail Pharmacy Refund Questionnaire. Each section of the Questionnaire must be completed prior to submitting to UFVARR_requests@mail.mil.  

Q2:

If I already have access to the TRICARE Retail Refund Website, do I need to submit a Questionnaire?

A:

You must submit a Questionnaire listing you as a POC for every new labeler code you require utilization access to.

Q3:

Can a new POC simply be added to a Questionnaire or does another POC have to be replaced?

A:

A manufacturer may add up to, but no more than, a total of three POCs. The primary POC must be an employee of the manufacturer, the secondary and alternate POCs may be either an employee of the manufacturer or a third party consulting company. If the manufacturer in question has two different POCs on their current Questionnaire, the manufacturer may add one additional POC on the new Questionnaire. 

Download the Questionnaire Now

Pharmaceutical Manufacturers: Contact Us - TRICARE Retail Refund Website (TRRWS)

Questions and answers about the TRICARE Retail Refund Website

Recommended Content:

Contact the TRICARE Retail Refund Team and FAQs
Q1:

How do I obtain labeler access on TRRWS?

A:

  • Verify that your name is listed on a Questionnaire as a POC for the labeler in question.  
  • Log into TRRWS (https://trrws.tricare.mil/Public/Login.aspx). 
  • Click the “Request Labeler Access” button.
  • Request labeler access on TRRWS with the submission of the six digit labeler code including the alpha character (X#####).  
  • An email will be sent to the Primary POC and to the TRRT for review.  You will receive an email when your access has been approved.

Q2:

How do I obtain an account on TRRWS?

A:

  • Verify that your name is listed on your company’s Questionnaire as a POC.  
  • Go to TRRWS (https://trrws.tricare.mil/Public/Login.aspx)
  • Select the “Request New User Account” link and complete the form.  A TRICARE Retail Refund Team member will review your request and complete your access. 
  • You can only request one (1) labeler for your initial login; additional labeler requests can be submitted once you have access to the site.

Q3:

When will my quarterly utilization files be available on TRRWS?

A:

An official GovDelivery email will be sent out when data utilization files are released on TRRWS.  

Sign up to Get Email Updates

Report Issue with the TRRWS Website

Pharmaceutical Manufacturers: Contact Us - Billing and Pricing

Questions and answers about Billing and Pricing

Recommended Content:

Contact the TRICARE Retail Refund Team and FAQs
Q1:

If a product is divested, what should a company do to let TRICARE know?

A:

It is the responsibility of both parties (the previous manufacturer and new manufacturer) to complete an Appendix A Change Request form in its entirety and submit it to UFVARR_Requests@mail.mil. The form must contain the signatures of both parties. Once the TRICARE Retail Refund Team (TRRT) receives, reviews, and approves the form, billing can be updated. Please note that if the form is submitted with transfer dates in a previous quarter, the transfer will be reflected in the upcoming billing quarter.

Q2:

How would a product be eligible for the TRICARE Retail Refund Program if it is not dispensed in the retail network (e.g. if the product is IV or other forms, to be administered by MD, or provided in the hospital)?

A:

If an NDC is reported to the TRRT with a positive minimum refund, it is a covered drug under 38 U.S.C. 8126 of the final rule and eligible for the TRICARE Retail Refund Program. A refund will be owed for covered drugs dispensed through pharmacies identified as part of the TRICARE Retail Network, which includes long term care facilities, specialty pharmacies, and pharmacies inside physician offices or hospitals. In the event that an NDC appears to be incorrectly reported to TRICARE as a covered drug, please contact your POC at the Department of Veterans Affairs. The manufacturer may also submit disputes for these claims (please see the Dispute Submission process in the TRICARE Retail Refund Program Process & Procedures Guide) so that proper credit can be given in the event that the disputes are accepted.

Q3:

If a company has a new NDC for the same pharmaceutical agent that has an ADP Agreement in place, but the NDC is not on this ADP Agreement, how will TRICARE bill the NDC? ii. Will this be handled differently depending on if the drug is on a FCP or WAC ADP Agreement?

A:

  • If an NDC is not included on an ADP Agreement and the pharmaceutical agent is the same for the NDC(s) for which an ADP Agreement is in place, it will be billed under the ADP Program and a discount percentage will be determined based on strength, dosage, and package size of similar NDCs.
  • Typically, WAC ADP Agreements will include drugs that are not Covered Drugs, such as diabetes testing supplies. If the NDC is not included on the WAC ADP Agreement for a non-Covered Drug, it will not be billed under WAC, ADP, or SDP. If the NDC of the pharmaceutical agent on the ADP Agreement is a Covered Drug, then it will be billed ADP (FCP or WAC based on the ADP Agreement in place)

Q4:

How does TRICARE calculate the refund owed for those NDCs not included on a pharmaceutical agent’s ADP Agreement?

A:

If an NDC is not included in a pharmaceutical agent’s ADP Agreement and is eligible to be billed under ADP, the TRRT will calculate the refund owed by assigning the additional percentage from an NDC on the ADP which closely matches this NDC in strength and package size. 

Q5:

If a drug was determined to be non-formulary per the final decision in a P&T Committee Meeting and is currently on an ADP Agreement, will it be terminated? If so, when?

A:

All ADP Agreements for drugs belonging to drug classes reviewed in Pharmaceutical & Therapeutics Committee Meetings will be terminated upon the effective dates determined within the review of each class, regardless of formulary standing. However, if a drug is designated non-formulary per the P&T Committee, a bid that may have been submitted for consideration will not be accepted. ADP Agreements to be terminated will be done so with a termination date determined within each class (not the signing of the minutes unless otherwise indicated). Please refer to the P&T Committee Meeting Minutes for more information.

Q6:

Why is a drug not covered under TRICARE Formulary although the company has a Pricing Agreement in place with the TRICARE Retail Refund Program?

A:

Although Section 703 Compliant, there are many reasons as to why a drug may not be covered under TRICARE formulary. All formulary questions should be directed to the TRICARE Industry Liaison via email or by calling 1-210-536-6121.

Pharmaceutical Manufacturers: Disputes Resolution

Questions and answers about Disputes

Recommended Content:

Contact the TRICARE Retail Refund Team and FAQs
Q1:

In my data there looks to be duplicates of the same Rx number filled on the same date of service. Is that possible?

A:

Yes. Examples of this occurring are when a child needs one inhaler for school and one for home. Patients also may need to get more than one fill if they are going on vacation, lost their medication or the doctor has increased the dosage. It is important to take this into consideration when disputing utilization data.

Q2:

My K codes have been rejected, but I know that these are 340b pharmacies.

A:

340b pharmacies are retail pharmacies that may service a variety of patients.  DHA requires that a Manufacturer TRICARE Retail Refund 340b Verification Form be completed by the pharmacy before we are able to accept these disputes. 

Download Operation Documents

Q3:

What pharmacies are eligible for the TRICARE Retail Refund Program?

A:

From the TRICARE Retail Refund Manufacturer Policy and Procedure Guide, a TRICARE retail pharmacy includes long term care facilities, specialty pharmacies, pharmacies inside a physician's office and hospital, and all other pharmacies identified as part of the TRICARE Retail Network.

Physical Disability Board of Review

Questions and answers about the Physical Disablity Board of Review (PDBR).

Recommended Content:

Physical Disability Board of Review
Q1:

What is a Physical Disability Board of Review?

A:

The FY 2008 National Defense Authorization Act (NDAA) requires the military services, upon request, to review certain separations for medical conditions where the rating was 20 percent or less and the member did not otherwise retire. The review will evaluate whether, under the applicable guidance in effect at the time, the rating awarded was fair and accurate.

Q2:

Who is eligible for a Physical Disability Board of Review?

A:

Veterans, to include members of the United States Coast Guard, as described above who were separated from between September 11, 2001 and December 31, 2009 can request this review.

Q3:

If the eligible Veteran is incapacitated or deceased, can someone else request a Physical Disability Board of Review on his or her behalf?

A:

Yes, the Veteran’s surviving spouse, next of kin or legal representative may request this review.

Q4:

How long do I have to apply for the Physical Disability Board of Review?

A:

At the present time, there is no time limit or cutoff date by which you must apply for this review. However, the longer you wait, the more difficult it may be to gather required medical evidence from your VA rating process, your service treatment record or other in service sources, which the PDBR uses in order to properly assess your claim.

Q5:

How do I request the Physical Disability Board of Review?

A:

To have your military disability ratings reviewed, see “How to Apply." 

You also have the option to send supporting documentation (statements, briefs, medical records, affidavits), but you don't need to send documents or records that are already included in your Military and VA medical records because the PDBR will collect these records.

Q6:

I wasn't in the Air Force. Why am I mailing my application for the Physical Disability Board of Review to Randolph AFB?

A:

DoD has designated the Air Force as lead component for implementing the PDBR process. As such, the AF has overall responsibility for case tracking and reporting, although the actual case evaluation and adjudication is done in a joint adjudication unit with all services (and components) represented. The Under Secretary of Defense for Personnel and Readiness retains overall responsibility for program policy.

Q7:

What should I include with my application for the Physical Disability Board of Review?

A:

An applicant may submit statements, briefs, medical records or affidavits in support of their application. Unless requested by the intake unit, the applicant does not need to send medical records that are already included among his or her service medical documents or the medical separation paperwork (informal physical evaluation board, formal physical evaluation board and appeal files and results).

Q8:

Is there another way the Physical Disability Board of Review occurs?

A:

Under special circumstances, the PDBR can initiate a review but if this occurs, the PDBR will contact the former member, explain why the board believes a review is appropriate and ask for his/her consent. If consent is not given, there will be no review.

Q10:

What is the difference between a Board for Correction of Military (or Naval) Records (BCMR/BCNR) review and a Physical Disability Board of Review; and can I file with the PDBR and BCMR/BCNR?

A:

This is a very important point and you should understand there are several differences between the scope and the consequences of the two reviews. To help you compare you may wish to refer to the comparison chart at the end of these FAQs. If you file with the PDBR, you cannot ask your service BCMR/BCNR to review the issue of whether you should have received a higher rating for the same medical condition(s) that resulted in separation. However, you can request your service BCMR/BCNR to review other issues such as whether you should have been rated for additional medical conditions. If you do not go to the PDBR, you can ask the BCMR/BCNR to consider all of the issues relevant to your separation, including the rating awarded for your unfit condition.

Q11:

Can you give me an example of differences between Board for Correction of Military (or Naval) Records (BCMR/BCNR) review and a Physical Disability Board of Review?

A:

You were found unfit for a back problem and separated at 10 percent for this condition. You also had asthma problems but they were not found to be unfitting (you met retention standards). Additionally, you also contend you suffer from tinnitus but this diagnosis was not documented in your physical evaluation board proceedings. You may ask the PDBR to re-evaluate your back injury rating and determine whether the asthma condition should have also been considered separately unfitting and factored in your overall rating. The PDBR could not consider the matter of claimed tinnitus if that condition was not documented in your original PEB proceedings. Alternatively, you could ask a BCMR/BCNR to change your record to show you were found unfit for all conditions. If you do not go to the PDBR, you could ask the BCMR/BCNR to consider everything; if you have been to the PDBR, the BCMR/BCNR will not review the rating for your back or asthma related conditions, but will consider whether you should have also been found unfit (and received an additional rating) for the tinnitus or any other medical condition you may be claiming.

Q12:

Should I choose a Board for Correction of Military (or Naval) Records (BCMR/BCNR) review or a Physical Disability Board of Review?

A:

There is no easy or clear-cut answer. The choice is important and highly dependent upon the facts and circumstance of your case. The applicant should weigh all of the factors and make a choice only after careful consideration (see chart at end of FAQs for side by side comparison between the PDBR and BCMR/NR with respect to deciding which venue would be optimal for pursuing a review of your disability).

Q13:

Is there someone who can help me make the choice between a Board for Correction of Military (or Naval) Records (BCMR/BCNR) review and a Physical Disability Board of Review?

A:

You should contact your local veterans’ service organizations, several of which provide excellent advice and service on these issues.

Q16:

Can I appear in person for the Physical Disability Board of Review?

A:

The PDBR is a document review only. There is no provision for a personal appearance.

Q17:

Why does the Physical Disability Board of Review need my VA records?

A:

Part of the PDBR review process is to consider the rating(s) previously awarded to an applicant by the VA for his or her unfitting medical condition(s), but particularly those awarded with an effective date within twelve months of the applicant’s date of separation. Access to applicable VA rating and medical documents, though not required by policy, are instrumental to the PDBR’s review process and greatly facilitate making any revision to the original disability rating provided by the military department PEB concerned.

Q18:

Will my privacy be respected during the Physical Disability Board of Review?

A:

Yes. Only individuals with a need to know will have access to information from the applicant’s service and medical records.

Q19:

What if I don't consent to the release of my VA records for the Physical Disability Board of Review?

A:

If the applicant does not consent to a release of DVA records, the service disability rating will be reviewed for fairness and accuracy, but the comparison to the DVA rating will not be possible and will therefore not be accomplished.

Q20:

Will the Physical Disability Board of Review review my case if my VA disability determination is pending?

A:

An important point to consider is the Physical Disability Board of Review will review a case and adjudicate a rating one time only. If the applicant’s VA determination is pending, the applicant must decide whether they want the PDBR review without this information. The PDBR will take the VA determination (for the unfitting condition(s) only) into account as one factor. The ideal objective for the PDBR is to compare the Military Department PEB rating(s) with the subsequent VA rating(s) – for all unfitting conditions. However, the significance of a higher VA rating varies as to how this serves as a valid indicator that an error has taken place. Therefore, it is difficult to set forth a general rule as to whether an applicant should wait for a VA determination letter before submitting an application for PDBR review.

Q21:

Where does the Physical Disability Board of Review take place?

A:

The case evaluation and consideration (so-called adjudication) will take place in a joint (all services and components represented) central adjudication unit in National Capital Area created especially to perform this mission.

Q22:

Who makes the final decision for the Physical Disability Board of Review?

A:

By law, the PDBR makes a recommendation to the applicant’s service secretary who makes the final decision. This responsibility may be delegated to, but to no lower than, the Directors of the Review Boards Agencies (Army and Air Force); for the Navy, the Assistant Secretary of the Navy (Manpower and Reserve Affairs) or the Associate Counsel; and for the Coast Guard, The Assistant Commandant for Human Resources (CG-1). These individuals are career members of the senior executive service (civilian general officer equivalents).

Q23:

How will I be notified about the decision of the Physical Disability Board of Review?

A:

The secretary of the military department concerned, or the designated decision authority, will notify the applicant of the final decision and the consequences if the rating is changed including the effect upon benefits. The applicant’s Service BCMR/BCNR, the VA, and Defense Finance and Accounting Servicer (DFAS), or in the case of the Coast Guard, the Pay and Personnel Center, will be responsible for correcting the military and finance records or adjustment of other benefits where appropriate.

Q24:

Will the Physical Disability Board of Review decision be explained to me?

A:

The final letter to the applicant will provide a rationale for the decision.

Q25:

If the decision of the Physical Disabilty Board of Review changes something in my records, when will the correction be effective?

A:

The military records will be corrected effective the date of execution of the Physical Evaluation Board’s separation action (retroactive to the date of separation). This is the same rule for BCMR/BCNR corrections.

Q26:

Can I appeal the decision of the Physical Disability Board of Review?

A:

By law, the decision of the secretary (or designee) is final. There are no provisions for appeal or reconsideration by the PDBR. On the other hand, previously denied BCMR/BCNR appeals may be reconsidered when relevant newly discovered evidence (not previously available) is presented.

Q28:

Whom can I contact if I have additional questions about the Physical Disability Board of Review?

A:

Please send your questions via email. Keep in mind, however, that this office will not offer advice or discuss the merits of your application.

Q29:

Am I eligible for Physical Disability Board of Review of my disability separation if I was put on the Temporary Disability Retired List (TDRL) prior to September 11, 2001?

A:

Yes, as long as you were removed from the TDRL and subsequently separated from your military department by reason of disability with a combined disability ratings of 20% or less, after September 11, 2001 and prior to December 31, 2009, you are eligible to apply to the PDBR for review of your disability separation.

Q30:

Am I eligible for Physical Disability Board of Review if I was placed on the Temporary Disability Retired List (TDRL) between September 11, 2001 and December 31, 2009 and then permanently separated from my Military Service, with severance pay (e.g. taken off the TDRL) with a combined rating of 20% or less AFTER December 31, 2009?

A:

You are not eligible for a review of your case at the PDBR because you were permanently separated from the military AFTER December 31, 2009. However, you can request review of your case in other venues, including your military service’s BCMR (or BCNR for Navy Department Veterans).

Q31:

What conditions will be reviewed by the Physical Disabiltity Board of Review if I leave block #3 of the DD Form 294 blank in my application?

A:

The PDBR will only review your medical conditions found unfit by your Service (military physical evaluation board [PEB], reconsiderations, etc.).

Q32:

What will be reviewed by the Physical Disability Board of Review if I only ask for one (named) medical condition to be reviewed, from a PEB with multiple medical conditions?

A:

The PDBR will review/adjudicate only the requested (named) medical condition, in addition to all unfitting conditions. (see DoDI 6040.44, June 27, 2008, Incorporating Change 1, 6/2/2009)

Q33:

Can I ask the Physical Disability Board of Review to review more of my medical conditions?

A:

Yes --The PDBR, when requested by the applicant, can review some or all of the medical conditions found on your military MEB/PEB. (see DoDI 6040.44, June 27, 2008, Incorporating Change 1, 6/2/2009)

Q34:

How can I get the most comprehensive PDBR review of my permitted medical conditions

A:

Applicants must inform the PDBR in block 3 of the DD Form 294 that the applicant wants all MEB/PEB conditions considered for being unfit for duty and rated. Unfit means unfit for duty or Category I, while rated means given a disability rating.

Comparison – BCMR/BCNR vs PDBR Review of Rating

Characteristic BCMR/BCNR PDBR
Panel Composition 3 civilians in grade of GS-15 and above. 3 military officers in grade of 05/06 (or civilian equivalents).
Review Authority May apply for review of military record, within three years of error/injustice (may be waived in the interest of justice). Medical separation 20% or less where member did not retire finalized between September 11, 2001 and December 31, 2009 (may be extended).
Review Process Application submitted, medical, personnel or legal advisories prepared and served on applicant with chance to comment before panel review and vote. Application submitted, then case summarized by PDBR medical member (or other experts) for presentation to PDBR before vote. Applicant can submit records from non-DoD sources.
Panel Outcome Recommendation or decision. Recommendation only.
Burden of Proof Member has the burden of proof to establish error or injustice. There is a presumption of regularity. Member need not allege anything, review accomplished upon request.
Standards Will correct errors in records and/or remove an injustice. Rating reviewed for fairness and accuracy.
Impact of subsequent VA Rating Within discretion of the Board. Will compare VA rating with particular attention to one given within 12 months.

Pharmacy Analytics Support Section: MTF Corner

View questions and answers from the Pharmacy Analytics Support Section for military pharmacies.

Recommended Content:

Pharmacy Analytics Support Section
Q1:

Where can I find the NCPDP number for 3rd party collections?

A:

You can request NCPDP information from the DHA PASS via email or by calling (210) 536-6650. In this request, include the military treatment facility (MTF) you are with, and any other outlying MTF sites that you need numbers for and the reason you need the NCPDP number. We will send information on how to get your NCPDP number for third party collections.

Q2:

I need to add, close, or modify an MTF pharmacy. What steps do I follow?

A:

Military Treatment Facility (MTF) Pharmacy Identifiers: National Council of Prescription Drug Programs (NCPDP) and National Provider Identifier (NPI)

The DHA Pharmacy Analytics Support Section (PASS) manages the process of applying for and updating NCPDP Provider ID numbers and NPI for all MTF outpatient dispensing pharmacies.

All pharmacy dispensing locations must have a valid and unique NCPDP and NPI provider number combination that identifies the pharmacy. A Request for New NCPDP/NPI Numbers form must be completed by the site point of contact (POC). If request is for an MTF ePharmacy, use the Request for New ePharmacy NCPDP/NPI Numbers form. Return to the PASS via email.

A dispensing location is defined as any outpatient dispensing pharmacy not physically co-located within another pharmacy. If pharmacies are physically separate, e.g. a Troop Medical Clinic located near the Post Exchange, the PASS recommends that the new pharmacy dispensing site have its own registered NCPDP/NPI numbers. If two pharmacies are co-located in the same physical location and workload will not be reported separately, e.g. a virtual pharmacy used for ScriptPro or RxMedic and the Main Outpatient Pharmacy, the pharmacies may share the same NCPDP/NPI number. Requests for ePharmacies will follow the same process; however, please note that ePharmacy requests require a fax number for fail over requirements.

New MTF Pharmacy

All new MTF pharmacy NCPDP/NPI requests should be submitted to the DHA PASS at least thirty (30) days prior to activation. The PASS will contact the site POC if there are any questions. Once the PASS receives and confirms all pharmacy information, the PASS will submit the NCPDP/NPI number applications online. Upon receipt of the new numbers from NCPDP, the PASS will notify the MTF Composite Health Care System (CHCS) Systems Administrator or the authorized pharmacy personnel who hold the required security key and are able to input NCPDP and NPI provider numbers.

Pharmacy Changes or Closures

An MTF Pharmacy must submit a change/closure request form to the PASS at least thirty (30) days in advance to close a dispensing location and to inactivate the location’s NCPDP/NPI provider numbers.

An MTF that is physically moving to a new dispensing location within the same military installation can use the same NCPDP/NPI numbers. The MTF must notify the PASS via a change/closure request form of the new mailing and physical addresses and new pharmacy fax and phone number, if applicable. These updates are necessary to maintain current and accurate pharmacy records at NCPDP.

Pharmacy transactions submitted without assigned, valid NCPDP/NPI numbers may reject due to NCPDP/NPI numbers not being loaded into the MTF pharmacy claims adjudication system for claims processing and pharmacy identification. This occurs when the pharmacy user selects an inactive pharmacy from a pick list in CHCS, which causes transactions to be placed in suspense at such pharmacies, resulting in prescription filling delays. This is also a potential patient safety issue as these claims do not pass through the PRODUR system which provides DUR warnings.

In sum, timely notification to the PASS that a pharmacy is opening, closing, or requires any demographic changes via the new or change/closure form(s) can avoid delays in outpatient prescription processing and transmission to PDTS as well.

Q3:

Where do I look for the PDTS Rx number in CHCS?

A:

Menu path OPM>PM>PPQ. Enter the Rx# without the leading zeros. No alpha character is required.

Q4:

How do providers look at the new Online Patient Profile (or the combined CHCS/PDTS profile)?

A:

The Online Patient Profile can be accessed through the ORE menu option. After entering the patient name and the requesting location, the user enters DPRX at the action prompt. Note: the DPRX option is offered as part of the "order Action" list if (??) is entered at the "Action" prompt. After choosing the PDTS profile, the user then defines the desired time frame based on the last fill/refill date. This is the number of days in the past the user wishes to look for both the PDTS and CHCS prescriptions. The user then has the option to send results to their CHCS mailbox, print the results, or view the results from the terminal. Results should include the CHCS profile (prescriptions filled at the requesting host MTF), and the PDTS profile (prescriptions filled at pharmacies outside of the requesting HOST's chain code, to include other MTF's, MCSC retail network pharmacies, as well as the TRICARE Pharmacy Home Delivery).

Q5:

How do I find my NCPDP/NPI?

A:

Menu: SFM>OMM>SIT "number is listed as PDTS Pharmacy ID". NOTE: User must have access to the supervisory menu.

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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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