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. Humana Military is responsible for identifying and investigating all potential third-party recovery claims. Inpatient claims submitted with diagnosis codes 800–999 (with some exclusions) 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. These claims will not be processed further until the beneficiary completes and submits a DD Form 2527 Statement of Personal Injury—Possible Third Party Liability Form.
 
There are certain diagnosis codes that are exceptions.  Refer to the Provider Handbook.