Defense Health Care: TRICARE Claims Processing Has Improved but Inefficiencies Remain
Highlights
Testifying before Congress in 2002, military beneficiary groups and civilian managed care support contractors described problems with the processing of TRICARE claims for civilian-provided care. These problems included slow payments and procedures that made claims processing inefficient. The Bob Stump National Defense Authorization Act of 2003 required GAO to review improvements to TRICARE claims processing and continuing impediments to claims processing efficiency. Specifically, GAO describes (1) efforts to improve claims processing and changes in processing timeliness and (2) Department of Defense (DOD) procedures and data that continue to affect claims processing efficiency. To identify improvements to claims processing and impediments to processing efficiency, GAO analyzed 1999 and 2002 claims data for changes in processing timeliness. GAO also interviewed and analyzed claims processing documentation from DOD officials, managed care support contractors, and claims processors.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | To improve the efficiency of TRICARE claims processing, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to evaluate DOD's process for issuing program changes and to identify ways to improve the consolidation and scheduling of such changes. |
Closed – Not Implemented
Since GAO made this recommendation, the Department of Defense (DOD) has implemented new TRICARE contracts. Under these contracts, DOD has eliminated many of the prescriptive requirements that formerly required the issuing of change orders. Further, DOD agreed that it will consolidate change orders due to statutory changes, when possible.
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