Release of Patient Information

If an inquiry is made by a beneficiary, including an eligible dependent child, regardless of age, the reply should be addressed to the beneficiary, not the beneficiary’s parent or guardian. The only exceptions are:

When a parent writes on behalf of a minor child (under 18 years old)
When a guardian writes on behalf of a physically or mentally incompetent beneficiary

In responding to a parent or guardian in the above circumstances, the Privacy Act of 1974 precludes disclosure of sensitive information, which, if released, could have an adverse effect on the beneficiary.

Providers must not furnish information to the parents or guardians of minors or incompetents when services are related to the following diagnostic codes:


AIDS: ICDM-9-CM	079.53;042
Alcoholism: ICDM-9-CM	291.9; 303-303.9; 305
Abortion: ICDM-9-CM	634-639.9; 779.6
Drug Abuse: ICDM-9-CM	292-292.2; 304-304.9; 305.2-305.9
Venereal Disease: ICDM-9-CM	090-099.9; 294.1

TRICARE-eligible beneficiaries must maintain a “signature on file” in the physician’s office to protect the patient’s privacy, for the release of important information, and to prevent fraud. A new signature is required every year for professional claims submitted on a CMS-1500 and every admission for claims submitted on a UB-04. Claims submitted for diagnostic tests, test interpretations, or other similar services do not require the beneficiary’s signature. Providers submitting these claims must indicate “patient not present” on the claim form.

Mentally incompetent or physically disabled TRICARE-eligible beneficiaries 18 years of age and older who are incapable of providing a signature may have a legal guardian appointed or a power of attorney issued on their behalf. This legal documentation must include the guardian’s signature, full name, address, relationship to patient, and reason the patient is unable to sign.

For civilian providers, the first claims submission on behalf of the beneficiary should include the legal documentation establishing the guardian’s signature authority. Subsequent claims may be stamped with “Signature on File” in the beneficiary signature box of the CMS-1500 or UB-04 claim form.

If the beneficiary is without legal representation, the provider must submit a written report with the claims describing the patient’s illness or degree of mental competence, and should annotate in Box 12 of the CMS-1500 claim form, “Patient’s or Authorized Representative’s Signature—Unable to Sign.”
If the beneficiary’s illness was temporary, the signature waiver must specify the dates the illness began and ended.
When the beneficiary is mentally competent but physically incapable of a signature, the representative may be issued a general or limited power of attorney by signing an “X” in the presence of a notary public.

Last Update: August 26, 2009