The Department of Defense has made improvements in processing Tricare claims for civilian-provided care, but some of the department's changes have created even more inefficiencies, says a report form the U.S. General Accounting Office released Thursday.
In recent years, DOD and its managed care support contractors have changed DOD requirements that were identified as inefficient or nonessential to accurate claims processing, the report says. For example, contractors now may return some claims with missing information that formerly had to be held until the requested information was supplied.
Also, to encourage providers to submit electronic claims, DOD allows contractors to decide whether to adjudicate electronic claims sooner than paper claims. Claims processors have improved their turnaround time, processing more than 97% of claims in 30 days or less in 2002, compared with 91% in 1999.
However, some of the changes have created extra work, and the GAO report notes that DOD does not adhere to a schedule when making Tricare program or benefits changes. In 2002, for example, DOD made 123 program changes on 19 different dates.
"Given the fact that implementing these changes often involves reprogramming and testing processing software, this approach can create rework for claims processors when DOD issues similar or related changes on separate occasions," the report says.
The report says DOD has agreed with the GAO recommendation that the department improve consolidation and scheduling of future claims processing changes.