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BY ORDER OF THE AIR FORCE INSTRUCTION 41 …

BY ORDER OF THE SECRETARY OF THE AIR FORCE AIR FORCE INSTRUCTION 41-210 6 JUNE 2012 Health Services TRICARE OPERATIONS AND PATIENT ADMINISTRATION FUNCTIONS COMPLIANCE WITH THIS PUBLICATION IS MANDATORY ACCESSIBILITY: Publications and forms are available for downloading or ordering on the e-Publishing website at: RELEASABILITY: There are no releasability restrictions on this publication. OPR: AFMSA/SG3SA Supersedes: AFI41-210, 22 March 2006 AFI41-115, 28 December 2001 AFI41-101, 1 April 1996 AFH41-114, 1 March 1997 Certified by: AF/SG (Lt Gen Charles B. Green) Pages: 422 This INSTRUCTION implements AFPD 41-2, Medical Support. This INSTRUCTION identifies and defines the requirements, policies, procedures, activities, and minimum expectations necessary to ensure a successful Air FORCE MTF TRICARE Operations and Patient Administration mission. It describes how to manage TRICARE Operations and Patient Administration functions including determining eligibility for care, protecting medical information, managing health records, the preparation and disposition of medical documentation and managing other administrative activities to support patients.

by order of the secretary of the air force air force instruction 41-210 6 june 2012 health services tricare operations and patient administration functions

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Transcription of BY ORDER OF THE AIR FORCE INSTRUCTION 41 …

1 BY ORDER OF THE SECRETARY OF THE AIR FORCE AIR FORCE INSTRUCTION 41-210 6 JUNE 2012 Health Services TRICARE OPERATIONS AND PATIENT ADMINISTRATION FUNCTIONS COMPLIANCE WITH THIS PUBLICATION IS MANDATORY ACCESSIBILITY: Publications and forms are available for downloading or ordering on the e-Publishing website at: RELEASABILITY: There are no releasability restrictions on this publication. OPR: AFMSA/SG3SA Supersedes: AFI41-210, 22 March 2006 AFI41-115, 28 December 2001 AFI41-101, 1 April 1996 AFH41-114, 1 March 1997 Certified by: AF/SG (Lt Gen Charles B. Green) Pages: 422 This INSTRUCTION implements AFPD 41-2, Medical Support. This INSTRUCTION identifies and defines the requirements, policies, procedures, activities, and minimum expectations necessary to ensure a successful Air FORCE MTF TRICARE Operations and Patient Administration mission. It describes how to manage TRICARE Operations and Patient Administration functions including determining eligibility for care, protecting medical information, managing health records, the preparation and disposition of medical documentation and managing other administrative activities to support patients.

2 Organizational alignment of these functions may vary among Medical Treatment Facilities. This INSTRUCTION directs the collection and maintenance of information subject to The Privacy Act of 1974 and the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This INSTRUCTION applies to all Air FORCE medical units and Air National Guard or Air FORCE Reserve Components where TRICARE Operations and Patient Administration functions are performed. OASD/HA Memorandum titled Armed Forces Reserve Component Medical Activities under the DoD Health Information Privacy Regulation, 2 Dec 2003 clarifies the status of the Armed Forces Reserve Component medical activities as it relates to compliance with privacy rules. Ensure that all records created as a result of processes prescribed in this publication are maintained in accordance with Air FORCE Manual (AFMAN) 33-363, Management of Records, and disposed of in accordance with Air FORCE Records Information Management System (AFRIMS) Records Disposition Schedule (RDS) located at 2 AFI41-210 6 JUNE 2012 All field publications that either implement or supplement this publication must be submitted to AFMSA/SG3SA for coordination prior to approval.

3 Comments or suggested improvements to this AFI must be submitted on an AF Form 847, Recommendation for Change of Publication, to AFMSA/SG3SA. SUMMARY OF CHANGES This document has been substantially revised, incorporates AFI 41-115, AFI 41-101 and AFH 41-114 and must be completely reviewed. Chapter 1 ROLES AND RESPONSIBILITIES 14 Section 1A TRICARE Operations Roles and Responsibilities 14 TRICARE Overview.. 14 TRICARE Operations Overview.. 14 Section 1B Patient Administration Roles and Responsibilities 14 Patient Administration Overview.. 14 Patient Administration Officer/Director/Noncommissioned Officer (NCO).. 16 HIPAA Privacy Officer.. 16 RHIA.. 16 Chapter 2 HEALTHCARE ENTITLEMENTS AND ELIGIBILITY REQUIREMENTS 17 Section 2A Healthcare for Current and Former Uniformed Services Personnel 17 Administering Healthcare Benefits.. 17 Provision of Services.. 17 Uniformed Services Active Duty Personnel.. 17 Medal of Honor Recipients.

4 17 Former US Military Personnel Held as Prisoners of War (POW) or Detainees by Foreign Governments.. 17 Academy Cadets and Midshipmen.. 17 Former Active Duty Female Service Members Obstetrical/Maternity Healthcare.. 18 Retired members of the Uniformed Services.. 20 Section 2B Healthcare Benefits for the Reserve Component 21 Reserve Component Authority.. 21 General Healthcare Entitlements.. 22 Physical Examinations & Specialty Consultations.. 25 AFI41-210 6 JUNE 2012 3 Special Eligibility Considerations.. 25 Section 2C Healthcare for Current and Former Uniform Service Family Members 27 Family Members (dependents) of Active Duty and Reserve Component Personnel of the Uniformed Services.. 27 Immediate Family Members (Dependents) of Medal of Honor Recipients.. 28 Family Members (Dependents) of US Military Personnel Held as Prisoners of War or Detainees by Foreign Governments.. 29 Un-remarried Former Spouses.. 29 Family Members of Reserve Component Members HIV Discovery.

5 30 Newborns Not Automatically Eligible for Healthcare Without Pre-Approval.. 30 Abused Family Members/Dependents.. 31 Section 2D Healthcare for Foreign Forces Members 34 SOFA (SOFA/PFP) Military Personnel.. 34 Non-SOFA Military Personnel.. 35 Foreign Military Sales (FMS) Personnel (Non-SOFA).. 35 International Military Student (IMS) Program Personnel.. 37 Aviation Leadership Program (ALP) Participants.. 37 Foreign Military Personnel Overseas.. 38 Section 2E Healthcare for Foreign Forces Family Members 39 Family Members (Dependents) of SOFA Personnel.. 39 Family Members (Dependents) of Non-SOFA Military Personnel.. 39 Family Members (Dependents) of Foreign Military Sales (FMS) Personnel (Non-SOFA).. 40 Family Members (Dependents) of International Military Student (IMS) Personnel (Non-SOFA).. 40 Section 2F Healthcare for Eligible Civilians and Special Categories of Beneficiaries and Their Family Members 41 Senior College or University ROTC Cadets; ROTC Membership Applicants; Uniformed Service Applicants; and Service Academy Applicants.

6 41 Members of Uniformed Services Auxiliaries (Official Government Business).. 43 Members of Uniformed Services Auxiliaries (Official Organizational Business). 44 Federal Civilian Employees.. 44 Family Members (Dependents) of Civil Service Personnel.. 51 Civilian Emergencies.. 52 4 AFI41-210 6 JUNE 2012 Contractors.. 52 Family Members (Dependents) of Contractors.. 54 Additional Beneficiary Categories.. 54 Section 2G Eligibility Priority and Verification Procedures 59 Eligibility Priority and Limiting Services in the Direct Care System.. 59 Eligibility Verification.. 59 Dependency Determinations for Incapacitated Children.. 62 Section 2H Other Services and Authorizations 64 TRICARE Extended Care Health Option (ECHO).. 64 TRICARE ECHO Home Healthcare (EHHC).. 70 TRICARE ECHO Cost-Share Liability.. 72 TRICARE ECHO Benefit Payment.. 72 TRICARE ECHO Benefit Authorization.. 74 Transitional Assistance Management Program (TAMP).

7 76 Reciprocal Healthcare Agreements.. 77 Medically Related Services.. 78 Authorization for Physical Examinations Other than Flying.. 78 Care of Minors.. 81 Elective Civilian Medical Care for Active Duty Members.. 82 Administration Requirements for Organ Donation Requests.. 83 Abortions.. 83 Artificial Insemination.. 84 Sperm Cell or Spermatozoa Frozen Storage.. 84 TRICARE Coverage of Surrogate Pregnancies.. 84 Intersex Surgery.. 85 Chapter 3 TRICARE OPERATIONS 86 Section 3A Access to Care Guidance 86 Access to Care (ATC) Standards.. 86 Specialty Care Access Standards.. 86 Non-Availability Statements.. 87 Section 3B Beneficiary Counseling and Assistance Coordinator (BCAC) 87 BCAC General Roles and Responsibilities.. 87 AFI41-210 6 JUNE 2012 5 BCAC Operational Activities.. 88 Key Professional BCAC Relationships and Contacts.. 89 Claims Assistance.. 89 Appeals and Grievances.. 90 Knowledge and Skills Required.

8 90 Complexities Associated with the BCAC Position.. 90 Resources Available to Assist the BCAC in Providing Services.. 91 Case Resolution Activities.. 91 Section 3C Debt Collection Assistance Officer (DCAO) 92 DCAO Roles and Responsibilities.. 92 Section 3D Service Change Requests 94 Changes in Clinical Services.. 94 Section 3E Referral Management Program 97 Referral Management Program.. 97 Section 3F Medical In/Out-Processing Program 98 Overview.. 98 In-processing Requirements.. 99 Out-processing Requirements.. 100 Section 3G TRICARE Online 101 TRICARE Online Background.. 101 TRICARE Online Roles and Responsibilities.. 101 TOL Scheduling and Appointment Management.. 105 Chapter 4 PATIENT ADMINISTRATION FUNCTIONS 106 Section 4A Legal Aspects of Protected Health Information and Release of Information 106 Safeguarding Medical Information and Health Record Custody and Control.. 106 Laws and Provisions Affecting Disclosure of Medical Information.

9 108 General Guidelines on Releasing Medical Information.. 110 Releasing Information and Patient Authorization.. 112 Disclosing or Releasing Information Not Requiring Patient Authorization.. 114 Electronic Transmission of Protected Health Information (ePHI).. 116 Personal Health Record Copy Requests.. 118 Entering Into Agreements to Manage Health Record Copy Requests.. 120 6 AFI41-210 6 JUNE 2012 Section 4B Patient Registration & Multiple Healthcare Eligibility 120 Patient Registration.. 120 Patients with Multiple-Eligibility.. 128 Section 4C Patient Travel 133 Patient Accountability for Service Members Traveling to Attend Medical Appointments.. 133 Patient Travel Benefit.. 133 Transferring Patients Through the Aeromedical Evacuation (AE) System.. 135 Section 4D Quarters Administration 136 Quarters Status.. 136 Section 4E Line of Duty (LOD) Program Administration 136 LOD Determinations.. 136 Section 4F Air FORCE Secretarial Designee Program Administration 140 Authority.

10 140 US Air FORCE Secretarial Designee Criteria.. 142 Applying for Air FORCE Designee Status.. 145 Secretary of Defense Designees.. 148 Operating the Air FORCE Secretarial Designee Program Overseas.. 149 Designee Status Used in Claims Against the United States.. 150 Section 4G Exceptional Family Member Program (EFMP) 150 Exceptional Family Member Program (EFMP).. 150 Family Member Relocation Clearance Coordinator (FMRCC).. 150 Section 4H Admissions and Dispositions Program Administration 150 Responsibility for Admission Processing.. 150 Administrative Admission & Disposition Requirements.. 150 Assuming Administrative Responsibility for Military Members Hospitalized in Non-Military Medical Facilities aka Absent Sick Status.. 151 Assuming Administrative Responsibility for Active Duty U.. 154 Admitting Infants Born Outside the MTF.. 155 Admitting Generals/Admirals (Flag Officers), Colonels, and Prominent Persons. 156 Reporting Aircraft Accident Admissions.


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