Privacy Act of 1974; System of Records, 15702-15704 [06-3001]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 71, Number 60 (Wednesday, March 29, 2006)]
[Notices]
[Pages 15702-15704]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-3001]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[DoD-2006-OS-0047]


Privacy Act of 1974; System of Records

AGENCY: Office of the Secretary, DoD.

ACTION: Notice to amend systems of records.

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SUMMARY: The Office of the Secretary of Defense is amending a system of 
records notice in its existing inventory of record systems subject to 
the Privacy Act of 1974, (5 U.S.C. 552a), as amended.

DATES: This proposed action will be effective without further notice on 
April 28, 2006 unless comments are received which result in a contrary 
determination.

ADDRESSES: Send comments to the OSD Privacy Act Coordinator, Records 
Management Section, Washington Headquarters Services, 1155 Defense 
Pentagon, Washington, DC 20301-1155.

FOR FURTHER INFORMATION CONTACT: Ms. Juanita Irvin at (703) 696-4940.

SUPPLEMENTARY INFORMATION: The Office of the Secretary of Defense 
systems of records notices subject to the Privacy Act of 1974, (5 
U.S.C. 552a), as amended, have been published in the Federal Register 
and are available from the address above.
    The specific changes to the record system being amended are set 
forth below followed by the notice, as amended, published in its 
entirety. The proposed amendments are not within the purview of 
susection (r) of the Privacy Act of 1974, (5 U.S.C. 552a), as amended, 
which requires the submission of a new or altered system report.

    Dated: March 23, 2006.
L.M. Bynum,
OSD Federal Register Liaison Officer, Department of Defense.
DTMA 04

System name:
    Medical/Dental Claim History Files (May 9, 2003, 68 FR 24938).

Changes:
Notification procedure:
    Add the following to the end of the entry: ``or TRICARE Management 
Activity Privacy Office, Skyline 5, Suite

[[Page 15703]]

810, 5111 Leesburg Pike, Falls Church, VA 22041-3201.''

Record access procedures:
    Add the following to the end of the entry: ``or TRICARE Management 
Activity Privacy Office, Skyline 5, Suite 810, 5111 Leesburg Pike, 
Falls Church, VA 22041-3201.''
DTMA 04

System name:
    Medical/Dental Claim History Files.

System location:
    TRICARE Management Activity, Department of Defense, 16401 East 
Centretech Parkway, Aurora, CO 80011-9066, and contractors under 
contract to TRICARE. A listing of TRICARE contractors maintaining these 
records is available from the system manager.

Categories of individuals covered by the system:
    Eligible beneficiaries and all individuals who seek health care 
(medical and dental) under TRICARE/CHAMPUS and CHAMPVA.

Categories of records in the system:
    File contains claims, billings for services, applications or 
approval forms, enrollment files, recoupment files, third-party 
liability files, fraud and abuse files, case management files, resource 
sharing files, utilization management/quality assurance files, payment 
files, medical/dental records, family history files, records of 
grievances with a medical/dental provider, appeals, hearings, or any 
other correspondence, memoranda, or reports which are acquired or 
utilized in the development and processing of TRICARE/CHAMPUS or 
CHAMPVA claims. Records are also maintained on health care 
demonstration projects, including enrollment and authorization 
agreements, correspondence, memoranda, forms and reports, which are 
acquired or utilized during the projects.

Authority for maintenance of the system:
    41 CFR 101-11.000; chapter 55, 10 U.S.C. 613, chapter 17, 38 
U.S.C.; 32 CFR part 199; and E.O. 9397 (SSN).

Purpose(s):
    TRICARE Management Activity and its contractors, DoD staff 
(including Military Treatment Facilities, clinics and Lead Agent Staff) 
use the information to control and process health care benefits 
available under TRICARE/CHAMPUS and CHAMPVA including the processing of 
medical/dental claims, the control and approval of medical/dental 
treatments, issuance of deductible certificates, and necessary 
interface with providers of health care. The system also supports 
audits of contractor-processed claims to determine payment and 
occurrence accuracy of the contractor's adjudication process.

Routine uses of records maintained in the system, including categories 
of users and purposes of such uses:
    In addition to those disclosures generally permitted under 5 U.S.C. 
552a(b) of the Privacy Act, these records or information contained 
therein may specifically be disclosed outside the DoD as a routine use 
pursuant to 5 U.S.C. 552a(b)(3) as follows:
    To the Department of Health and Human Services and/or the 
Department of Veterans Affairs consistent with their statutory 
administrative responsibilities under TRICARE/CHAMPUS and CHAMPVA 
pursuant to chapter 55, 10 U.S.C. and section 613, chapter 17, 38 
U.S.C.
    Referral to Federal, State, local, or foreign governmental 
agencies, and to private business entities, including individual 
providers of care (participating and non-participating), on matters 
relating to eligibility, claims pricing and payment, fraud, program 
abuse, utilization review, quality assurance, peer review, program 
integrity, third-party liability, coordination of benefits, and civil 
or criminal litigation related to the operation of TRICARE/CHAMPUS.
    Disclosure to the Department of Justice and the United States 
Attorneys in situations where the United States is an interested party.
    Disclosure to third-party contacts in situations where the party to 
be contacted has, or is expected to have, information necessary to 
establish the validity of evidence or to verify the accuracy of 
information presented by the individual concerning his or her 
entitlement, the amount of benefit payments, any review of suspected 
abuse or fraud, or any concern for program integrity or quality 
appraisal.
    The DoD `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.


    Note: This system of records contains individually identifiable 
health information. The DoD Health Information Privacy Regulation 
(DoD 6025.18-R) issued pursuant to the Health Insurance Portability 
and Accountability Act of 1996, applies to most such health 
information. DoD 6025.18-R may place additional procedural 
requirements on the uses and disclosures of such information beyond 
those found in the Privacy Act of 1974 or mentioned in this system 
of records notice.

Disclosure to consumer reporting agencies:
    Disclosures pursuant to 5 U.S.C. 552a(b)(12) may be made from this 
system to consumer reporting agencies as defined in the Fair Credit 
Reporting Act of 1966 (15 U.S.C. 1681a(f)) or the Federal Claims 
Collections Act of 1966 (31 U.S.C. 3701(a)(3)). The purpose of the 
disclosure is to aid in the collection of outstanding debts owed to the 
Federal Government; typically, to provide an incentive for debtors to 
repay delinquent Federal Government debts by making these debts part of 
their credit records.
    The disclosure is limited to information necessary to establish the 
identity of the individual, including name, address, and taxpayer 
identification number (Social Security Number); the amount, status, and 
history of the claim; and the agency or program under which the claim 
arose for the sole purpose of allowing the consumer reporting agency to 
prepare a commercial credit report.

Policies and practices for storing, retrieving, accessing, retaining, 
and disposing of records in the system:
Storage:
    Records are maintained on paper, electronic, microfilm, imaging, or 
optical formats.

Retrievability:
    Information is retrieved by sponsor's name; sponsor's Social 
Security Number; beneficiary's name; beneficiary's Social Security 
Number; provider's name; provider's number (Tax Identification Number 
or Social Security Number); internal control number; classification of 
medical diagnosis; procedure code; geographical location of care 
provided; and selected utilization limits.

Safeguards:
    Records are maintained in areas accessible only to authorized 
personnel who are properly screened, cleared and trained. Decentralized 
automated segments within contractor's operations are accessible on-
line only to authorized persons possessing user identification codes. 
The automated portion of the Primary System is accessible only through 
TRICARE Management Activity on-line data systems. Security systems and/
or security guards protect buildings where records are maintained.

Retention and disposal:
    Paper records are closed out at the end of the calendar year in 
which finalized and held six additional years and then destroyed. Where 
hard copy

[[Page 15704]]

records (except Claims History Files) have been converted to 
electronic, microfilm, imaging, or optical formats, the hard copy 
record is destroyed and the electronic, microfilm, imaging, or optical 
format is kept by the contractor for six years after claim is processed 
to completion and then destroyed. Claims History Files maintained in 
electronic format are kept for ten years and are then destroyed or 
deleted.

System manager(s) and address:
    TRICARE Management Activity, Department of Defense, Administration 
and Evaluation Directorate, 16501 East Centretech Parkway, Aurora, CO 
80011-9066.

Notification procedure:
    Individuals seeking to determine whether information about 
themselves is contained in this system should address written inquiries 
to the TRICARE Management Activity, Department of Defense, ATTN: 
Privacy Act Officer, 16401 Centretech Parkway, Aurora, CO 80011-9066; 
or TRICARE Management Activity Privacy Office, Skyline 5, Suite 810, 
5111 Leesburg Pike, Falls Church, VA 22041-3201.

Record access procedures:
    Individuals seeking access to information about themselves 
contained in this system should address written inquiries to the 
TRICARE Management Activity, Department of Defense, ATTN; Privacy Act 
Officer, 16401 Centretech Parkway, Aurora, CO 80011-9066; or TRICARE 
Management Activity Privacy Office, Skyline 5, Suite 810, 5111 Leesburg 
Pike, Falls Church, VA 22041-3201.
    Written request for information should include the full name of the 
beneficiary, the full name of the sponsor and sponsor's Social Security 
Number, current address and telephone number.
    For personal visits to examine records, the individual should 
provide some acceptable identification such as a driver's license or 
other form of picture identification.
    If it is determined that the release of medical information to the 
requester could have an adverse effect upon the individual's physical 
or mental health, the requester should be prepared to provide the name 
and address of a physician who would be willing to receive the medical 
record, and at the physician's discretion, inform the individual 
covered by the system of the contents of that record. In the event the 
physician does not agree to convey the information contained within the 
record to the individual, TRICARE Management Activity will take 
positive measures to ensure the individual is provided the requested 
information.

Contesting record procedures:
    The OSD rules for accessing records, for contesting contents and 
appealing initial agency determinations are published in OSD 
Administrative Instruction 81; 32 CFR part 311; or may be obtained from 
the system manager.

Record source categories:
    Contractors, Health Benefit Advisors; other Components of the 
Department of Defense; all branches of the uniformed Services; 
Congressional offices; providers of care; consultants; and individuals.

Exemptions claimed for the system:
    None.

[FR Doc. 06-3001 Filed 3-28-06; 8:45 am]
BILLING CODE 5001-06-M