- Administering foreign medical claims for the TRICARE Overseas Program
- Processing more than 545,000 claims annually for nearly 550,000 beneficiaries
- Paying more than $270 million in benefits annually
- Processing TRICARE claims
- Offering customer service, supporting providers, and responding to questions and concerns with billing and enrollment
- Coordinating Managed Care Support Contractor and Defense Manpower Data
- Verifying beneficiary eligibility via DEERS interface
- Submitting TRICARE Encounter Data (TED) records
- Serving 6 million beneficiaries (two out of three in the TRICARE population) while processing 31 million claims and paying $7.5 billion in benefits per year
- Processing claims for TRICARE-eligible beneficiaries who have Medicare Part A and B coverage
- Providing high-quality customer service to beneficiaries and health care providers
- Maintaining full-function beneficiary and provider portals for 24/7 self-service access to claims, program information, and educational materials
- Coordinating with the Defense Manpower Data Center for DEERS interface
- Submitting TED records
- Preserving effective cost-containment through medical review and program integrity units to ensure reimbursement of medically necessary services and covered benefits
- Serving 2.34 million beneficiaries annually, while processing 53.2 million claims and paying $3.8 billion in benefits
- Subcontracting on a 10-year, $1 billion contract vehicle for professional consulting and health care services covering health system transformation and innovation, implementation and operations support, and health care business-enabling services
- Managed veterans PC3 claims, initially for three regions serving 750,000 beneficiaries while processing 4 million claims and paying $1 billion per year, and then for the entire nation during the transition to Community Care Network
- Served approximately 1.5 million CCN beneficiaries
- Received, processed, adjudicated, and paid provider claims for 13 states over the western United States
- Enrolling providers in four states as well as additional Medicare Part A providers in 47 states
- Delivering customer service
- Processing claims and appeals
- Performing medical reviews, provider audits and reimbursements, and data analytics
- Serving 4 million beneficiaries and 67,000 providers annually, processing 65 million claims while paying $30 billion in benefits
- Enrollng providers in two states
- Delivering customer service
- Processing claims and appeals
- Performing medical reviews, provider audits and reimbursements, and data analytics
- Serving 3 million beneficiaries and 78,000 providers annually, processing 61 million claims while paying $17 billion in benefits
Note: Beneficiaries and annualized claims estimated and rounded as of Dec. 31, 2021.