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HRD-83-89 1 (1983-09-08)

handle is hein.gao/gaobabepq0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING Q------.-----........ W A S H I N G T O N , D . C . 2 0 5 4 8. . . . . . . . . . . . . . . . . . 14r. MaT HUMAN RFSOURCKS DIVISI lN September 8, 19, Mr. Theodore D. Wood Director Office of Civilian Health and Medical Program of the Uniformed Services 124428 Dear Mr. Wood: Subject: Interim Report on CHAMPUS Payment Practices (GAO/HRD-83-89) As you are aware, the U.S. General Accounting Office is surveying payment practices of the the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) with a con- centration on the extent to which (1) previous recommendations we made concerning this area have been implemented and (2) fiscal intermediaries know of other insurance that beneficiaries have which may affect CHAMPUS reimbursements. To date, we have obtained the views of CHAMPUS officials and one fiscal inter- mediary (Blue Shield of California) on payment practices and the methods used to identify whether beneficiaries have other health insurance, the adequacy of these techniques, and alternative or additional steps that can be taken to obtain the needed infomation. We also have examined a variety of commercial health insurance claim forms to determine whether and how similar information is sought. While we have not completed our survey it appears, based on our work to date, that better information regarding other insur- ance still needs to be obtained. We understand that CHAMPUS is planning to revise one of its commonly used claim forms and believe an opportunity exists for improving the quality of data gathered within the existing information gathering systems used by CHAMPUS and fiscal intermediaries. In four previous reports we discussed the need for accurate and specific information regarding other health insurance carried by CHAMPUS beneficiaries and recommended ways to obtain (101081) 7 -: .J. I

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