Referral Management & Translation Services
Welcome to Rota!
The following guidelines will ensure prompt, effective support to meet your medical needs in cases in which you may be referred outside U.S. Naval Hospital Rota for further diagnostic testing and/or medical treatment not available within our Military Treatment Facility (MTF).
Referral Management
-
Assistance with referrals generated by a Primary Care Manager (PCM) or Specialty Provider from U.S. Naval Hospital Rota for care not available within our MTF which must be obtained from our TRICARE Preferred Provider Network (PPN).
-
The assistance provided includes, but is not limited to, the following:
-
Obtaining authorization from the TRICARE Overseas Program (TOP) contractor for Prime Beneficiaries.
-
Obtaining a TRICARE benefit review to determine TRICARE coverage for Standard Beneficiaries.
-
Scheduling your appointment with the appropriate PPN provider.
-
Ensuring that patients take all additional medical documentation (i.e., lab results, radiological studies, previous reports, etc.) recommended by Naval Hospital Rota's Utilization Manager (UM) or Primary Care Manager (PCM) to the appointment that has been set up with the civilian specialty clinic.
-
Providing a translation of the PPN referral along with all necessary instructions required for the appointment with the civilian specialty clinic.
-
Providing directions to facilitate finding the civilian specialty clinic (GPS coordinates, maps, etc.).
Medical Translation
-
Translation of medical reports generated by civilian specialty clinics from our Preferred Provider Network (PPN) that are associated to referrals originally initiated by a Primary Care Manager/Specialty Provider from U.S. Naval Hospital Rota for Prime Beneficiaries. Translation of initial medical report for associated referrals for Standard and Civilian Beneficiaries.
-
The assistance provided includes, but is not limited to, the following:
-
Translation of these results from Spanish to English.
-
Ensuring that these reports (original and translated copy) are uploaded into your electronic medical record and that a hard copy is also taken to the Outpatient Records Department to be placed in your physical medical record.
-
Notifying the referring provider, once the report has been translated, that it is ready for their review.
-
Providing on-site interpretation services for all beneficiaries as needed.
-
Providing interpretation services for Preferred Provider Network appointments for Prime Beneficiaries if needed (medical interpretation assistance by telephone is available for Standard & Civilian Beneficiaries).
Beneficiary Counseling and Assistance Coordinator
-
A BCAC (Beneficiary Counseling and Assistance Coordinator) educates beneficiaries, and enhances a thorough understanding of TRICARE programs.
-
The assistance provided includes, but is not limited to, the following:
-
Counsel beneficiaries and clarify information on their TRICARE benefit and consult with others as necessary, describing or seeking clarification on eligibility requirements and benefits based on the category of the beneficiary seeking assistance.
-
Provide or directly communicate information on healthcare services that TRICARE covers and excludes and convey how these benefits and policies integrate with other healthcare sources.
-
Help beneficiaries understand the TRICARE claims process (DD form 2642), including information on status of claims, resolving unpaid healthcare claims,
pre-authorization requirements, and third-party liability (DD form 2527).
-
Explain appeals and grievance procedures and advise beneficiaries on the appropriate use of these procedures.
Debt Collection Assistance Officer
- DCAO (Debt Collection Assistance Officer) provides assistance with debt collection matters concerning unpaid TRICARE claims.
Are you eligible to receive these services?
These services are available to all patients that are eligible for care at U.S. Naval Hospital Rota, Spain.