[Federal Register Volume 65, Number 94 (Monday, May 15, 2000)]
[Notices]
[Pages 30966-30974]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-12072]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Privacy Act of 1974; System of Records

AGENCY: Office of the Secretary, DoD.

ACTION: Notice to alter systems of records.

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[[Page 30967]]

SUMMARY: The Office of the Secretary of Defense proposes to alter 
systems of records notices in its inventory of record systems subject 
to the Privacy Act of 1974 (5 U.S.C. 552a), as amended.

DATES: The changes will be effective on June 14, 2000 unless comments 
are received that would result in a contrary determination.

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

FOR FURTHER INFORMATION CONTACT: Mr. David Bosworth at (703) 588-0159.

SUPPLEMENTARY INFORMATION: The Office of the Secretary of Defense 
notices for systems of records 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 records systems being amended are set 
forth below followed by the notices, as amended, published in their 
entirety.
    The proposed system report, as required by 5 U.S.C. 552a(r) of the 
Privacy Act of 1974, as amended, was submitted on April 24, 2000, to 
the House Committee on Government Reform, the Senate Committee on 
Governmental Affairs, and the Office of Management and Budget (OMB) 
pursuant to paragraph 4c of Appendix I to OMB Circular No. A-130, 
`Federal Agency Responsibilities for Maintaining Records About 
Individuals,' dated February 8, 1996 (February 20, 1996, 61 FR 6427).

    Dated: May 9, 2000.
L. M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
DOCHA 01

System name:
    Health Benefits Authorization Files (March 24, 1994, 59 FR 13934).

Changes:
System identifier:
    Delete entry and replace with `DTMA 01'.
* * * * *

Categories of records in the system:
    Delete entry and replace with `Original correspondence to and from 
individuals; medical/dental statements; medical/dental histories; 
Health Care Advise Nurse records; Congressional inquiries; medical/
dental treatment records; authorization and pre-authorization requests 
for care; case status sheets; memoranda for the record; follow-up 
reports justifying extended care; correspondence with contractors; and 
work-up sheets maintained by case workers.'
* * * * *

Purpose(s):
    Add a new paragraph `To determine eligibility of an individual, 
authorize payment, control and review health care management plans, 
health care demonstration programs, control accomplishment of reviews, 
and coordinate subject matter clearance for internal and external 
audits and reviews of the program.'

Routine use(s) of records maintained in the system, including 
categories of users and purposes of such uses:
    Delete paragraph two, and add a new paragraph `Disclosure to the 
Department of Justice and the United States Attorneys in situations 
where the United States is an interested party.'
* * * * *
DTMA 01

System name:
    Health Benefits Authorization Files.

System location:
    TRICARE Management Activity, Department of Defense, 16401 East 
CentreTech Parkway, Aurora, CO 80011-9043, and Managed Care Contractors 
under contract to TRICARE. A listing of TRICARE Managed Care 
Contractors is available from the system manager.

Categories of individuals covered by the system:
    All individuals who seek authorization or pre-authorization for 
medical and dental health care under TRICARE/CHAMPUS and CHAMPVA.

Categories of records in the system:
    Original correspondence to and from individuals; medical/dental 
statements; medical/dental histories; Health Care Advise Nurse records; 
Congressional inquiries; medical/dental treatment records; 
authorization and pre-authorization requests for care; case status 
sheets; memoranda for the record; follow-up reports justifying extended 
care; correspondence with contractors; and work-up sheets maintained by 
case workers.

Authority for maintenance of the system:
    41 CFR part 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):
    To maintain and control records pertaining to requests for 
authorization or pre-authorization of health and dental care under 
TRICARE/CHAMPUS.
    To determine eligibility of an individual, authorize payment, 
control and review health care management plans, health care 
demonstration programs, control accomplishment of reviews, and 
coordinate subject matter clearance for internal and external audits 
and reviews of the program.

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 `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.

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.

[[Page 30968]]

Retrievability:
    Information is retrieved by sponsor's Social Security Number and 
sponsor's or beneficiary's name.

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. Security systems and/or security guards protect 
buildings where records are maintained.

Retention and disposal:
    Automated indexes are maintained for six years. Hard copy records 
are closed out at the end of the calendar year in which finalized and 
held six additional years. Where hard copy records have been converted 
to electronic, microfilm, imaging, or optical formats, the hard copy is 
destroyed and the electronic, microfilm, imaging, or optical format is 
kept by the contractor for six years after claim is processed to 
completion.

System manager(s) and address:
    TRICARE Management Activity, Department of Defense, Administration 
and Evaluation Directorate, 16401 East CentreTech Parkway, Aurora, CO 
80011-9043.

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 80011-9043.

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 80011-9043.
    Written requests 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 Benefits Advisors, all branches of the 
Uniformed Services, congressional offices, providers of care, 
consultants and individuals.

Exemptions claimed for the system:
    None.
DOCHA 02

System name:
    Medical Care Inquiry Files (March 24, 1994, 59 FR 13936).

Changes:
System identifier:
    Delete entry and replace with `DTMA 02'.

System name:
    Delete entry and replace with `Medical/Dental Care and Claims 
Inquiry Files'.
* * * * *

Purpose(s):
    Delete entry and replace with `To maintain and control records 
pertaining to requests for information concerning an individual's 
TRICARE/CHAMPUS eligibility status, the benefits provided under 
programs of TRICARE/CHAMPUS and CHAMPVA and the processing of 
individual TRICARE/CHAMPUS and CHAMPVA claims.'
* * * * *

Routine uses of records maintained in the system, including categories 
of users and the purposes of such uses:
    Delete paragraph two, and add a new paragraph `Disclosure to the 
Department of Justice and the United States Attorneys in situations 
where the United States is an interested party.'
* * * * *

Record source categories:
    Delete entry and replace with `Contractors, congressional offices, 
Health Benefits Advisors, all branches of the Uniformed Service, 
congressional offices, providers of care, consultants and individuals.'
* * * * *
DTMA 02

System name:
    Medical/Dental Care and Claims Inquiry Files.

System location:
    TRICARE Management Activity, Department of Defense, 16401 East 
CentreTech Parkway, Aurora, CO 80011-9043, and Managed Care Contractors 
under contract to TRICARE. A listing of TRICARE Managed Care 
Contractors is available from the system manager.

Categories of individual covered by the system:
    All individuals who seek information concerning health care 
(medical and dental) under TRICARE/CHAMPUS and CHAMPVA.

Categories of records in the system:
    Documents reflecting inquiries received from private individuals 
for information on TRICARE/CHAMPUS and CHAMPVA and replies thereto; 
congressional inquiries on behalf of constituents and replies thereto; 
and files notifying personnel of eligibility or termination of 
benefits.

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

Purpose(s):
    To maintain and control records pertaining to requests for 
information concerning an individual's TRICARE/CHAMPUS eligibility 
status, the benefits provided under programs of TRICARE/CHAMPUS and 
CHAMPVA and the processing of individual TRICARE/CHAMPUS and CHAMPVA 
claims.

Routine uses of records maintained in the system, including categories 
of users and the 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

[[Page 30969]]

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 `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.

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 case number, sponsor name and/or Social 
Security Number, and inquirer name.

Safeguards:
    Records are maintained in areas accessible only to authorized 
personnel who are properly screened, cleared, and trained. Automated 
segments are accessible only by authorized persons possessing user 
identification codes. Security systems and/or security guards protect 
buildings where records are maintained.

Retention and disposal:
    Paper records are retained in active file until end of calendar 
year in which closed, held two additional years, and then destroyed. 
Where hard copy records 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.

System manager(s) and address:
    TRICARE Management Activity, Department of Defense, Administration 
and Evaluation Directorate, 16401 East CentreTech Parkway, Aurora, CO 
80011-9043.

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 80011-9043.

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 80011-9043.
    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, congressional offices, Health Benefits Advisors, all 
branches of the Uniformed Service, congressional offices, providers of 
care, consultants and individuals.

Exemptions claimed for the system:
    None.
DOCHA 04

System name:
    Legal Opinion Files (February 22, 1993, 58 FR 10227).

Changes:
System identifier:
    Delete entry and replace with `DTMA 03'.
* * * * *

Categories of individuals covered by the system:
    Delete entry and replace with `Individuals who have contacted or 
corresponded with TRICARE Management Activity regarding any matter 
requiring legal clarification or resolution.'
* * * * *

Purpose(s):
    Delete entry and replace with `TRICARE Management Activity uses 
these records to address and resolve legal issues and for research, 
precedent, historical, and record purposes.'

Routine uses of records maintained in the system, including categories 
of users and the purposes of such uses:
    Delete entry and replace with `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

[[Page 30970]]

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 `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.'
* * * * *
DTMA 03

System name:
    Legal Opinion Files.

System location:
    TRICARE Management Activity, Department of Defense, Office of 
General Counsel, 16401 East CentreTech Parkway, Aurora, CO 80011-9043.

Categories of individuals covered by the system:
    Individuals who have contacted or corresponded with TRICARE 
Management Activity regarding any matter requiring legal clarification 
or resolution.

Categories of records in the system:
    Inquiries received from individuals, attorneys, fiscal 
administrators, hospital contractors, other government agencies, Health 
Care Advise Nurse records, and congressional offices. Files contain 
legal opinions, correspondence, memoranda for the record, and similar 
documents. Medical/dental treatment records, authorizations and pre-
authorizations, care and claims inquiry documents, and medical/dental 
history files may be included in these records, as appropriated to 
document TRICARE legal determinations.

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 uses these records to address and 
resolve legal issues and for research, precedent, historical, and 
record purposes.

Routine uses of records maintained in the system, including categories 
of users and the 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 `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.

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 subject matter with cross-reference by 
individual name and/or Social Security Number.

Safeguards:
    Records are maintained in areas accessible only to authorized 
personnel who are properly screened, cleared, and trained. Security 
systems and/or security guards protect buildings where records are 
maintained.

Retention and disposal:
    Records are permanent. Paper records are retired to the Denver 
Regional Records Center when ten years old or when no longer needed for 
current business. Records are transferred to the NARA when thirty years 
old. Electronic and other non-paper media records are maintained until 
no longer needed for current business and are then deleted or 
destroyed.

System manager(s) and address:
    TRICARE Management Activity, Department of Defense, Office of 
General Counsel, 16401 East CentreTech Parkway, Aurora, CO 80011-9043.

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 80011-9043.

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 80011-9043.
    Written requests 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 be 
able to 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.

[[Page 30971]]

Record source categories:
    Individuals (TRICARE/CHAMPUS and CHAMPVA beneficiaries, sponsors, 
or others), attorneys, fiscal administrators, hospital contractors, 
managed care support contractors, providers of care, medical records, 
other government agencies (Federal, state, local and foreign), and 
Congressional offices.

Exemptions claimed for the system:
    None.
DOCHA 07

System name:
    Medical Claim History Files (March 24, 1994, 59 FR 13937).

Changes:
System identifier:
    Delete entry and replace with `DTMA 04'.

System name:
    Add `/Dental' after `Medical.
* * * * *

Categories of records in the system:
    Delete entry and replace with `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.'
* * * * *

Purpose(s):
    Delete entry and replace with `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:
    Delete entry and replace with `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 `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.'
* * * * *
DTMA 04

System name:
    Medical/Dental Claim History Files.

System location:
    TRICARE Management Activity, Department of Defense, 16401 East 
CentreTech Parkway, Aurora, CO 80011-9043, and Managed Care Contractors 
under contract to TRICARE. A listing of TRICARE Managed Care 
Contractors 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

[[Page 30972]]

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 `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.

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 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, 16401 East CentreTech Parkway, Aurora, CO 
80011-9043.

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 80011-9043.

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 80011-9043.
    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.
DOCHA 09

System name:
    Grievance Records (August 9, 1993, 58 FR 42303).

Changes:
System identifier:
    Delete entry and replace with `DTMA 05'

[[Page 30973]]

Routine uses of records maintained in the system, including categories 
of users and the purposes of such uses:
    Delete entry and replace with `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 disclose information to any source from which additional 
information is requested in the course of processing a grievance, to 
the extent necessary to identify the individual, inform the source of 
the purpose(s) of the request, and identify the type of information 
requested.
    To disclose information to another Federal agency or to a court 
when the Government is party to a judicial proceeding before the court.
    To disclose information to officials of the Federal Labor Relations 
Authority and its General Counsel; or the Equal Employment Opportunity 
Commission, when requested in performance of their authorized duties.
    To disclose in response to a request for discovery or for 
appearance of a witness, information that is relevant to the subject 
matter involved in a pending judicial or administrative proceeding.
    To provide information to officials of labor organizations 
recognized under the Civil Service Reform Act when relevant and 
necessary to the performance of their exclusive representation duties 
concerning personnel policies, practices, and matters affecting working 
conditions.
    The `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.'
* * * * *
DTMA 05

System name:
    Grievance Records.

System location:
    TRICARE Management Activity, Department of Defense, Personnel 
Office, 16401 CentreTech Parkway, Aurora, CO 80011-9043.

Categories of individuals covered by the system:
    Current or former Federal employees of TRICARE Management Activity 
or its predecessor, Office of Civilian Health and Medical Program of 
the Uniformed Services who have submitted grievances in accordance with 
5 U.S.C. 2302 and 5 U.S.C. 7121 or a negotiated procedure.

Categories of records in the system:
    Documents related to grievances including statements of witnesses, 
reports of interviews and hearings, examiner's findings and 
recommendations, copy of the original and final decision, and related 
correspondence and exhibits. This system includes files and records of 
internal grievance and arbitration systems that TRICARE Management 
Activity may establish through negotiations with recognized labor 
organizations.

Authority for maintenance of the system:
    5 U.S.C. 2302; 5 U.S.C. 7121; and E.O. 11491.

Purpose(s):
    To control and process grievances of Federal employees of TRICARE 
Management Activity or its predecessor, Office of Civilian Health and 
Medical Program of the Uniformed Services.

Routine uses of records maintained in the system, including categories 
of users and the 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 disclose information to any source from which additional 
information is requested in the course of processing a grievance, to 
the extent necessary to identify the individual, inform the source of 
the purpose(s) of the request, and identify the type of information 
requested.
    To disclose information to another Federal agency or to a court 
when the Government is party to a judicial proceeding before the court.
    To disclose information to officials of the Federal Labor Relations 
Authority and its General Counsel; or the Equal Employment Opportunity 
Commission, when requested in performance of their authorized duties.
    To disclose in response to a request for discovery or for 
appearance of a witness, information that is relevant to the subject 
matter involved in a pending judicial or administrative proceeding.
    To provide information to officials of labor organizations 
recognized under the Civil Service Reform Act when relevant and 
necessary to the performance of their exclusive representation duties 
concerning personnel policies, practices, and matters affecting working 
conditions.
    The `Blanket Routine Uses' set forth at the beginning of OSD's 
compilation of systems of records notices apply to this system.

Policies and practices for storing, retrieving, accessing, retaining, 
and disposing of records in the system:
Storage:
    Paper records maintained in file folders.

Retrievability:
    Information is retrieved by individual name.

Safeguards:
    Security systems and/or security guards protect buildings where 
records are maintained.

Retention and disposal:
    Records are closed at the end of the calendar year in which they 
are closed, held an additional four years, and then destroyed.

System manager(s) and address:
    TRICARE Management Activity, Department of Defense, Personnel 
Office, 16401 East CentreTech Parkway, Aurora, CO 80011-9043.

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 80011-9043.

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 80011-9043.
    Written requests for information should include the full name of 
the individual.
    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.

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:
    Individuals, witnesses, agency officials, and organizations.

[[Page 30974]]

Exemptions claimed for the system:
    None.
[FR Doc. 00-12072 Filed 5-12-00; 8:45 am]
BILLING CODE 5001-10-F