+----------------------------------------+-----------------------------+
| State of Washington                    | > DSHS/HRSA                 |
|                                        | >                           |
| Department of Social & Health Services | > Payment Review Program    |
|                                        | >                           |
| Health and Recovery Services           | > Veterans Benefit          |
| Administration                         | > Enhancement               |
|                                        | >                           |
|                                        | > Project Phone 360 725     |
|                                        | > 1020                      |
|                                        | >                           |
|                                        | > PO Box 45511 or 360 725   |
|                                        | > 2077                      |
|                                        | >                           |
|                                        | > Olympia, WA 98504-5511    |
+----------------------------------------+-----------------------------+

Military Health Insurance Identification

Using PARIS Federal (Dept of Defense) File Data to Maximize Third Party
Liability

![](media/image1.png){width="1.9166666666666667in"
height="0.5840277777777778in"} ![](media/image2.png){width="0.875in"
height="1.625in"}

# PARIS Federal File Includes TRICARE Sponsors and Beneficiaries

The Federal File data received from the PARIS match provides states with
useful verification of client gross income from Defense Finance and
Accounting Service (DFAS) and Office of Personnel Management (OPM).
Additionally, the Federal File data identifies persons eligible for
[TRICARE](http://www.tricare.osd.mil/) military health insurance, which
is the Department of Defense's worldwide health care program for active
duty and retired uniformed services members and their families. TRICARE
consists of TRICARE Prime, a managed care option; TRICARE Extra, a
preferred provider option; and TRICARE Standard, a fee-for-service
option. TRICARE For Life is also available for Medicare-eligible
beneficiaries age 65 and over. Beneficiaries may receive care at either
a Department of Defense military treatment facility or from a
TRICARE-authorized civilian provider.

TRICARE provides, among many other benefits, a world-class pharmacy
benefit to all Uniformed Service members eligible for TRICARE, including
TRICARE for Life (TFL) beneficiaries entitled to Medicare Part A and B.
Eligible beneficiaries may fill prescription medications at [military
treatment facility (MTF)
pharmacies](http://www.tricare.osd.mil/Factsheets/viewfactsheet.cfm?id=299#mtf);
through the [TRICARE Mail Order Pharmacy
(TMOP)](http://www.tricare.osd.mil/Factsheets/viewfactsheet.cfm?id=299#tmop);
at TRICARE [retail network
pharmacies](http://www.tricare.osd.mil/Factsheets/viewfactsheet.cfm?id=299#rnp);
and at non-network pharmacies. To have a prescription filled,
beneficiaries need a written prescription and a valid Uniformed Services
identification card. They must have their address and other information
updated in the [Defense Enrollment Eligibility Reporting System
(DEERS)](http://www.tricare.osd.mil/deers/default.cfm).

**Categories of Eligible TRICARE Beneficiaries include:**

-   Active duty and retired service members

-   Spouses and unmarried children (including stepchildren) of active
    duty or retired service members. [Note]{.underline}: Stepchildren
    lose eligibility after a divorce unless adopted by the sponsor.

## Reserve Component members on active duty for more than 30 days -- under Federal orders

-   Spouses and unmarried children of reserve component service members
    (Covered while reserve component sponsor is on active duty for more
    than 30 consecutive days).

-   Retired reserve component service members and their family members
    \[When the retired reserve component service member is eligible for
    retirement pay (usually at age 60), the member and his/her eligible
    family members become TRICARE eligible\]

-   Widows or widowers and unmarried children of deceased active duty or
    retired service members.

# PARIS Federal File Identifies TRICARE Sponsors and Beneficiaries 

TRICARE sponsors and beneficiaries are identified in the PARIS Federal
File by the **Record Type** indicators (located at element position 317,
following the State data):

> RECORD TYPE = CD DOD CIVILIAN
>
> RECORD TYPE = CO OPM CIVILIAN
>
> RECORD TYPE = CR OPM CIVIL SERVICE RETIREMENT
>
> RECORD TYPE = **MA** **MILITARY ACTIVE DUTY**
>
> RECORD TYPE = **MR** **MILITARY RETIRED PAY**
>
> RECORD TYPE = **MV** **MILITARY RESERVES**
>
> RECORD TYPE = NF NON-APPROPRIATED FUNDS

Active-duty military members, military retirees, and in certain cases,
military reservists[^1] are eligible for TRICARE health insurance.
Family members, surviving spouses and surviving unmarried children are
normally also eligible for TRICARE.

[It is important to recognize]{.underline} that the PARIS Federal File
identifies only the primary recipient of military benefits; it does not
list spouses and other family members associated with that individual
who may (also) be receiving state medical assistance. Some
TRICARE-eligible military personnel identified by the PARIS Federal File
are not recipients of state medical assistance (i.e., some are
non-applying or ineligible spouses / parents of recipients). In other
cases, the TRICARE-eligible individual is receiving state medical
assistance together with a spouse and/or other family members.

For these reasons, a complete list of state medical recipients
associated with the TRICARE beneficiary / sponsor must be compiled, to
ascertain which clients need Third Party Liability profiles updated.
This can be done by extracting from the state records an inventory of
all medical assistance recipients corresponding to the **Case Number**
(located at element position 133 of the Federal File, in the state data
section) of the TRICARE beneficiary / sponsor.

# Notify State Medical Benefits Coordination of Military TPL 

The register of TRICARE-eligible sponsors and family members receiving
state medical assistance is forwarded to the state coordination of
benefits group for Third Party Liability data update, as needed.

To be eligible for TRICARE, beneficiaries must be enrolled in the
Defense Enrollment Eligibility Reporting System (DEERS). DEERS is a
computerized database of military sponsors, families and others
worldwide who are entitled under the law to TRICARE benefits.
Active-duty and retired service members are automatically registered in
DEERS, but they must take action to register their family members and
ensure they're correctly entered into the database. Enrollment
information is available at
[www.tricare.osd.mil/deers/default.cfm](http://www.tricare.osd.mil/deers/default.cfm).

The appropriate state medical benefits coordinator confirms DEERS
enrollment for the TRICARE sponsor and family members. Once enrollment
and eligibility are confirmed, the Third Party Liability profile is
updated, which notifies medical providers that TRICARE is to pay covered
medical care costs before Medicaid pays a claim.

# Identification of TRICARE-eligible Clients Saves Money

TRICARE provides comprehensive health care coverage for the Uniformed
Service member and eligible family members. In addition to comprehensive
medical coverage, enrolled beneficiaries are also eligible for TRICARE's
pharmacy benefit.

Utilization of the PARIS Federal file match has contributed greatly to
the decline of medical claim reimbursements for Children's Medical
recipients identified as having TRICARE due to the PARIS (primarily
Federal File) match. 

The data utilized in the graph below is comprised from the larger groups
of recipients verified as having TRICARE in the same month, so that
their collective changes in medical claim reimbursements could be
measured over time.

The graph illustrates how monthly medical claim reimbursements for these
recipient groups declined significantly in the months following
identification/verification of TRICARE TPL. It is apparent that the
major contributing factor appears to be the identification of new TPL,
as the change in reimbursements clearly coincides with the verification
of TRICARE TPL. Overall, medical claim reimbursements decreased from an
average of \$125.15 per month per recipient in the months preceding
verification of TRICARE TPL to an average of \$15.45 per month per
recipient in the months following identification.

Utilizing the PARIS Federal file, Washington State has identified and
enrolled close to 1,000 Medicaid recipients that had TRICARE TPL
coverage that was unknown to the department (Coordination of Benefits).

![](media/image3.wmf){width="6.99375in" height="3.7819444444444446in"}

 

[^1]: ^1^ For military reservists, the **Category Code** (element
    position 573 in the Federal File, following Pay Status) must
    correspond to TRICARE eligibility guidelines for the reservist (and
    family members) to be TRICARE eligible.