The Federal Medical Recovery Act allows the government to be reimbursed for costs associated with treating a TRICARE beneficiary who has been injured in an accident caused by someone else. When a claim appears to have possible third-party involvement, certain actions must be taken that can affect total processing time.

Knowing the third-party liability process can help providers take steps that can ensure more timely payment of such claims.

Humana Military is responsible for identifying and investigating all potential third-party recovery claims. Inpatient claims submitted with diagnosis codes between 800 and 999 (with some exceptions), regardless of the billed amount, and claims for professional services that exceed a TRICARE liability of $500, which indicate an accidental injury or illness will be pended for research.

Such claims are not processed further until the beneficiary completes and submits a Statement of Personal Injury— Possible Third-Party Liability form (DD Form 2527). When a claim is suspected to have third-party liability, the following steps occur:
 

• The DD Form 2527 is mailed to the beneficiary.
• The claim is pended for up to 35 calendar days awaiting receipt of the form from the beneficiary.
• If the form is not received, the claim may be denied.
• Once the beneficiary completes and returns the form, the claim will be reprocessed.

If the illness or injury was not caused by a third party, but the diagnosis code(s) still falls within 800–999, the beneficiary may still be responsible for filling out the form.

Claims with the following 800–999 diagnosis codes are not automatically pended for possible third-party liability review.
 

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