TRICARE Provider Handbook Your guide to TRICARE programs, policies, and procedures
Table Of Contents
Handbook PDF version
What is TRICARE? Your Managed Care Support Contractor Humana Military’s Network Subcontractors and Vendors Provider Resources Healthy People 2010—Be a Part of the Success Humana Military Disease Management Program
TRICARE Policy Resources Health Insurance Portability and Accountability Act of 1996 TRICARE Provider Types Credentialing Provider Responsibilities Updating Provider Information Beneficiary Rights and Responsibilities
How to Verify Eligibility Important Notes about Eligibility Special Eligibility Rules under Diagnosis-Related Groups Entitlement to Medicare and TRICARE Eligibility for TRICARE and Veterans Affairs Benefits
TRICARE Prime TRICARE Prime Remote and TRICARE Prime Remote for Active Duty Family Members TRICARE Standard and TRICARE Extra TRICARE For Life TRICARE Pharmacy Program Dental Programs Offered by TRICARE TRICARE for the National Guard and Reserve DoD/National Cancer Institute Demonstration Program TRICARE Extended Care Health Option Supplemental Health Care Program Transitional Health Care Benefits
Covered Services Limitations and Exclusions
Referral and Authorization Requirements Provider Responsibilities Outpatient Services Inpatient Services Alcoholism and Other Substance Use Disorders Court-Ordered Care Non-Covered Behavioral Health Services Behavioral Health Care Management Appeals and Reconsiderations Behavioral Health Medical Record Documentation Billing and Claims Behavioral Health Care Coverage Details
Referrals and Authorizations Providing Care to Beneficiaries from Other Regions Medical Records Documentation Utilization Management National Quality Monitoring Contractor Clinical Quality Management Fraud and Abuse Grievances Appeals
South Region Claims Processor Claims Processing Standards and Guidelines ClaimCheck® Proper Treatment Room Billing Billing with V Codes Global Maternity Claims Injectable Drugs Claims Filing Processing Claims for Out-of-Region Care Claims for Beneficiaries Using Medicare and TRICARE Claims for Active Duty Service Members Claims for NATO Beneficiaries Claims for CHAMPVA Claims for the Continued Health Care Benefit Program Claims for the Extended Care Health Option Supplemental Health Care Program Claims Claims for TRICARE Reserve Select TRICARE and Other Health Insurance TRICARE and Third-Party Liability Insurance TRICARE and Workers’ Compensation Avoiding Collection Activities Prepayment Review TRICARE Claim Appeals/Reconsiderations
Reimbursement Limitations CHAMPUS Maximum Allowable Charge TRICARE-Allowable Charge Anesthesia Rates Ambulatory Surgery Grouper Rates Diagnosis-Related Group Reimbursement Bonus Payments in Health Professional Shortage Areas Skilled Nursing Facility Pricing Home Health Agency Pricing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Pricing Modifiers Assistant Surgeon Services Multiple Surgeries Hospice Pricing Outpatient Prospective Payment System Updates to TRICARE Rates and Weights
Acronyms Glossary of Terms Forms
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