Federal Register: February 8, 2005 (Volume 70, Number 25)
DOCID: FR Doc 05-2381
DEPARTMENT OF DEFENSE
Defense Department
NOTICE: NOTICES
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Proposed Collection; Comment Request
DATES: Consideration will be given to all comments received April 11, 2005.
DOCUMENT SUMMARY:
In accordance with section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Assistant Secretary of Defense for Health Affairs announces the proposed extension of a public information collection and seeks public comment on the provisions thereof. Comments are invited on: (a) Whether the proposed extension of collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the information collection; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the information collection on respondents, including through the use of automated collection techniques or other forms of information technology.
SUMMARY:
Agency information collection activities; proposals, submissions, and approvals,
DOCUMENT BODY:
In accordance with section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Assistant Secretary of Defense for Health Affairs announces the proposed extension of a public information collection and seeks public comment on the provisions thereof. Comments are invited on: (a) Whether the proposed extension of collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the information collection; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the information collection on respondents, including through the use of automated collection techniques or other forms of information technology.
SUPPLEMENTAL INFORMATION
Summary of Information Collection
This collection instrument is for use by medical institutions
filing for reimbursement with the Defense Health Program, TRICARE,
which includes the Civilian Health and Medical Program of the Uniformed
Services (TRICARE/CHAMPUS). TRICARE/CHAMPUS is a health benefits
entitlement program for the dependent of active duty members of the
Uniformed Service, and deceased sponsors, retirees and their
dependents, dependents of department of transportation (Coast Guard)
sponsors, and certain North Atlantic treaty Organization, National
Oceanic and Atmospheric Administration, and Public Health Service
eligible beneficiaries. Use of the UB92 (also known as the HCFA 1450)
continues TRICARE/CHAMPUS commitments to use the national standard
claim form for reimbursement of medical services/supplies provided by institutional providers.
Dated: January 31, 2005.
Patricia L. Topplings,
Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 052381 Filed 2705; 8:45 am]
BILLING CODE 500106M
FOR FURTHER INFORMATION CONTACT
To request more information on this proposed information collection, please write to the above address or call TRICARE Management Activity, Office of Program Requirements at (303) 6763580.
Title Associated With Form, and OMB Number: Health Insurance Claim Form, UB 92, OMB Number 07200013.
Needs and Uses: The information collection requirement is necessary for a medical institution to claim benefits under the Defense health Program, TRICARE, which includes the Civilian Health and Medical Program for the Uniform Services (CHAMPUS). The information collected will be used by TRICARE/CHAMPUS to determine beneficiary eligibility, other health insurance liability, certification that the beneficiary received the care, and that the provider is authorized to receive TRICARE/CHAMPUS payments. The form will be used by TRICARE/CHAMPUS and it's contractors to determine the amount of benefits to be paid to TRICARE/CHAMPUS institutional providers.
Affected Public: Business or other forprofit; notforprofit institutions.
Annual Burden Hours: 525,000.
Number of Respondents: 2,100,000 annually.
Responses Per Respondent: 1.
Average Burden Per Response: 15 minutes.
Frequency: On occasion.