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TOP Network Change Request Form
TRICARE Training
Created on February 25, 2025
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TOP Network change request Form
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TOP Network Change Request Form
The TOP Network Change Request Form must be completed in detail to request a change to the network.
The form contains five (5) sections pertaining to the information required to make a determination on the change.
The change request will be denied if the form is not completed correctly or does not contain enough information.
LINK
Click on the icon to open the link!
Section 1: Basic Information
Select a Change Request Type
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Select the appropriate 'Change Request Type' from the dropdown list.
Click on the field for more information!
CONTRACT OPTION YEAR & MONTH
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Select the contract option month or the month the request is being made from the dropdown list.
Select the correct contract option year from the dropdown list. This relates to the year of the current contract.
Click on the fields for more information!
The current TOP contract started in September 2021. This is when option year 1 (OPY1) started. Each option year starts at the beginning of September and goes through to the end of the following August.
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HELP Anthony...
Anthony is completing the TOP Network Change Request Form to request the addition of a Speech Therapist to the network. If the date of the request is May, 2025, which contract option year should he enter in to the form?
OPY5
OPY4
OPY3
Select the correct answer!
CORRECT!
The contract option years are counted as follows: OPY 1: Sep 2021 - Aug 2022 OPY 2: Sep 2022 - Aug 2023 OPY 3: Sep 2023 - Aug 2024 OPY 4: Sep 2024 - Aug 2025 OPY 5: Sep 2025 - Aug 2026 OPY 6: Sep 2026 - Aug 2027 OPY 7: Sep 2027 - Aug 2028
PROVIDER INFORMATION
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Select the appropriate country from the list.
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Enter the name of the provider as seen in SPIN. If the provider is not yet in SPIN, ensure the spelling is correct as this form will be used to create a SPIN record.
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Tick the 'SPIN ID Available' checkbox only if the provider is in SPIN. A new field to enter the SPIN ID will appear.
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PROVIDER INFORMATION (CONT.)
Enter the address of the provider.
Enter the main contact number for the provider. This should include the country code.
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Enter either a contact number or e-mail address for the main point of contact (POC) at the provider. This only needs to be used if there was no SPIN ID available.
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PROVIDER type/specialty
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Select the provider type/specialty from the dropdown list. Several options can be selected if applicable.
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CHOOSING A SPECIALTY
When choosing the provider type or specialty, carefully read the instructions provided in the form:
Hospitals:
- Ensure 'Hospital' is selected as the provider type.
- Specify the main specialties or subspecialties offered at the facility.
Individual services:
- Indicate the patient age group (e.g. adult, pediatrics).
- Specify the relevant specialties offered by the provider or group.
Section 2: Network Adequacy
Instructions
This section MUST be completed fully with information taken from the CDRL M100.
Most specialties are listed in the CDRL M100 for both Prime and Prime Remote sites.
It is not acceptable to add 'Not in the M100'.
LINK
Info
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Network Adequacy
Enter the current number of providers in this location offering the required specialty.
Complete this section using data from the CDRL M100:
Enter the target number of providers needed for this specialty in this location.
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Enter the number of days it currently takes for a beneficiary to access this specialty care in this location.
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Click on the fields for more information!
Section 3: client feedback
Client Feedback
Enter the name and rank/position of the person who raised the need for the change.
This section will ONLY need to be completed if this request has been raised by an MTF or Health Unit POC:
Enter the name and rank/position of the MTF Commander or Embassy Health Unit POC who raised the need for the change.
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Enter the date the request was raised by the client .
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Section 4: REASON FOR CHANGE REQUEST
Instructions
Before submitting a request, please ensure that the change is warranted and aligned with the rules and regulations outlined in the TOP Network Change Request Form.
If the reason for requesting the change falls within these rules, the request can be submitted.
Data-driven supporting evidence and detailed information must be provided to ensure the request is not denied.
Info
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Category FOR CHANGE
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Select the appropriate 'Category for Change' from the dropdown list.
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Category for change
Change requests MUST be submitted for a reason that will fall into one of the following categories:
MTF Capabilities
Access to Care
Quality or Service
Adequacy
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Reason FOR CHANGE
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Description of Reason For Change
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Enter all supporting evidence that has been collected in support of the change request.
Click on the field for more information!
Help Anthony...
Anthony is submitting a change request as the MRI machine at the local MTF is no longer in use and beneficiaries need other alternatives. Which of the below statements offer a better description of the reason for change?
read
read
read
STATEMENT 2
STATEMENT 3
STATEMENT 1
Select the correct answer!
CORRECT!
Statement #3 provides more details. Including additional data such as patient numbers at local providers would be even more efficient!
Beneficiaries Impacted
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Enter the number of beneficiaries that will be impacted by this change request.
Prime Sites: This information can be obtained directly from the MTF
Remote Sites: This information can be found in the Remote Population Report (CDRL M230)
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Section 5: network impact
Network Impact
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Enter the time period that this change should stay in place. This should either be entered as 'permanent' or the exact years/months.
Click on the field for more information!
Submitting The change request form
The user should mark the check box for 'Send me a copy of my responses'. Doing this will ensure that once a decision has been made, the user will get a copy of the approval/denial.
Once the form has been completed, the user can click 'Submit'. This form will then go to the next step for approval/denial.
thank you!
Home
INCORRECT!
Check your answer and try again.
GO BACK
The available options in the secondary field will depend on which selection has been made.
Multiple options can be selected.