HT940210D0001

THE PURPOSE OF THIS CONTRACT IS TO ASSIST HEALTH AFFAIRS, TRICARE MANAGEMENT ACTIVITY (TMA), THE TRICARE REGIONAL OFFICES (TRO), THE DESIGNATED PROVIDER PROGRAM OFFICE (DPPO), THE TRICARE OVERSEAS (TAO) EURASIA-AFRICA, PACIFIC AND LATIN AMERICA/CANADA PROGRAM OFFICES, THE TRICARE DUAL ELIGIBLE FISCAL INTERMEDIARY CONTRACT (TDEFIC), THE PHARMACY AND DENTAL PROGRAM OFFICES, BY PROVIDING THE GOVERNMENT WITH AN INDEPENDENT, IMPARTIAL EVALUATION OF THE CARE PROVIDED TO MILITARY HEALTH SYSTEM (MHS) BENEFICIARIES. THE TRICARE QUALITY MONITORING CONTRACTOR (TQMC) SHALL REVIEW CARE PROVIDED BY THE DESIGNATED PROVIDERS (DP) UNDER THE UNIFORMED SERVICES FAMILY HEALTH PLAN (USFHP), THE MANAGED CARE SUPPORT CONTRACTS (MCSCS) AND THE TDEFIC CONTRACTOR. IN ADDITION, THE TQMC WILL REVIEW RECORDS FROM OTHER TRICARE CONTRACTORS (E.G., TRICARE PHARMACY AND DENTAL CONTRACTORS) TO SATISFY REQUIREMENTS TO VALIDATE THE QUALITY OF CARE DELIVERY UNDER THE TRICARE BENEFIT. THE TQMC IS PART OF TRICARE S QUALITY AND UTILIZATION REVIEW PEER REVIEW ORGANIZATION PROGRAM, IN ACCORDANCE WITH CODE OF FEDERAL REGULATIONS 32 CFR 199.15. OBJECTIVES. THE OBJECTIVES UNDER THIS CONTRACT ARE: TO PROVIDE AN INDEPENDENT, IMPARTIAL EVALUATION OF THE HEALTH CARE PROVIDED TO THE MHS BENEFICIARIES. TO EVALUATE BEST VALUE HEALTH CARE AS DEFINED IN THE TRICARE OPERATIONS MANUAL. TO MEASURE, EVALUATE, AND IDENTIFY SUPERIOR QUALITY HEALTH CARE SERVICES AND RECOMMEND MEANS TO TRANSFER SUCCESSES. TO PROVIDE COMPREHENSIVE AND TIMELY REVIEWS THAT ARE CONSISTENT WITH ALL TRICARE REQUIREMENTS, TO ENSURE RECEIPT OF APPROPRIATE LEVELS OF HEALTH CARE FOR ALL BENEFICIARIES.