10 U.S.C. § 1095c — TRICARE program: facilitation of processing of claims

submitted 27 years ago by Pub. L. 106-65 to r/title-10-ARMED-FORCES · 570 words · no verdicts yet

in plain englishAI-generated · not legal advice

This section sets deadlines for processing TRICARE claims, gives certain contractors start-up time, encourages electronic claims, and limits claim-support information.

(a)(1) The Secretary of Defense must operate a TRICARE claims system that processes at least 95 percent of clean claims within 30 days and all clean claims within 100 days after submission. (2) Consistent with the “Prompt Payment Act,” the Secretary may require interest on clean claims not processed within 30 days. (3) “Clean claim” means a claim without a defect, impropriety, missing required support, or special circumstance that prevents timely payment. (b) A new managed-care-support contractor generally must receive at least nine months, but no more than one year, after contract award before beginning work. This applies when it has not previously held such a contract or its subcontractors have not previously held the related subcontracts. The Secretary may shorten nine months after finding the shorter period sufficient, notifying the House and Senate Armed Services Committees, and waiting 60 days. (c) New managed-care-support contracts must permit financial incentives for providers who submit claims electronically. (d) The Secretary must limit supporting information for TRICARE claims to information also required for corresponding Medicare claims, except for information uniquely required by TRICARE, and must report each exception and its justification to both Armed Services Committees.

the actual law source: uscode.house.gov ↗public domain

(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.

Source credit: (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.)

history & why it existsrecord from the source credit

1999Enacted · Pub. L. 106-65 · 113 Stat. 688
2001Amended · Pub. L. 107-107 · 115 Stat. 1164
2002Amended · Pub. L. 107-314 · 116 Stat. 2588

A history note hasn’t been published yet. The record shows enactment by Pub. L. 106-65 on 1999-10-05.

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