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Introduction Letter

         

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Important Provider Information 

Health Insurance Portability and Accountability Act of 1996
HIPAA Privacy Rules
HIPAA Identifier Rules
HIPAA Transaction and Code Sets
TRICARE Provider Types
Credentialing
Updating Provider Information and Provider Responsibilities
Primary Care Manager's Role
Medical Releases
Balance Billing
Non-Covered Services
Beneficiary Rights and Responsibilities

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TRICARE Eligibility       

Verifying Eligibility
Eligibility Rules

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TRICARE Program Options

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
TRICARE Pharmacy Tools and Resources
Specialty Medications
Dental Programs Offered by TRICARE
TRICARE for the National Guard and Reserve
TRICARE Reserve Select
Cancer Clinical Trials
TRICARE Extended Care Health Option
DoD Enhanced Access to Autism Services Demonstration
Supplemental Health Care Program
Transitional Health Care Benefits

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Medical Coverage 

Covered Services
Adjunctive Dental Care
Clinical Preventive Services
Coverage Differences Based on Beneficiary Program Option
Durable Medical Equipment
Ambulance Services, Emergency and Urgent Care
Home Health and Skilled Nursing Facility (SNF) Care
Hospice Care
Maternity Care
Vision Care
Limitations & Exclusions

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Behavioral Health Care Services 

Referral and Authorization Requirements
Referral and Authorization Requirements by Category
Provider Responsibilities
Outpatient Services
Inpatient Services
Psychiatric Partial Hospitalization Programs and Residential Treatment Centers Alcoholism and Other Substance Use Disorders
Court-Ordered Care
Non-Covered Behavioral Health Care Services
Behavioral Health Care Management
Appeals and Reconsiderations
Behavioral Health Care Medical Record Documentation
Billing and Claims
Behavioral Health Care Coverage Details

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Health Care Management and Administration 

Referrals
Prior Authorizations
Providing Care to Beneficiaries from Other Regions
Medical Records Documentation
Utilization Management
Quality Management
Fraud and Abuse
Grievances
Appeals

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Claims Processing and Billing Information 

Standards and Guidelines
Other Helpful Hints
ClaimCheck
Billing with V Codes
Global Maternity Claims
Physician-Administered Drug and Vaccine Claim Filing
Processing Claims for Out-of-Region Care
Claims for Beneficiaries Using Medicare and TRICARE
NATO & CHAMPVA
Special Program Claims
Other Health Insurance
Third Party Liability
Avoiding Collection Activities
Reconsiderations

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TRICARE Reimbursement Methodologies 

CHAMPUS and TRICARE Allowed Charges
Anesthesia Rates
Ambulatory Surgery Grouper Rates
Diagnosis-Related Group Reimbursement
Bonus Payments in Health Professional Shortage Areas
Pricing
Surgeon Services
Hospice Pricing
Pricing Updates

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Last Update: August 26, 2009