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51 Cards in this Set
- Front
- Back
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WHAT ARE THE STANDARDS FOR THE FOUR CATEGORIES OF BENEFICIARIES-URGENT CARE, ROUTINE APPOINTMENT, ROUTINE SPECIALTY CARE, AND WELLNESS, HEALTH PROMOTION?
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(1) URGENT CARE- 24 HOURS; (2)ROUTINE APPOINTMENT- 7 DAYS; (3) ROUTINE SPECIALTY CARE- 28 DAYS/4 WEEKS; (4) WELLNESS, HEALTH PROMOTION- 28 DAYS/4 WEEKS.
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WHAT MODEL ALLOWS MTFs TO ACCOMODATE MORE PATIENTS WITHOUT WORKING LONGER DAYS AND IMPROVE THE EDUCATIONAL CONTENT OF THE PATIENT ENCOUNTERS?
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DIGMA.
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WHAT IS THE BENEFIT OF THE APPOINTMENT UTILIZATION REPORT?
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SEE IF APPOINTMENT TYPE SLOTS ARE BEING CREATED FOR SPECIAL APPOINTMENT TYPES BUT NOT BEING USED.
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NAME THE CHCS MODULE UTILIZED FOR ALL APPOINTMENT BOOKING.
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MCP.
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WHICH CHCS REPORT PROVIDES THE NUMBER OF FACITLITY APPOINTMENT CANCELLATIONS BY REASON FOR EACH CLINIC AND PROVIDER?
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FACILITY CANCELLATION STATISTICAL REPORT.
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TOOLS, SUCH AS THE P2R2 ACCESS METRIC, THE CHCS ATC SUMMARY REPORTS, AND THE MTF TAT, AND APPOINTMENT TYPE UTILIZATION REPORTS ARE AVAILABLE TO ASSIST MTF PERSONNEL DO WHAT?
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MANAGE ACCESS TO CARE.
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WHICH CHCS REPORT PROVIDES A PREVIEW OF THE AVAILABILITY OF APPOINTMENTS BY APPOINTMENT TYPE AND PROVIDER WITH A CLINIC ON A GIVEN DATE AND TIME?
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NEXT AVAILABLE APPOINTMENT REPORT.
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WHAT IS THE NAME OF THE SITE ON THE WEB WHERE YOU CAN LOCATE THE TOOLS TO RUN AND UTILIZE REPORTS?
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THE TRICARE OPERATIONS CENTER.
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WHAT IS THE PURPOSE OF THE CHCS ATC SUMMARY REPORT?
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CALCULATES THE TIME BETWEEN THE APPOINTMENT REQUEST AND WHEN THE PATIENT IS SEEN.
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EXPLAIN WHY EACH MTF USES THE P2R2 ACCESS METRIC.
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RECORD AND MANAGE MONTHLY ACCESS TO CARE PERFORMANCE IN RELATION TO ESTABLISHED STANDARDS.
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WHICH TOOL ALLOWS EACH MTF TO COMPARE THEIR PERFORMANCE TO OTHER PEER FACILITIES?
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TOC. TRICARE OPTIMIZATION CENTER
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WHAT SERVES AS AN MTF-LEVEL MANAGEMENT TOOL THAT EVALUATES SCHEDULING ADEQUACY AND SUFFICIENCY OF AN MTF's SCHEDULE AND/OR TEMPLATES IN SUPPORT OF TRICARE PRIME ACCESS STANDARDS?
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TAT. TEMPLATE ANALYSIS TOOL
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WHO REPRESENTS THE NEW MANAGEMENT ORGANIZATION FOR THE MANAGING REGIONAL CONTRACTORS AND OVERSEEING AN INTEGRATED HEALTH CARE DELIVERY SYSTEM IN THE us?
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TRO. TRICARE REGIONAL OFFICE
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WHAT TOOL PROVIDES A USER-FRIENDLY INTERFACE THAT ALLOWS NAVIGATION AND CASE OF VIEWING APPOINTMENT SUPPLY AND DEMAND BY ALL CLINICS IN AN MTF?
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AIM. ACCESS IMPROVEMENT TOOL
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NAME EACH OF THE THREE REGIONAL OFFICES AND THE REGIONAL CONTRACTOR OF EACH.
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(1) TRO NORTH- HEALTH NET, (2)TRO SOUTH- HUMANA, (3) TRO WEST- TRIWEST.
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HOW DOES THE AFMS AND THE MTFs IMPROVE BIOMETRIC DATA QUALITY?
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BIOMETRIC DATA QUALITY SERVICE.
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WHAT ARE SOME OF THE SPECIFIC RESPONSIBILITIES OF THE TRICARE REGIONAL OFFICES?
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(1)ENSURE NETWORK QUALITY(2)MONITOR CUSTOMER SATISFACTION OUTCOMES(3)MANAGE TRO CUSTOMER SERVICE ISSUES(4)COORDINATE APPOINTING AND REFERRAL MANAGEMENT POLICIES(5)ADDRESS ENROLLEMT ISSUES(6)MANAGE CONTRACT FISCAL MANAGEMENT FUNCTIONS(7)ESTABLISH AND COORDINATE REGIONAL MARKETING AND EDUCATION FUNCTIONS(8)OVERSEE CONTRACT CREDENTIALING(9)DEVELOP TRICARE MAXIMUM ALLOWANCE CHARGE WAIVER PACKAGE(10)APPROVE RESOURCE SHARING AGREEMENTS ENTERED INTO BY THE CONTRACTORS(11)ENSURE CONTRACT SUPPORT FOR MTF OPTIMIZATION(12)APPROVE MEMORANDUMS OF UNDERSTANDING WITH THE CONTRACTOR(13)SERVE AS THE AWARD FEE DETERMINATION OFFICIAL FOR THE HEALTH CARE SERVICES AND ADMINISTRATION CONTRACT.
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NAME THREE WAYS THE BDQAS BIOMETRIC DATA IS USED.
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(A) SUPPORTS POPULATION HEALTH MANAGEMENT DECISIONS, (B) PROVIDE QUANTITIVE JUSTIFICATION FOR RESOURCE DECISIONS, (C) SUPPORT MANAGED CARE CONTRACT NEGOTIATIONS, BUSINESS COST ANALYSIS, AND THE BID PRICE ADJUSTMENT.
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WHO MONITORS MTF PERFORMANCE IN ACCORDANCE WITH THE BUSINESS PLANS AND COMMUNICATES WITH THE MTF COMMANDERS?
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REGIONAL DIRECTOR.
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EXPLAIN THE MOST RECENT CHANGE TO THE TRICARE PROGRAM.
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THE NUMBER OF STATESIDE HEALTH CARE SERVICE CONTRACTS DECREASED FROM SEVEN TO THREE AND THE NUMBER OF STATESIDE TRICARE REGIONS DECREASED FROM 11 TO THREE.
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WHO DOES THE MCS (MANAGED CARE SUPPORT) CONTRACTOR WORK WITH TO MANAGE TRICARE AT A REGIONAL LEVEL?
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TRO- TRICARE REGIONAL OFFICE
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NAME FIVE INCENTIVES THAT THE AFMS GIVES TO EACH MCS (MANAGED CARE SUPPORT) CONTRACTOR FOR TOP PERFORMANCE.
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(1) QUALITY MEDICAL OUTCOMES (2) TELEPHONE ACCESS (3)CLAIMS PAYMENTS (4) BENEFICIARY, MTF COMMANDER, AND REGIONAL DIRECTOR SATISFACTION (5) COST-CONTROL
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IF THERE ARE ANY DEFICIENCIES OBSERVED, WHO SHOULD THE COTR COMMUNICATE WITH BOTH ORALLY AND WRITTEN?
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TRO, COR, ACO (ADMINISTRATIVE CONTRACTING OFFICER) AND MTF COMMANDER OR DESIGNEE
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NAME THE SPECIFIC RESPONSIBILITIES OF THE TRICARE REGIONAL OFFICE ADMINISTRATIVE CONTRACTING OFFICER: (TRO ACO)
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(1)ASSISTING THE TRO IN DEFINING NEW REQUIREMENTS THAT NECESSITATE CONTRACT MODIFICATIONS(2)PERFORMING TECHNICAL EVALUATIONS OF CHANGE-ORDER PROPOSALS(3)ASSISTING IN RESOLVING CONTRACTUAL ISSUES(4)EVALUATING CONTRACTOR-PROPOSED RESOURCE SHARING AGREEMENTS(5)PROPOSING RESOURCE-SHARING AGREEMENTS TO THE CONTRACTOR(6) EVALUATING THE DEVELOPMENT OF PROVIDER NETWORKS WITH RESPECT TO MTF REQUIREMENTS (7) ADMINISTER THE ENROLLMENT PROCESS
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THE COTR WILL PREPARE MINUTES FOR ALL MEETINGS WITH WHOM?
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CONTRACTOR OR CONTRACTOR PERSONNEL
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WHO PERFORMS ANNUAL BID ADJUSTMENTS?
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COR- CONTRACTING OFFICER'S REPRESENTATIVE
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THE COTR ASSISTS WHAT ELEMENT BY CERTIFYING CONTRACTOR INVOICES BY CROSS-MATCHING WITH TIME SHEETS, SCHEDULES, AND WEEKLY REPORTS?
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BUSINESS ANALYSIS ELEMENT
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MTF COTR (CONTRACTING OFFICER TECHNICAL REPRESENTATIVE) RESPONSIBILITIES INCLUDE DEVELOPING AND IMPLEMENTING SURVEILLANCE PROGRAMS TO MONITOR THE TSC's (TRICARE SERVICE CENTER) PERFORMANCE IN MEETING THE TRICARE CONTRACT AND WHAT OTHER FUNCTION?
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TFL (TRICARE FOR LIFE) SPECIFICATIONS
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WHAT SHOULD YOUR COTR HAVE A THOROUGH UNDERSTANDING OF?
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FEDERAL AQUISITION REGS, TRICARE MCSC (MANAGED CARE SUPPORT CONTRACT) SPECIFICATIONS, TMA REGULATIONS AND TFL AND MEDICARE SPECIFICATIONS AND SUPPLEMENTS.
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WHAT IS EXPECTED OF THE MTF COTR?
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TO ENSURE STRICT COMPLIANCE WITH THE TRICARE CONTRACT AND ASSIST IN DEVELOPMENT OF REQUIRED RESOURCE-SHARING AGREEMENTS.
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AS A COTR YOU SHOULD BE ABLE TO PERFORM YOUR JOB INDEPENDENTLY. WHAT WOULD BE A SITUATION THAT MIGHT REQUIRE YOUR SUPERVISOR'S HELP OR INPUT?
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MOST UNUSUAL OR CONTROVERSIAL SITUATIONS.
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AS A COTR YOU WILL HAVE TO STAY WITHIN GUIDELINES. CAN GUIDELINES BE BOTH WRITTEN AND ORAL
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YES
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WHO'S RESPONSIBILITY IS IT TO DEVELOP AND IMPLEMENT A RESOURCE-SHARING PROGRAM FOR SEEKING AGREEMENTS WITH INDIVIDUAL MTF COMMANDERS?
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THE CONTRACTOR.
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WHAT WILL COTRs PARTICIPATING IN EXECUTIVE LEVEL MEETINGS BE EXPECTED TO DO?
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INDENTIFY OPERATIONAL ISSUES, DEVELOP RECOMMENDATIONS TO CORRECT SHORTCOMINGS, RESOLVE PROBLEMS AND, EVALUATE RESOURCE SHARING/RESOURCE SUPPORT PROPOSALS.
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WHO MUST THE CONTRACTOR RECEIVE APPROVAL FROM BEFORE IMPLEMENTING ANY AGREMENTS?
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TRO-TRICARE REGIONAL OFFICE
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WHAT IS THE PURPOSE OF CONTACTS?
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TO EFFICTIVELY MONITOR AND EVALUATE THE TSC's PERFORMANCE, TO ADVISE AND RESOLVE PROBLEM SITUATIONS, TO COORDINATE STAFF PROPOSALS FOR DECISION MAKING, AND TO ADVISE THE COMMANDER AND DEPARTMENT/DIVISION CHIEFS ON MATTERS PERTAINING TO CONTRACT EXECUTION.
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THE CONTRACTOR WILL SUBMIT THE FINALIZED PLAN TO THE TRO NO LATER THAN WHAT TIME FRAME?
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60 CALENDAR DAYS PRIOR TO THE START OF EACH NEW HEALTH CARE DELIVERY OPTION PERIOD
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ONE OF THE GOALS OF RESOURCE SHARING IS TO PROMOTE AGRRESSIVELY WITH WAHT TYPE OF INCENTIVES?
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WIN-WIN
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FOR INTERNAL SHARING AGREEMENTS, WHAT SHALL THE COST ANALYSIS INCLUDE?
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THE CONTRACTOR'S ACTUAL COST OF PROVIDING PERSONNEL, EQUIPMENT, EQUIPMENT MAINTENANCE, AND SUPPLIES
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WHAT ARE THE ADVANTAGES ON RESOUCE SHARING?
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(1) OTHER ALTERNATIVES REQUIRE THE MTF TO RESOURCE THE PROJECT COMPLETELY (2) CONTRACTOR CAN OFFSET MTF's TRUE MARGINAL COSTS WITH CASH PAYMENTS (3) BENEFICIARIES RECEIVE CARE AT THEIR PREFERRED SOURCE WITH NO CO-PAYMENT
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WHICH RESOURCE AGREEMENT SHALL INCLUDE THE MTF's ACTUAL COST OF PROVIDING THE SERVICES, THE MONETARY BENEFITS RECEIVED BY THE CONTRACTOR, PROJECTED WORKLOAD, ADMINISTRATIVE COSTS, WORKLOAD CREDIT SPLIT FOR THE CONTRACTOR AND THE MTF, AND THE CONTRACTOR'S ACTUAL COST OF PROVIDING SERVICES IN SUPPORT OF EXTERNAL RESOURCE-SHARING PROVIDERS?
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EXTERNAL RESOURCE SHARING AGREEMENTS
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THE CONTRACTOR SHALL PROVIDE THE MTF COMMANDER WITH A COMPLETE COST ANALYSIS WITHIN HOWMANY DAYS OF WRITTEN REQUEST?
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30 CALENDAR DAYS
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THE CONTRACTOR SHALL PROVIDE ADMINISTRATIVE SUPPORT FULFILLING THE REQUIREMENTS OF THE RESOURCE SHARING AGREEMENT WITHIN HOW MANY DAYS?
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60 CALENDAR DAYS
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WHAT IS THE GOAL OF THE VA/DOD SHARING AGREEMENTS?
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IMPROVE ACCESS TO AND QUALITY, EFFICIENCY, AND EFFECTIVENESS OF, THE HEALTH CARE PROVIDED BY THE MHS (MILITARY HEALTH SYSTEM) AND THE VHA TO THE RESPECTIVE BENEFICIARIES.
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WHO IS RESPONSIBLE FOR ENSURING THAT EXTERNAL-SHARING PROVIDERS ARE LICENSED TO PRACTICE MEDICINE IN A US JURISDICTION DURING THE TERM OF RESOURCE SHARING AGREEMENT?
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MTF COMMANDER
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ARE VA MEDICAL FACILITIES SUBJECT TO THE SAME UTILIZATION MANAGEMENT AND QUALITY ASSURANCE REQUIREMENTS THAT APPLY TO OTHER NETWORK PROVIDERS?
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YES
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WHO IS RESPONSIBLE FOR COSTS BORNE BY THE CONTRACTOR IN PROVIDING SERVICES TO TRICARE BENEFICIARIES IN MTFS?
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MCS CONTRACTORS
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WHO IS RESPONSIBLE FOR IMPLEMENTING A FORMAL DOD/VA HEALTH CARE RESOURCE SHARING PROGRAM?
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TMA DIRECTOR
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WHO IS RESPONSIBLE FOR QUERYING THE NATIONAL PRACTITIONER DATA BANK ABOUT EACH PROVIDER UPON INITIAL APPOINTMENT AND EVERY TWO YEARS THERAFTER AND FOR PROVIDING THE MTF COMMANDERS WITH COPIES OF THE NPDB REPORT EACH TIME THAT ONE IS RECEIVED ON A RESOURCE-SHARING PROVIDER?
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MSC CONTRACTOR
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INTERNAL RESOURCE SHARING SHALL BE BASED UPON WRITTEN AGREEMENTS BETWEEN THE CONTRACTOR AND WHO ELSE?
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MTF COMMANDER
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WHO WILL MAKE CERTAIN THAT RESOURCE-SHARING ACTIVITY IS CORRECTLY REPORTED IN THE REMAINING YEARS OF THE CONTRACT?
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TRO- TRICARE REGIONAL OFFICE
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