MAXIMUS, Inc., of Reston, Va., is the TRICARE National Quality Monitoring Contractor (NQMC) and will assist DoD Health Affairs, the TRICARE Management Activity (TMA), MTF market managers, and the TRICARE Regional Offices by providing the government with an independent, impartial evaluation of the care provided to beneficiaries within the Military Health System. The NQMC will review care provided by TRICARE network providers and subcontractors on a limited basis. The NQMC is part of TRICARE’s Quality and Utilization Peer Review Organization Program, in accordance with 32 CFR 199.15.

Medical records will be requested from the regional contractor on a monthly basis to comply with requirements detailed in Chapter 7, Section 3 of the TRICARE Operations Manual. Your facility may be required to submit records to meet those requirements.

Should you receive a request letter, you are required to submit the entire medical record that was requested. Failure to do so will result in recoupment of payment for the hospitalization and/or any other services for which you were paid in accordance with 32 CFR 199.4(a)(5).
      

The Humana Military Quality Management Department is responsible for oversight of clinical care provided to TRICARE beneficiaries. TRICARE providers must agree to participate in clinical quality studies and to make their medical records available for review for quality purposes. TRICARE Prime beneficiaries and PCMs receive reminder letters from the Humana Military Quality Management Department to promote awareness of recommended preventive care services.