Not Ready for Prime Time Closed Network Customer Service


For a full week we have been attempting to get even some basic answers from the “Not ready for prime time” TMA/ISOS/Global 24 Customer Service to various issues with no or little result.

One example was a question what some of the strange specialty listing on the Approved Provider list meant. One would think if they placed them on the list they would know what they mean but apparently not. A second question was what the purpose of the email addresses were for on the Approved Provider list and what were the response time requirements of the providers. We had the same expectation that they knew what they were for but after a week still no response and now they have disappeared from the list. It appears columns and fields will come and go with no rhyme or reason but more at the whim of some poorly trained clerk.

Another issue we addressed early on was that the search engine on their web page did not work.

Below is a response we received but which did not relate to the questions in the original message but related to a previous message and our response. To better understand the thread we reversed the order by placing the oldest emails first.

(Original Email)

From: Jim

Sent: Friday, 9 November, 2012 8:34 AM

To: Global24NS.Support

Cc: kenneth; Michael FREWEN; Mark ZIMMERMAN; Forestell, Francine, CIV, OASD(HA)/TMA

Subject: Still Waiting for Answers

As of 0830 hours on Friday 9 November 2012 I am still waiting for answers to questions sent via email as follows.

Questions dealing with entries on the approved list; specifically clarification on two specialty entries and the purpose and rules of use of the unexplained email addresses. Original email sent 1006 hrs 3 Nov 12. Received an email with a promise that “a detailed response within 48 hrs from time of receipt.” at 1844 hrs 6 Nov 12 in response to a resubmission of the questions due to lack of response at 1641 hrs 6 Nov 12. However that was an empty promise as the 48 hrs passed a long time ago and still nothing but silence.

Questions dealing with filing grievances and protection of the beneficiary. Original email sent 1038 hrs 8 Nov 12.

Questions dealing with blanket waivers. Original email sent 1119 hrs 8 Nov 12

(Response to email above)

On 11/9/2012 1:14 PM, Global24NS.Support wrote:

Dear ,

Thank you for your email. Significant work has been done on the provider search tool over the last 72hrs and we continue to make improvements. We would encourage you to revisit the tool at: http://www.tricare-overseas.com/ProviderSearch/Beneficiary_PhilippineDemonstration_ProvSearch.aspx.

Identified improvements are being addressed in the search tool improvements, and are being updated in the PDF and Excel files over the coming 72 hrs.

Kind regards,

Global 24 Network Services

P.O. Box # 13892

Emerald Avenue, Ortigas Center

Post Office

Pasig City, Philippines 1605

Phone: +63-2687-8656

Toll Free Phone: 1-800-10-4562324

Fax: +63-2687-8609

Support: Support@GLOBAL24NS.com

(Our response to their response but addressed it to TMA and ISOS)

Sent to:

To: “Halliwell, Thomas W CIV TMA (US)” <thomas.w.halliwell.civ@mail.mil>, Mick Frewen ISOS <Michael.FREWEN@internationalsos.com>, Mark ZIMMERMAN ISOS <mark.zimmerman@internationalsos.com>, “Forestell, Francine, CIV, OASD(HA)/TMA” <Francine.Forestell@tma.osd.mil>, “Gamble, Byran, BG, (Dep, Dir, TMA)” <w.byran.gamble@tma.osd.mil>, “Woodson, Jonathan, Dr, (Dir TMA)” <jonathan.woodson@ha.osd.mil>

CC: “Global24NS.Support” <Support@GLOBAL24NS.com>, Kenneth, Bob Washington (FRA), Kathy Beasley (MOAA)

BCC: “Tritten, Travis (S&S)” <trittent@pstripes.osd.mil>

Message below:

While it appears you have made some strides in improving the two spreadsheets they still contain spelling errors which will kill any attempt to use your search tool.

Secondly your entire approach to your search tool seems to have been done by someone without any knowledge of automation, data, databases and spreadsheets. As such it will never work but it will lead beneficiaries to make very wrong decisions on their medical care which is a serious issue.

But even if you finally get it to work, unless you clean up your data, which has been an issue for many years, the results will still be incomplete and misleading.

Some simple observations based on 5 minutes of looking at the spreadsheets and attempting a couple of searches.

* Multiple specialties are not represented by the drop down list so they will never appear. It also appears this is a manually created list which will always result in missing specialties as the data is updated.

* I did two sample searches to see how well your search engine worked and it totally failed again. I searched Angeles for Infectious Disease and the result was “There were no Approved/Certified Providers found for your search.” which is not true as there is one listed. I searched Angeles for General Practice and again the result was “There were no Approved/Certified Providers found for your search.” which is also not true. See attached.

The TOM Chapter 18 Section 12 Para 5.2.4 clearly states “Establish and maintain a list of all approved demonstration providers, including each provider’s specialty, subspecialty, gender, work address, work fax number, and work telephone number for each demonstration location, and whether or not they are accepting new TRICARE patients. The approved list of providers must be submitted to TMA no later than 120 calendar days prior to the start of health care delivery under the demonstration. The TOP contractor shall provide beneficiaries with easy access to both the approved provider listing and the certified provider listing via a user-friendly searchable World Wide Web (WWW) site and any other means established at the contractor’s discretion no later than 60 calendar days prior to the start of health care delivery in each demonstration area. Information on the WWW site and any other electronic lists shall be current within the last 30 calendar days. At a minimum, the data base shall be searchable by provider location, provider name, and provider specialty (if available).”

The contractor admitted at the closed limited attendance meetings that the approved list of providers was still a work in progress. So we know that the contractor failed to meet the requirement to submit the list to TMA NLT 120 days prior to the start of the demonstration. Secondly the contractor was required to provide a user-friendly searchable WWW site and other means, Excel, NLT 60 days prior to the start of the demonstration. We are well past the 60 day limit and there is still not a complete list and there is not no workable search option.

TMA and the contractor have been working on this project for years. In particular the contractor has been attempting to develop a network for at least a year yet it is extremely limited in specialty providers with at most one specialty provider in a location and most specialties missing. So it appears to be a network of extremely limited use to beneficiaries who were promised quality care from providers that would process their claims. The quality component is obviously missing and it appears much of the care beneficiaries will need will have to come from blanket waivers which puts them back into the old system making this demonstration a hodge podge of providers from different systems and processes which will make it extremely difficult for the average beneficiary to manage and understand.

The demonstration must be at least postponed until a viable and complete network of providers who meet minimum quality standards is available and presented to TMA within the mandated time-frame as well as providing a workable and user-friendly database and search engine 60 days before the start of the demonstration. Failure to comply with these requirements not only violates TMA’s own manuals but will place beneficiaries in harms way.

All of this clearly begs the question if the entire Limited Closed Network is anywhere near ready for use and if the contractor is capable of administering the program.

On another note I am still waiting for answers to the basic questions, below, that were first asked on 3 Nov 12!

Jim

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About TRICARE Overseas Philippines

We are U.S. Military retirees working to insure we obtain the medical benefit promised in spite of the Defense Health Agency.
This entry was posted in Closed Network, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines and tagged , , . Bookmark the permalink.

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