Release of Medical Records

All providers are required to request that the TRICARE beneficiary sign a release of medical information at each office visit (unless a signed release is on file), to include ancillary services associated with each visit whereby the PCM and/or the MTF commanders are designated as the recipients of the medical records. For an urgent care visit, the records should be given to the beneficiary at the time of the visit. Providers are required to submit beneficiary records for review upon request.

Under the TPR program (described in the TRICARE Program Options section of this handbook), ADSMs will be instructed to sign annual medical release forms with the provider who manages their care much like a PCM, to allow information to be forwarded to civilian and military providers. If an ADSM is reassigned to a new location, the PCM should provide complete copies of medical records and specialty and ancillary care documentation to the ADSM within 30 calendar days of the request—prior to moving.
     

Inpatient facilities are required to provide each TRICARE beneficiary with a copy of the document, “An Important Message from TRICARE.” This document details the beneficiary’s rights and obligations upon admission to the hospital. The signed document must be kept in the beneficiary’s file. A new document is needed for each admission.
        

A provider may not require payment from a TRICARE beneficiary for any excluded or excludable services the beneficiary received from the network provider (i.e., the beneficiary will be held harmless) except as follows:

TRICARE beneficiaries must be properly informed in advance and in writing of specific services or procedures that are not covered under TRICARE before they are provided. If they choose to be financially responsible for the non-covered services, beneficiaries may sign a waiver agreeing to pay for non-covered services.

However, if the provider does not obtain a legal signed waiver, and the care is not authorized by Humana Military, the provider is expected to accept full financial liability for the cost of the care. In addition, a waiver signed by a beneficiary after the care was rendered is not valid under TRICARE regulations.

For the beneficiary to be considered fully informed, TRICARE regulations require that:

General agreements to pay, such as those signed by the beneficiary at any time of admission, are not evidence that the beneficiary knew specific services were excluded or not allowable.

Providers should maintain copies of the waiver in their office and fully inform beneficiaries in advance when specific services or procedures are not covered. See the Medical Coverage section of this handbook for a summary of TRICARE-covered and non-covered services and benefits.
         

A network provider can utilize the waiver of non-covered services by completing the TRICARE Non-Covered Services Waiver form when the beneficiary is properly informed, in advance, that TRICARE does not cover a particular service and he or she agrees in writing to be financially responsible.