[Federal Register Volume 62, Number 51 (Monday, March 17, 1997)]
[Notices]
[Page 12608]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-6645]


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DEPARTMENT OF DEFENSE
Office of the Secretary


Proposed Collection; Comment Request

agency: Office of the Assistant Secretary of Defense for Health 
Affairs.

action: Notice.

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    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 a proposed uniform public information 
collection and seeks public comment on the provisions thereof. Comments 
are invited on: (a) whether the proposed 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 proposed 
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.

dates: Consideration will be given to all comments received on or 
before May 16, 1997.

addresses: Written comments and recommendations on the proposed 
information collection should be sent to the Office of the Civilian 
Health and Medical Program of the Uniformed Services (OCHAMPUS), 
Fitzsimons U.S. Army Garrison, Program Development and Evaluation 
Directorate, ATTN: Mr. Joe Rhea, Aurora, CO 80045-6900.

for further information contact: To request more information on this 
proposed information collection or to obtain a copy of the proposal and 
associated collection instruments, please write to the above address, 
or call OCHAMPUS, Program Development and Evaluation Directorate, at 
(303) 361-1018.
    Title, Associated Form, and OMB Number: TRICARE/CHAMPUS Provider 
Enrollment Application, HCFA-855, OMB Number 0938-0685.
    Needs and Uses: This information is needed to enroll health care 
providers not enrolled by Medicare by identifying them, verifying their 
qualifications and eligibility to participate in TRICARE/CHAMPUS, and 
to price and pay their claims correctly.
    Affected Public: Business or other for-profit; small businesses 
organizations, Federal Government.
    Annual Burden Hours: 105,000.
    Number of Respondents: 70,000.
    Responses per Respondent: 1.
    Average Burden per Response: 90 minutes.
    Frequency: Initial Application.

supplementary information: Application is supported by photocopies of 
licensure, certification, and educational qualifications documents on a 
selected basis.

Summary of Information Collection

    Respondents are health care providers who file claims seeking 
reimbursement directly or on behalf of eligible TRICARE/CHAMPUS 
beneficiaries for services and supplies which are authorized benefits 
of this health care program. The enrollment application and 
verification procedures will collect the information from providers 
needed to ensure that they can be uniquely identified and enumerated, 
and are qualified and eligible to participate in the TRICARE/CHAMPUS 
program. The use of the HCFA-855 Provider Enrollment Form makes uniform 
the information collection. Providers who have already been enrolled in 
Medicare will be required only to sign and submit the Form's 
certification statement and submit supplemental agreements for 
facsimile signatures and electronic claims submission which may remain 
specific and separate for Medicare and TRICARE/CHAMPUS. This 
application will implement the enrollment application for all TRICARE/
CHAMPUS providers/suppliers, and collect information necessary to issue 
the National Provider Identifier. The National Provider Identifier 
(NPI) will be assigned to all current providers and to all incoming 
providers as part of the enrollment process. Periodic Re-Verification 
of Provider Data will ensure that, once enrolled, all providers/
suppliers remain current under the Conditions of Enrollment.

    Dated: March 12, 1997.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-6645 Filed 3-14-97; 8:45 am]
BILLING CODE 5000-04-M