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A Three-Pronged Approach

 
 

NDMS Definitive Care Reimbursement Program


The NDMS Definitive Care Program can be d​escribed as a three-pronged approach, without one, the other two components cannot function effectively.


 


A flowchart titled “National Disaster Medical System Definitive Care Program.” Three main components appear beneath the title in orange rounded boxes: “National Disaster Claims Processing System,” “National Disaster Case Management System,” and “NDMS Partner Healthcare Facilities.” Under “National Disaster Claims Processing System,” a blue box reads “Contractor (Apprio).” Under “National Disaster Case Management System,” a blue box reads “Case Managers.” Under “NDMS Partner Healthcare Facilities,” three stacked blue boxes read “VA Federal Coordinating Centers,” “DoD Federal Coordinating Centers,” and “NDMS Memorandum of Agreement with Healthcare Facilities.” White connecting lines link each main component to the program title above, showing how each part contributes to the overall system.  

The National Disaster Claims Processing System has been defined by Federal Register, Vol. 70, No. 225/Wednesday, November 23, 2005​. The primary purpose of the system is to justify and document payments for inpatient hospital and related practitioner services provided in connection to the NDMS. Apprio is our current NDMS Definitive Care contractor who supports NDMS with review of claims, submission, and reimbursement. Apprio works in concert with the NDMS Federal Patient Movement Chief and Definitive Care Program Lead.

The NDMS Case Management is managed by the NDMS Case Manager Lead, who provides training and coordination to our medical case managers and contractors who may be activated to support the tracking, movement, medical care management of federal patients and provide critical support during a national disaster as outlined under ESF #8 authorities. Case managers have a significate role in supporting federally designated patients by providing care coordination and updates through the Joint Patient Assessment and Tracking System (JPATS), updating pertinent information to NDMS’s claims contract support to verify medical claims.

NDMS partner healthcare facilities are supported not only by NDMS Patient Movement and Definitive Care, but also with our interagency partnerships through VA and DoD Federal Coordinating Centers (FCCs). One of the primary missions of VA and DoD FCC’s is to partner with local healthcare facilities within each of their catchment areas to build strong civilian coalitions to support federal patient movement and definitive care when needed through the enactment of a national emergency or military contingency.

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