Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 192Appendix D - ResourcesVersion 3.0Medical Management GuideTRICARE Regional Office (TRO)TRICARE has three regional offices: North, South, and West.Resources: http://www.tricare.osd.mil/Uniformed Biostatistical Utility (UBU) Working GroupThe group responsible for the detailed analysis required to standardize biostatistical data elements, definitions,data collection processes, procedure codes, diagnoses, and algorithms across the MHS. The UBU WorkingGroup consists of multi-disciplinary functional experts from each Service. The UBU also consists of a subworkgroupof Service coders who develop and publish DoD Coding Guidelines when coding patient care in theMHS.Resources: http://www.tricare.mil/ocfo/bea/ubu/index.cfmUniformed Business Office (UBO)An office within the TRICARE Office of the Chief Financial Officer (OCFO) Management Control & FinancialStudies (MCFS) Division. It supports TRICARE managed care programs by providing tools and policies toenhance and improve the effectiveness of the financial and collection operations. This includes providingsupport for managing and expediting collections from patients and third-party insurers; consistent and uniformreporting of expense, manpower, and workload data; and enhancing third-party reimbursements. These effortsare coordinated by the charted UBO Advisory Working Group, which includes members from each Service.Resources: http://www.tricare.mil/ocfo/mcfs/ubo/index.cfmU.S. Army Medical Command (MEDCOM) Quality Management Office (QMO)Resources: https://www.qmo.amedd.army.mil/U.S. Preventive Services Task Force (USPSTF)An independent panel of experts in primary care and prevention that systematically reviews the evidence ofeffectiveness and develops recommendations for clinical preventive services.Resources: http://www.ahrq.gov/clinic/uspstfix.htmUtilization Review Accreditation Commission (URAC) (formerly American Accreditation HealthcareCommission [AAHC])A not-for-profit organization founded to promote the accountability of healthcare organizations withthe establishment of utilization review accreditation standards. Individual states often require utilizationmanagement organizations to be URAC-accredited before they can operate.Resources: www.urac.org
Medical Management Guide Version 3.0 Appendix D - ResourcesPage 193Warrior in Transition Program (WT) — see also Army Wounded Warrior Program (AW2)As a result of Global War on Terrorism (GWOT) missions, including Operation Iraqi Freedom (OIF) and OperationEnduring Freedom (OEF), the highest rate of transition resource need has occurred in the Army. A uniqueresponsibility for case managers working in the MHS involves caring for Army Service members in WarriorTransition (WT) status.A WT member is defined as a Service member from any component (Active Compo [1], Army National Guard[2], or USAR [3]) who has been assigned to a WT unit.• Active Compo soldiers who require at least six months of significant care and rehabilitation and intensiveCM are assigned to a WTU.• Reserve Component (RC) WT soldiers are assigned to a WTU when they:o Have experienced injury or illness during training prior to mobilization (e.g., during training).o Have sustained injuries during deployment and were Medevaced.o Upon redeployment, were identified with an injury or illness that was caused by mobilization oraggravated during mobilization.RC soldiers are placed on Medical Retention Processing (MRP), MRP2, or Active Duty Medical Extension (ADME)orders when they are assigned to the WTU.WTU Nurse Case Manager (NCM)The WTU nurse case manager (NCM) in the WTU is involved not only with the medical care and executionof the treatment plan, but also with the WT soldier’s transition back to duty; or to civilian life, if separatedfrom the Service. As part of the Triad of care (the primary case manager [PCM], NCM, and squad leader), theNCM plays a key role in the development of the Comprehensive Transition Plan (CTP). He/she is responsiblefor documenting the clinical aspects of the CTP, coordinating with the VA for post-WTU care and follow-onservices, and ensuring the family is aware and engaged to the extent possible in the WT soldier’s care andtransition. The NCM also works closely with other members of the recovery team, including AW2 advocates,FRCs, and RCCs.While in WT status, a soldier is on a Temporary or Permanent profile and receives the appropriate medical careuntil he/she is determined to fall under one of the following statuses:• Found fit for duty and returned to his/her unit.• Released from Active Duty (REFRAD) Reserve Component (RC) soldier.• Has achieved optimal medical benefit according to the PCM (and therefore does not meet retentionstandards), has been referred to and completed a Medical Evaluation Board (MEB), and has completed thePhysical Disability Evaluation System (PDES) process.The Army has instituted the following enhanced access standards to improve the medical treatment process:• Seventy-two hours for initial specialty referrals.• One week for magnetic resonance imaging and other diagnostic studies.• Two weeks for surgery (from decision time to day of surgery).In addition, the ratio of WT soldiers to NCMs is 1:20, to facilitate close monitoring and assistance for the WT
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Medical Management Guide, 2009, Version 3.0 - Tricare

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