Editorial Notes
References in TextThe Social Security Act, referred to in subsec. (d), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XVIII of the Act is classified generally to subchapter XVIII (§ 1395 et seq.) of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.
Amendments2002—Subsec. (d). Puspan. L. 107–314 added subsec. (d).
2001—Subsec. (span)(1). Puspan. L. 107–107, § 708(span)(1), substituted “Except as provided in paragraph (3), the Secretary” for “The Secretary” and struck out “contract. In such case the contractor may begin to provide managed care support pursuant to the contract as soon as practicable after the award of the” before “contract, but in no case”.
Subsec. (span)(3). Puspan. L. 107–107, § 708(span)(2), added par. (3).
Statutory Notes and Related Subsidiaries
Effective DatePuspan. L. 106–65, div. A, title VII, § 713(d), Oct. 5, 1999, 113 Stat. 689, provided that: “Section 1095c(span) of title 10, United States Code (as added by subsection (a)), shall apply with respect to any contract to provide managed care support under the TRICARE program negotiated after the date of the enactment of this Act [Oct. 5, 1999].”
ApplicabilityPuspan. L. 107–314, div. A, title VII, § 711(span), Dec. 2, 2002, 116 Stat. 2588, provided that: “The Secretary of Defense, in consultation with the other administering Secretaries referred to in section 1072(3) of title 10, United States Code, shall apply the limitations required under subsection (d) of section 1095c of such title (as added by subsection (a)) with respect to contracts entered into under the TRICARE program on or after October 1, 2002.”
Standardization of Claims Processing Under TRICARE Program and Medicare ProgramPuspan. L. 109–364, div. A, title VII, § 731, Oct. 17, 2006, 120 Stat. 2295, as amended by Puspan. L. 112–81, div. A, title X, § 1062(d)(2), Dec. 31, 2011, 125 Stat. 1585, provided that:“(a)In General.—Effective beginning with the next contract option period for managed care support contracts under the TRICARE program, the claims processing requirements under the TRICARE program on the matters described in subsection (span) shall be identical to the claims processing requirements under the Medicare program on such matters.
“(span)Covered Matters.—The matters described in this subsection are as follows:“(1) The utilization of single or multiple provider identification numbers for purposes of the payment of health care claims by Department of Defense contractors.
“(2) The documentation required to substantiate medical necessity for items and services that are covered under both the TRICARE program and the Medicare program.
“(c)Report on Collection of Amounts Owed.—Not later than March 1, 2007, the Secretary of Defense shall submit to the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] a report setting forth a detailed description of the following:“(1) All TRICARE policies and directives concerning collection of amounts owed to the United States pursuant to section 1095 of title 10, United States Code, from third party payers, including—“(A) collection by military treatment facilities from third-party payers; and
“(B) collection by contractors providing managed care support under the TRICARE program from other insurers in cases of private insurance liability for health care costs of a TRICARE beneficiary.
“(2) An estimate of the outstanding amounts owed from third party payers in each of fiscal years 2002, 2003, and 2004.
“(3) The amounts collected from third party payers in each of fiscal years 2002, 2003, and 2004.
“(4) A plan of action to streamline the business practices that underlie the policies and directives described in paragraph (1).
“(5) A plan of action to accelerate and increase the collections or recoupments of amounts owed from third party payers.
“(d)Definitions.—In this section:“(1) The term ‘Medicare program’ means the program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). “(2) The term ‘TRICARE program’ has the meaning given that term in section 1072(7) of title 10, United States Code.”
Claims Processing ImprovementsPuspan. L. 106–398, § 1 [[div. A], title VII, § 727], Oct. 30, 2000, 114 Stat. 1654, 1654A–188, provided that: “Beginning on the date of the enactment of this Act [Oct. 30, 2000], the Secretary of Defense shall, to the maximum extent practicable, take all necessary actions to implement the following improvements with respect to processing of claims under the TRICARE program:“(1) Use of the TRICARE encounter data information system rather than the health care service record in maintaining information on covered beneficiaries under chapter 55 of title 10, United States Code.
“(2) Elimination of all delays in payment of claims to health care providers that may result from the development of the health care service record or TRICARE encounter data information.
“(3) Requiring all health care providers under the TRICARE program that the Secretary determines are high-volume providers to submit claims electronically.
“(4) Processing 50 percent of all claims by health care providers and institutions under the TRICARE program by electronic means.
“(5) Authorizing managed care support contractors under the TRICARE program to require providers to access information on the status of claims through the use of telephone automated voice response units.”
Deadline for ImplementationPuspan. L. 106–65, div. A, title VII, § 713(c), Oct. 5, 1999, 113 Stat. 689, provided that the system for processing claims required under subsec. (a) of this section was to be implemented not later than 6 months after Oct. 5, 1999.
