Improvement of provider directory accuracy for specialty care providers under the TRICARE program

(a) In general By not later than five years after the date of the enactment of this Act, the Director of the Defense Health Agency (in this section referred to as the Director) shall ensure that the accuracy of the provider directory under the TRICARE program for all specialty care provider types reaches an average accuracy across all specialty care providers of not less than 70 percent. (b) Measurement of accuracy Average accuracy under subsection (a) shall be measured biannually and shall be disaggregated by provider type for each specialty care provider group. (c) Inclusion in contracts The Director shall ensure that each managed care contract under the TRICARE program includes requirements that the managed care contractor comply with the accuracy requirement under subsection (a), including by requiring each such contractor to— (1) conduct comprehensive outreach campaigns, to include electronic and non-electronic means, and mass email campaigns to network providers providing— (A) information relating to T–5 Contract penalties associated with inaccurate provider directory information; (B) resources; and (C) direct links for providers to update their directory information; (2) make it a condition of joining the TRICARE network managed by such contractor for providers to validate their provider directory information not less frequently than quarterly; (3) ensure that when providers file for reimbursement, such providers are prompted to review and verify their directory accuracy; and (4) create a mechanism by which beneficiaries under the TRICARE program can report provider directory inaccuracy to the contractor. (d) Other methods The Director shall carry out any other methods that the Director finds useful for the improvement of provider directory accuracy. (e) Testing of directory information Not less frequently than quarterly, the Inspector General of the Department of Defense shall conduct random tests, encompassing all specialty care provider types, of the accuracy of information relating to specialty care providers contained in the provider directory under the TRICARE program. (f) Reports and briefings (1) In general Not later than one year after the date of the enactment of this Act, and annually thereafter, the Director shall submit a report and provide a briefing to the Committees on Armed Services of the Senate and the House of Representatives on progress towards reaching the average accuracy target required under subsection (a). (2) Elements Each report under paragraph (1) shall include, at a minimum, the following: (A) A description of the techniques that are most effective in improving accuracy of provider directories. (B) An identification of the authorities or tools that the Defense Health Agency lacks for improving such accuracy. (C) An identification of challenges specific to each specialty care provider type that limit such accuracy. (D) An assessment of the impact of efforts of the Defense Health Agency towards improving such accuracy on providers either leaving the TRICARE program or on the willingness of non-network providers to join the TRICARE program. (g) Comptroller General review Not later than one year after the date of the enactment of this Act, and annually thereafter, the Comptroller General of the United States shall— (1) conduct a holistic review of provider directory accuracy under the TRICARE program to measure the progress of the Director towards meeting the requirement under subsection (a); and (2) submit to Congress a report on the review conducted under paragraph (1).

(a) In general By not later than five years after the date of the enactment of this Act, the Director of the Defense Health Agency (in this section referred to as the Director) shall ensure that the accuracy of the provider directory under the TRICARE program for all specialty care provider types reaches an average accuracy across all specialty care providers of not less than 70 percent. (b) Measurement of accuracy Average accuracy under subsection (a) shall be measured biannually and shall be disaggregated by provider type for each specialty care provider group. (c) Inclusion in contracts The Director shall ensure that each managed care contract under the TRICARE program includes requirements that the managed care contractor comply with the accuracy requirement under subsection (a), including by requiring each such contractor to— (1) conduct comprehensive outreach campaigns, to include electronic and non-electronic means, and mass email campaigns to network providers providing— (A) information relating to T–5 Contract penalties associated with inaccurate provider directory information; (B) resources; and (C) direct links for providers to update their directory information; (2) make it a condition of joining the TRICARE network managed by such contractor for providers to validate their provider directory information not less frequently than quarterly; (3) ensure that when providers file for reimbursement, such providers are prompted to review and verify their directory accuracy; and (4) create a mechanism by which beneficiaries under the TRICARE program can report provider directory inaccuracy to the contractor. (d) Other methods The Director shall carry out any other methods that the Director finds useful for the improvement of provider directory accuracy. (e) Testing of directory information Not less frequently than quarterly, the Inspector General of the Department of Defense shall conduct random tests, encompassing all specialty care provider types, of the accuracy of information relating to specialty care providers contained in the provider directory under the TRICARE program. (f) Reports and briefings (1) In general Not later than one year after the date of the enactment of this Act, and annually thereafter, the Director shall submit a report and provide a briefing to the Committees on Armed Services of the Senate and the House of Representatives on progress towards reaching the average accuracy target required under subsection (a). (2) Elements Each report under paragraph (1) shall include, at a minimum, the following: (A) A description of the techniques that are most effective in improving accuracy of provider directories. (B) An identification of the authorities or tools that the Defense Health Agency lacks for improving such accuracy. (C) An identification of challenges specific to each specialty care provider type that limit such accuracy. (D) An assessment of the impact of efforts of the Defense Health Agency towards improving such accuracy on providers either leaving the TRICARE program or on the willingness of non-network providers to join the TRICARE program. (g) Comptroller General review Not later than one year after the date of the enactment of this Act, and annually thereafter, the Comptroller General of the United States shall— (1) conduct a holistic review of provider directory accuracy under the TRICARE program to measure the progress of the Director towards meeting the requirement under subsection (a); and (2) submit to Congress a report on the review conducted under paragraph (1).