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Identifying Tricare Insurance for Medicaid Recipients Using the PARIS FEDERAL FILE Presented by Stefanie Johnson, MBA Business Analyst New Hampshire Department.

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Presentation on theme: "Identifying Tricare Insurance for Medicaid Recipients Using the PARIS FEDERAL FILE Presented by Stefanie Johnson, MBA Business Analyst New Hampshire Department."— Presentation transcript:

1 Identifying Tricare Insurance for Medicaid Recipients Using the PARIS FEDERAL FILE Presented by Stefanie Johnson, MBA Business Analyst New Hampshire Department of Health & Human Services New Hampshire Department of Health & Human Services

2 New Hampshire History with Paris August 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 well Presently NH participates in all three PARIS matches on a quarterly basis By far, the Federal file has yielded the most valuable information for NH Medicaid, Third Party Liability/Coordination of Benefits New Hampshire Department of Health

3 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 Services

4 Determining Tricare Eligibility Client records containing the following codes in the Record Type field are eligible for Tricare health insurance MA for Military Active Duty MR for Military Retired MV for Military Reserved TRICARE 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 clients (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 Services

5 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 Hampshire Department of Health & Human Services

6 Determining Federal Health Insurance Coverage Client records containing the following codes in the Record Type field may be eligible for Federal health insurance coverage CD for Civilian Department of Defense CO for Civilian Office of Personnel Management CR for Civilian Retired The NH return file has only reported Civilian Retired personnel. Policy information is not provided on the Federal Return file NH 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 Services

7 Why is Tricare Insurance Data Important to New Hampshire? Military Installations Located in NH Portsmouth Naval Shipyard in Portsmouth, NH Pease Air National Guard Base in Portsmouth, NH New Hampshire Department of Health & Human Services

8 Benefits for Identifying Other Insurance Compliance with Federal Law to assure Medicaid is Payor of Last Resort Tricare 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 only Reduces the States Medicaid costs by transferring eligible costs from Medicaid to other insurance Medicaid 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 Services

9 1st Year Results (3 return files) w/ PARIS Federal File Using DEERS On-Line Identified 100 Medicaid Recipients with Tricare Insurance Medicaid Cost avoided over $82,000 in claims deferred to Tricare Medicaid 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 Services

10 Access to DEERS On-Line Web site provided by the Defense Manpower Data Center (DMDC) MOU Agreement and Justification for Access Letter Standard documents to which state must fill in site specific information and which must be signed by a director level individual Authority to Operate (ATO) A letter which states your system has been properly tested and certified Contact: For documentation and submission process New Hampshire Department of Health & Human Services


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