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Managed Care Program

Policy

The Executive Director of the TRICARE Management Activity (TMA) recommends the use of the Composite Health Care System (CHCS) Managed Care Program (MCP) module for outpatient appointing for enrollees and non-enrollees for the reasons listed in the following paragraph. All regions will be directed to convert to MCP booking for outpatient appointing as soon as possible and before 1 April 2000.

The CHCS MCP supports TRICARE appointing policies including the capabilities needed to support appointing consistent with the Primary Care Manager by Name initiative for enrollees. In addition, new enhancements are scheduled for MCP that will facilitate and track access to care when searching for or booking an appointment. New standards and procedures will be implemented to provide a consistent method of appointing nationwide. Clerks will have more accurate search criteria to find appropriate, increased appointment options for a patient. The new standards include nine appointment types, codes used to reserve appointments for beneficiaries by access type, and a coded detail field to document the special care requirements of a specific appointment.

Provider File and Table Build

In order to implement MCP successfully, the Provider File and Table build must be completed accurately. Some important rules for successfully creating providers, groups, and Primary Care Managers (PCMs) are described in the Provider Templating topic on this Web site.

MCP Current Features MCP currently supports Access to Care with the following features:
  • Automatic verification of eligibility
  • Appropriate appointing for prime enrollees with their PCM
  • Broader appointment searches across multiple clinics and geographical areas
  • Direct appointing to a provider or clinic
  • Referral management and tracking
  • Better Integration of MCP with Consult Tracking
  • Better appointment options for the patient
  • No user knowledge of the clinics required to book an appointment
The integration of Consult Tracking with MCP in CHCS supports appropriate patient appointment booking and communication of provider results. Booking is accomplished directly from the ordering provider's instructions. The referred-to provider sees the patient, then enters the results directly into CHCS. The results are returned to the ordering provider, enhancing patient management and improving outcomes.

MCP Imminent Features

CHCS future releases will implement the new appointing standardization features in the MCP module and in the Patient Appointing and Scheduling Schedule Build module. The File and Table will also reflect changed functions. The most important new features are listed below:
  • Use nine standard appointment types
  • Set clinic naming conventions
  • Reserve appointments by patient access type
  • Set appointments' duration based on the care to be provided not on the appointment type
  • Book appointments within the access to care standards
  • Match patient age to provider capabilities
  • Match needed care to clinical resources via the detail field
  • Release reserved appointments automatically according to a schedule and criteria defined by the provider, e.g., releasing appointment slots reserved by beneficiary priority, by detail field, or by appointment type thus making it easier for Managed Care Support Contractor appointment clerks
  • Reserve appointments using the patient access type to ensure appropriate access to care for enrollees and others
  • Allow PCM booking outside the enrollee's place of care but within the enrollee's MTF