One third of Americans risk mental, physical and social problems by drinking excessively each year. What’s more, there are nearly 75,000 alcoholrelated deaths each year.

As you know, the long-term effects of alcohol abuse include a variety of health conditions like heart and liver disease, cancer and inflammation of the pancreas.

As a health care provider, you can help patients identify, prevent and obtain treatment for symptoms of alcohol abuse and dependence.

The opportunity to talk with your patients about the negative effects of alcohol can be a turning point in their lives. Getting advice from their doctor, whom they trust and respect, can have a more profound impact than earlier attempts at intervention from a family member or friend.

For more information and resources on helping your patients deal with alcohol abuse, please visit the NIAAA or SAMHSA Web sites.

  
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New claims must be submitted for payment no later than one year from the date of service or hospital discharge.
 

Date of Service or Discharge	Date Contractor Must Receive By
June 6, 2006	June 6, 2007
December 26, 2006	December 26, 2007

 

To ensure that your claim is filed within the proper time limits, any written request for benefits may be submitted initially. However, a TRICARE-approved claim form is preferable for processing benefits.

If a non-standard claim is received, the contractor will notify you if additional information is required. If so, claimants must re-submit their claim on a CMS 1500 or UB-92 or DD 2642 form, along with any supporting documents, within one year from the date of service or 90 days from when they received contractor notification, whichever is later.

Exceptions to these rules may be granted in these instances:
 

• Retroactive determinations once determined eligible
• Administrative errors on the part of a TRICARE Management Activity employee or contractor
• Beneficiary’s mental or communication deficiencies
• Change in provider status from non-participating to participating
• Double or other health insurance
• Medicare eligibility

The process for handling adjustments differs depending on whether the funds being recouped are financially underwritten or not. The Federal Claims Collection Act is the governing body over non-financially underwritten fund recoupments. Under this act, TMA must rectify erroneous payments and make claims adjustments when government funds are involved.

Adjustment requests must be received no later than 90 days from the date the explanation of benefits (EOB) is issued. An example of this is when the claimant provides additional information about a service or supply that has already been processed, whether paid or not.

If the claimant questions the accuracy of the claim’s processing, adjustment requests must be filed within nine months of receipt of the EOB. Reasons for other adjustments include voluntarily returned or refunded payment for these reasons:
 

• Unwanted payment
• Payment amount in question
• Overpayment
• Incorrect payee

  
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Updated: March 3, 2008