10 USC 1095c - TRICARE program: facilitation of processing of claims

U.S Code last checked for updates: Nov 26, 2024

§ 1095c.

TRICARE program: facilitation of processing of claims

(a)

Reduction of Processing Time.—

(1)

With respect to claims for payment for medical care provided under the TRICARE program, the Secretary of Defense shall implement a system for processing of claims under which—

(A)

95 percent of all clean claims must be processed not later than 30 days after the date that such claims are submitted to the claims processor; and

(B)

100 percent of all clean claims must be processed not later than 100 days after the date that such claims are submitted to the claims processor.

(2)

The Secretary may, under the system required by paragraph (1) and consistent with the provisions in chapter 39 of title 31 (commonly referred to as the “Prompt Payment Act”), require that interest be paid on clean claims that are not processed within 30 days.

(3)

For purposes of this subsection, the term “clean claim” means a claim that has no defect, impropriety (including a lack of any required substantiating documentation), or particular circumstance requiring special treatment that prevents timely payment on the claim under this section.

(b)

Requirement to Provide Start-Up Time For Certain Contractors.—

(1)

Except as provided in paragraph (3), the Secretary of Defense shall not require that a contractor described in paragraph (2) begin to provide managed care support pursuant to a contract to provide such support under the TRICARE program until at least nine months after the date of the award of the contract, but in no case later than one year after the date of such award.

(2)

A contractor under this paragraph is a contractor who is awarded a contract to provide managed care support under the TRICARE program—

(A)

who has not previously been awarded such a contract by the Department of Defense; or

(B)

who has previously been awarded such a contract by the Department of Defense but for whom the subcontractors have not previously been awarded the subcontracts for such a contract.

(3)

The Secretary may reduce the nine-month start-up period required under paragraph (1) if—

(A)

the Secretary—

(i)

determines that a shorter period is sufficient to ensure effective implementation of all contract requirements; and

(ii)

submits notification to the Committees on Armed Services of the House of Representatives and the Senate of the Secretary’s intent to reduce the nine-month start-up period; and

(B)

60 days have elapsed since the date of such notification.

(c)

Incentives for Electronic Processing.—

The Secretary of Defense shall require that new contracts for managed care support under the TRICARE program provide that the contractor be permitted to provide financial incentives to health care providers who file claims for payment electronically.

(d)

Correspondence to Medicare Claims Information Requirements.—

The Secretary of Defense, in consultation with the other administering Secretaries, shall limit the information required in support of claims for payment for health care items and services provided under the TRICARE program to that information that is identical to the information that would be required for claims for reimbursement for those items and services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) except for that information, if any, that is uniquely required by the TRICARE program. The Secretary of Defense shall report to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives any information that is excepted under this provision, and the justification for that exception.

(Added Pub. L. 106–65, div. A, title VII, § 713(a)(1), Oct. 5, 1999, 113 Stat. 688; amended Pub. L. 107–107, div. A, title VII, § 708(b), Dec. 28, 2001, 115 Stat. 1164; Pub. L. 107–314, div. A, title VII, § 711(a), Dec. 2, 2002, 116 Stat. 2588.)

cite as: 10 USC 1095c