UCCI – Statement of Work (SOW) Dental Coverage for all Active Duty Service Members (ADSMs)
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Oct. 6, 2015
Autopsy Diagram of the Head and Neck
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Used during the autopsy to diagram the head and neck
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Autopsy Diagram of a Female
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Used during the autopsy to diagram a female patient
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Autopsy Diagram Extended Neck
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Oct. 1, 2015
Pre Deployment Health Assessment DD Form 2795
This form is used to collect information on your physical and mental health status before a deployment.
Form/Template
Oct. 1, 2015
Post Deployment Health Assessment Sample
This form is completed at the end of a deployment. All forms are submitted electronically.
Form/Template
Oct. 1, 2015
Cosmetic Surgery Superbill 2015
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222.29 KB
Cosmetic Surgery Superbill 2015
Form/Template
Sept. 15, 2015
UBO Compliance Plan/Code of Conduct Receipt
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13.89 KB
Each employee/service member/contractor should complete and sign this acknowledging they have received and read the Compliance Plan and Code of Conduct.
Form/Template
Sept. 15, 2015
Sample Compliance Committee Charter
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27.50 KB
Use this sample charter to develop the Compliance Committee Charter for your MTF.
Form/Template
Sept. 15, 2015
UBO Compliance Plan Template
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39.27 KB
This Compliance Plan is a template, not a final document. You should edit it to include your MTF’s specific processes, procedures, policies, and information as appropriate.
Form/Template
Sept. 15, 2015
MSA Claim Post-Submission Review Worksheet
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18.34 KB
Use this review worksheet to help establish a consistent UBO billing submission framework.
Form/Template
Sept. 15, 2015
Memorandum Template for a Uniform Business Office Compliance Plan
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13.78 KB
Use this template to develop your memorandum to create a UBO Compliance Plan.
Form/Template
Sept. 15, 2015
MAC Claim Post-Submission Review Worksheet
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17.57 KB
Use this review worksheet to help establish a consistent UBO billing submission framework.
Form/Template
Sept. 15, 2015
Annual Review of Compliance Program Effectiveness Checklist
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26.92 KB
The UBO Compliance Officer will regularly review the implementation and execution of the compliance program elements. This review will be conducted as least annually and will include an assessment of each of the basic elements individually, as well as the overall success of the program. It will help identify any weaknesses in your compliance program ...
Form/Template
Sept. 15, 2015
UBO Compliance Audit Checklist
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477.00 KB
This Compliance Audit Checklist Template is an element of our MTF’s Internal Control Review and is part of your compliance program. It covers the basic points of TPC, MSA, and MAC programs. It can also be used in business case analysis/reengineering initiatives for the Uniform Business Office.
Form/Template
Sept. 15, 2015
TPCP Claim Post-Submission Review Worksheet
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31.60 KB
Use this review worksheet to help establish a consistent UBO billing submission framework.
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