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TRICARE Operations Manual 6010.62-M, April 2021
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Other Manuals
32 CFR 199 (DHA Version), December 2016
DoD Women, Infants, and Children (WIC) Overseas Program Policy Manual, July 2017
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TRICARE Operations Manual 6010.51-M, August 2002
Manual Change History
TRICARE Operations Manual 6010.51-M, August 2002
TOC
Change 144 (August 13, 2012)
Change 137 (February 29, 2012)
Change 115 (March 14, 2011)
Change 100 (August 17, 2010)
Change 18 (January 12, 2005)
Change 4 (November 12, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Foreword
Change 27 (August 1, 2005)
Baseline (August 1, 2002)
Chap 1 -- Administration
Change 81 (June 12, 2009)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- Organization Of The TRICARE Management Activity (TMA)
Baseline (August 1, 2002)
Sect 2 -- Contract Administration And Instructions To Contractors
Change 144 (August 13, 2012)
Baseline (August 1, 2002)
Sect 3 -- TRICARE Processing Standards
Change 54 (September 24, 2007)
Change 32 (March 31, 2006)
Change 12 (May 20, 2004)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Management
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 5 -- Compliance With Federal Statutes
Change 81 (June 12, 2009)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 6 -- Legal Matters
Baseline (August 1, 2002)
Sect 7 -- Fiscal Controls And Access To Records
Baseline (August 1, 2002)
Sect 8 -- Transitions
Change 144 (August 13, 2012)
Change 132 (December 22, 2011)
Change 72 (September 29, 2008)
Change 66 (May 23, 2008)
Change 54 (September 24, 2007)
Change 19 (January 20, 2005)
Change 7 (January 16, 2004)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum A -- Figures
Change 81 (June 12, 2009)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Chap 2 -- Records Management
Change 151 (February 12, 2013)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- General
Change 151 (February 12, 2013)
Change 81 (June 12, 2009)
Baseline (August 1, 2002)
Sect 2 -- Record Series Subject And Description Of Government Records
Change 151 (February 12, 2013)
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Digital Imaging (Scanned) And Electronic (Born-Digital) Records Process And Formats
Change 151 (February 12, 2013)
Baseline (August 1, 2002)
Sect 4 -- Electronic Records Disposition, Storage, And Transfer
Change 151 (February 12, 2013)
Baseline (August 1, 2002)
Sect 5 -- Transferring Records (Federal Records Centers (FRCs) And Transitions)
Change 151 (February 12, 2013)
Change 5 (November 27, 2002)
Baseline (August 1, 2002)
Sect 6 -- Destruction Of Records
Change 151 (February 12, 2013)
Baseline (August 1, 2002)
Addendum A -- Paper Record Transfer Procedures
Change 151 (February 12, 2013)
Baseline (August 1, 2002)
Addendum B -- Electronic Record Transfer Procedures
Change 151 (February 12, 2013)
Baseline (August 1, 2002)
Chap 3 -- Financial Administration
Change 51 (June 12, 2007)
Change 42 (December 21, 2006)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 1 -- General
Baseline (August 1, 2002)
Sect 2 -- Financing Mechanisms
Change 42 (December 21, 2006)
Change 26 (May 18, 2005)
Change 19 (January 20, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 3 -- TED - Voucher Preparation, Check Release Authorization And Payment Integrity
Change 13 (June 28, 2004)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 4 -- Non-TED Vouchers
Change 59 (February 25, 2008)
Change 42 (December 21, 2006)
Change 32 (March 31, 2006)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 5 -- Non-Routine Checks And Vouchers
Baseline (August 1, 2002)
Sect 6 -- Payments to Beneficiaries/Providers
Change 54 (September 24, 2007)
Baseline (August 1, 2002)
Sect 7 -- Refund And Collection Procedures
Change 42 (December 21, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 8 -- Staledated, Voided, Or Returned Checks/EFTs
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 9 -- Administrative Contract Line Item Number (CLIN) Payments
Change 51 (June 12, 2007)
Change 42 (December 21, 2006)
Change 32 (March 31, 2006)
Change 14 (September 2, 2004)
Baseline (August 1, 2002)
Sect 10 -- Reports
Change 42 (December 21, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Addendum A -- Figures
Change 42 (December 21, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Chap 4 -- Provider Certification And Credentialing
Change 32 (March 31, 2006)
Change 19 (January 20, 2005)
Baseline (August 1, 2002)
Sect 1 -- General
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 21 (February 14, 2005)
Change 19 (January 20, 2005)
Change 17 (December 7, 2004)
Change 8 (March 1, 2004)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum A -- Figures
Baseline (August 1, 2002)
Addendum B -- Criminal History Background Checks On Individuals In Child Care Services
Baseline (August 1, 2002)
Chap 5 -- Provider Networks
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- Network Development
Change 107 (November 23, 2010)
Change 82 (July 2, 2009)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Chap 6 -- Enrollment
Change 75 (January 9, 2009)
Change 68 (July 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- Enrollment Plan
Change 148 (December 17, 2012)
Change 147 (September 21, 2012)
Change 142 (June 7, 2012)
Change 141 (May 7, 2012)
Change 138 (March 5, 2012)
Change 132 (December 22, 2011)
Change 129 (November 21, 2011)
Change 111 (January 25, 2011)
Change 104 (September 1, 2010)
Change 97 (May 13, 2010)
Change 75 (January 9, 2009)
Change 72 (September 29, 2008)
Change 68 (July 23, 2008)
Change 39 (September 5, 2006)
Change 37 (August 28, 2006)
Change 28 (August 3, 2005)
Change 27 (August 1, 2005)
Change 24 (April 4, 2005)
Change 7 (January 16, 2004)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Enrollment Portability
Change 129 (November 21, 2011)
Change 128 (November 14, 2011)
Change 113 (February 9, 2011)
Change 5 (November 27, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Split Enrollment
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- TRICARE Plus
Change 80 (June 11, 2009)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Chap 7 -- Utilization And Quality Management
Change 126 (September 19, 2011)
Change 92 (December 22, 2009)
Change 76 (January 22, 2009)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- Management
Change 72 (September 29, 2008)
Change 41 (September 28, 2006)
Change 35 (August 4, 2006)
Change 27 (August 1, 2005)
Change 22 (March 3, 2005)
Change 6 (December 31, 2003)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Preauthorizations
Change 123 (June 24, 2011)
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Change 12 (May 20, 2004)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Contractor Relationship With The Military Health System (MHS) TRICARE Quality Monitoring Contractor (TQMC)
Change 126 (September 19, 2011)
Change 92 (December 22, 2009)
Change 76 (January 22, 2009)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 4 -- Clinical Quality Management Program (CQMP)
Change 126 (September 19, 2011)
Change 76 (January 22, 2009)
Change 6 (December 31, 2003)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Addendum A -- An Important Message From TRICARE
Baseline (August 1, 2002)
Addendum B -- Hospital Issued Notices Of Noncoverage
Baseline (August 1, 2002)
Addendum C -- Hospital Adjustments
Change 52 (July 17, 2007)
Baseline (August 1, 2002)
Chap 8 -- Claims Processing Procedures
Change 133 (January 3, 2012)
Change 27 (August 1, 2005)
Change 15 (October 12, 2004)
Change 12 (May 20, 2004)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 1 -- General
Change 133 (January 3, 2012)
Change 52 (July 17, 2007)
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 2 -- Jurisdiction
Change 98 (August 3, 2010)
Change 73 (November 4, 2008)
Change 61 (March 14, 2008)
Change 45 (March 9, 2007)
Change 15 (October 12, 2004)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 3 -- Claims Filing Deadline
Change 91 (December 17, 2009)
Change 52 (July 17, 2007)
Change 35 (August 4, 2006)
Change 32 (March 31, 2006)
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Baseline (August 1, 2002)
Sect 4 -- Signature Requirements
Change 148 (December 17, 2012)
Change 142 (June 7, 2012)
Change 52 (July 17, 2007)
Baseline (August 1, 2002)
Sect 5 -- Referrals/Preauthorizations/Authorizations
Change 144 (August 13, 2012)
Change 131 (December 20, 2011)
Change 121 (March 31, 2011)
Change 119 (March 25, 2011)
Change 89 (October 21, 2009)
Change 79 (June 1, 2009)
Change 55 (September 28, 2007)
Change 40 (September 27, 2006)
Change 36 (August 8, 2006)
Change 27 (August 1, 2005)
Change 23 (March 29, 2005)
Change 12 (May 20, 2004)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 6 -- Claim Development
Change 88 (August 31, 2009)
Change 47 (March 27, 2007)
Change 43 (January 16, 2007)
Change 35 (August 4, 2006)
Change 27 (August 1, 2005)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 7 -- Application Of Deductible And Cost-Sharing
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 8 -- Explanation Of Benefits (EOBs)
Change 99 (August 9, 2010)
Change 90 (October 28, 2009)
Change 72 (September 29, 2008)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 9 -- Duplicate Payment Prevention
Baseline (August 1, 2002)
Addendum A -- Figures
Change 72 (September 29, 2008)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Chap 9 -- TRICARE Duplicate Claims System - HCSR Version
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- Overview
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Quick Start Instructions
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 3 -- Duplicate Claims Data
Change 71 (September 23, 2008)
Change 65 (May 1, 2008)
Change 25 (April 28, 2005)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Claim Sets And The Claim Set Life Cycle
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 5 -- User's Guide
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 6 -- Multi-Contractor Claim Sets
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 7 -- Mass Change Function For Contract Transitions
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 8 -- Reports
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 9 -- System Implementation And Operational Requirements
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum A -- Duplicate Claims System Displayed Data Fields
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Addendum B -- Reason Codes
Change 106 (September 13, 2010)
Change 71 (September 23, 2008)
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Baseline (August 1, 2002)
Addendum C -- Incoming Contractor Support Of Both HCSR And TED Versions Of The TRICARE Duplicate Claims System
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum D -- Contractor To Contractor Transition Guide
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum E -- Report Descriptions And Examples
Change 71 (September 23, 2008)
Change 65 (May 1, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum F -- Download Files
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Chap 10 -- TRICARE Duplicate Claims System - TED Version
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- Overview
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Quick Start Instructions
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 3 -- Duplicate Claims Data
Change 78 (May 8, 2009)
Change 74 (December 22, 2008)
Change 71 (September 23, 2008)
Change 65 (May 1, 2008)
Change 49 (May 22, 2007)
Change 43 (January 16, 2007)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Claim Sets And The Claim Set Life Cycle
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 5 -- User's Guide
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 6 -- Multi-Contractor Claim Sets
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 7 -- Mass Change Function For Contract Transitions
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 8 -- Reports
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Sect 9 -- System Implementation And Operational Requirements
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum A -- Duplicate Claims System Displayed Data Fields
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Addendum B -- Reason Codes
Change 106 (September 13, 2010)
Change 71 (September 23, 2008)
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum C -- Incoming Contractor Support Of Both HCSR And TED Versions Of The TRICARE Duplicate Claims System
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum D -- Contractor To Contractor Transition Guide
Change 71 (September 23, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum E -- Report Descriptions And Examples
Change 71 (September 23, 2008)
Change 65 (May 1, 2008)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum F -- Download Files
Change 71 (September 23, 2008)
Baseline (August 1, 2002)
Chap 11 -- Claims Adjustments And Recoupments
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 1 -- General
Change 35 (August 4, 2006)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 2 -- Underpayments
Baseline (August 1, 2002)
Sect 3 -- Overpayments Recovery - Financially Underwritten Funds
Change 144 (August 13, 2012)
Change 35 (August 4, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Baseline (August 1, 2002)
Sect 4 -- Overpayments Recovery - Non-Financially Underwritten Funds
Change 144 (August 13, 2012)
Change 72 (September 29, 2008)
Change 42 (December 21, 2006)
Change 35 (August 4, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 5 -- Third Party Recovery Claims
Change 124 (September 12, 2011)
Change 72 (September 29, 2008)
Change 42 (December 21, 2006)
Change 32 (March 31, 2006)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum A -- Figures
Change 60 (February 29, 2008)
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum B -- Listing Of Government Claims Offices
Change 91 (December 17, 2009)
Change 72 (September 29, 2008)
Change 44 (January 31, 2007)
Baseline (August 1, 2002)
Chap 12 -- Beneficiary And Provider Services
Change 144 (August 13, 2012)
Change 114 (February 22, 2011)
Change 57 (November 21, 2007)
Change 23 (March 29, 2005)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- Marketing And Education Requirements
Change 144 (August 13, 2012)
Change 130 (November 28, 2011)
Change 72 (September 29, 2008)
Change 29 (August 4, 2005)
Change 23 (March 29, 2005)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Beneficiary Education
Change 144 (August 13, 2012)
Change 27 (August 1, 2005)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 3 -- TRICARE Service Centers
Change 144 (August 13, 2012)
Change 120 (March 29, 2011)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Beneficiary, Congressional, And Health Benefit Advisor Relations
Change 144 (August 13, 2012)
Change 5 (November 27, 2002)
Baseline (August 1, 2002)
Sect 5 -- Inquiry Services Department - General
Change 144 (August 13, 2012)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 6 -- Correspondence Control, Processing And Appraisal
Change 144 (August 13, 2012)
Change 6 (December 31, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 7 -- Telephone Inquiries
Change 144 (August 13, 2012)
Change 114 (February 22, 2011)
Change 54 (September 24, 2007)
Change 35 (August 4, 2006)
Change 5 (November 27, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 8 -- Allowable Charge Reviews (Includes DRGs)
Change 144 (August 13, 2012)
Baseline (August 1, 2002)
Sect 9 -- Grievances And Grievance Processing
Change 144 (August 13, 2012)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 10 -- Collection Actions Against Beneficiaries
Change 144 (August 13, 2012)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum A -- TRICARE Logo
Change 144 (August 13, 2012)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Chap 13 -- Appeals And Hearings
Change 6 (December 31, 2003)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 1 -- General
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Governing Principles
Change 72 (September 29, 2008)
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Reconsideration Procedures
Change 144 (August 13, 2012)
Change 110 (January 4, 2011)
Change 32 (March 31, 2006)
Change 6 (December 31, 2003)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 4 -- Appeals Of Medical Necessity Determinations
Change 5 (November 27, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 5 -- Appeal Of Factual (Non-Medical Necessity) Determinations
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 6 -- TMA Appeals
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum A -- Figures
Change 72 (September 29, 2008)
Change 32 (March 31, 2006)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Chap 14 -- Program Integrity
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 1 -- General
Change 35 (August 4, 2006)
Baseline (August 1, 2002)
Sect 2 -- Case Development And Action
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 3 -- Prevention And Detection
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 4 -- Evaluation
Baseline (August 1, 2002)
Sect 5 -- Reporting
Change 27 (August 1, 2005)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 6 -- Provider Exclusions, Suspensions And Terminations
Change 72 (September 29, 2008)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 7 -- Provider Reinstatements
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 8 -- Threats Against Contractors
Baseline (August 1, 2002)
Addendum A -- Figures
Change 93 (March 4, 2010)
Change 27 (August 1, 2005)
Baseline (August 1, 2002)
Chap 15 -- Audits, Inspections, And Reports
Change 118 (March 23, 2011)
Change 102 (August 27, 2010)
Change 82 (July 2, 2009)
Change 76 (January 22, 2009)
Change 27 (August 1, 2005)
Change 8 (March 1, 2004)
Change 7 (January 16, 2004)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- Audits And Inspections
Baseline (August 1, 2002)
Sect 2 -- Weekly Reports To TMA
Change 35 (August 4, 2006)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 3 -- Monthly Reports
Change 118 (March 23, 2011)
Change 82 (July 2, 2009)
Change 76 (January 22, 2009)
Change 54 (September 24, 2007)
Change 27 (August 1, 2005)
Change 8 (March 1, 2004)
Change 7 (January 16, 2004)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 4 -- Monthly Workload and Cycletime Reports
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 5 -- Quarterly Reports
Change 102 (August 27, 2010)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 6 -- Annual Reports
Change 102 (August 27, 2010)
Change 76 (January 22, 2009)
Change 5 (November 27, 2002)
Baseline (August 1, 2002)
Sect 7 -- Special Reports
Change 5 (November 27, 2002)
Baseline (August 1, 2002)
Addendum A -- Figures
Change 21 (February 14, 2005)
Change 17 (December 7, 2004)
Baseline (August 1, 2002)
Chap 16 -- Regional Director/MTF And Contractor Interfaces
Change 118 (March 23, 2011)
Change 8 (March 1, 2004)
Baseline (August 1, 2002)
Sect 1 -- Regional Directors/MTF Commanders Interface
Change 5 (November 27, 2002)
Baseline (August 1, 2002)
Sect 2 -- Resource Sharing
Change 118 (March 23, 2011)
Change 72 (September 29, 2008)
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Clinical Support Agreement (CSA) Program
Change 118 (March 23, 2011)
Change 27 (August 1, 2005)
Change 8 (March 1, 2004)
Baseline (August 1, 2002)
Addendum A -- Model Memorandum Of Understanding
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Chap 17 -- TRICARE Prime Remote Program
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- General
Change 72 (September 29, 2008)
Change 32 (March 31, 2006)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Health Care Providers And Review Requirements
Change 46 (March 15, 2007)
Change 35 (August 4, 2006)
Change 34 (August 2, 2006)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Marketing, Enrollment, And Support Services
Change 129 (November 21, 2011)
Change 72 (September 29, 2008)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 4 -- Contractor Responsibilities And Reimbursement
Change 146 (September 19, 2012)
Change 34 (August 2, 2006)
Change 32 (March 31, 2006)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 5 -- Reports And Contractor Reimbursement
Change 32 (March 31, 2006)
Baseline (August 1, 2002)
Sect 6 -- TRICARE Prime Remote for Active Duty Family Members Program
Change 129 (November 21, 2011)
Change 41 (September 28, 2006)
Change 32 (March 31, 2006)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum A -- Points Of Contacts
Baseline (August 1, 2002)
Addendum B -- Active Duty Care Guidelines
Change 146 (September 19, 2012)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum C -- Dental Coverage For Active Duty Service Members (ADSMS) Enrolled In The TRICARE Prime Remote Program
Baseline (August 1, 2002)
Addendum D -- Service Point Of Contact (SPOC) Review For Fitness For Duty: Protocols And Procedures
Baseline (August 1, 2002)
Chap 18 -- Civilian Care Referred By MHS Facilities
Change 121 (March 31, 2011)
Change 70 (September 18, 2008)
Baseline (August 1, 2002)
Sect 1 -- General
Change 85 (August 14, 2009)
Change 83 (July 15, 2009)
Change 79 (June 1, 2009)
Change 72 (September 29, 2008)
Baseline (August 1, 2002)
Sect 2 -- Providers Of Care
Change 140 (May 1, 2012)
Change 121 (March 31, 2011)
Change 83 (July 15, 2009)
Change 35 (August 4, 2006)
Change 34 (August 2, 2006)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Contractor Responsibilities
Change 146 (September 19, 2012)
Change 144 (August 13, 2012)
Change 94 (March 11, 2010)
Change 88 (August 31, 2009)
Change 87 (August 27, 2009)
Change 83 (July 15, 2009)
Change 70 (September 18, 2008)
Change 56 (November 6, 2007)
Change 46 (March 15, 2007)
Change 34 (August 2, 2006)
Change 6 (December 31, 2003)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Payment For Contractor Services Rendered
Change 32 (March 31, 2006)
Baseline (August 1, 2002)
Sect 5 -- Points Of Contact
Baseline (August 1, 2002)
Addendum A -- Points Of Contact
Baseline (August 1, 2002)
Addendum B -- Dental Coverage For Active Duty Service Members (ADSMS)
Baseline (August 1, 2002)
Addendum C -- Definitions, Terms, And Limitations As Applied To The Respite Benefit Under This Section
Change 70 (September 18, 2008)
Baseline (August 1, 2002)
Addendum D -- Memorandum Of Agreement (MOA) Between Department Of Veterans Affairs (DVA) And Department Of Defense (DoD) For Processing Payment For Disability Compensation And Pension Examinations (DCPE) In The Integrated Disability Evaluation System (IDES)
Change 121 (March 31, 2011)
Baseline (August 1, 2002)
Chap 19 -- Civilian Health Care Of Uniformed Service Members
Change 140 (May 1, 2012)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 1 -- General
Change 32 (March 31, 2006)
Baseline (August 1, 2002)
Sect 2 -- Providers Of Care
Change 140 (May 1, 2012)
Change 46 (March 15, 2007)
Change 34 (August 2, 2006)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Contractor Responsibilities
Change 146 (September 19, 2012)
Change 94 (March 11, 2010)
Change 56 (November 6, 2007)
Change 34 (August 2, 2006)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Payment For Contractor Services Rendered
Change 72 (September 29, 2008)
Baseline (August 1, 2002)
Addendum A -- Points Of Contact
Baseline (August 1, 2002)
Addendum B -- Service Point Of Contact (SPOC) Review For Authorization: Protocols And Procedures
Baseline (August 1, 2002)
Addendum C -- Memorandum Of Agreement (MOA) Between Department Of Veterans Affairs (DVA) And Department Of Defense (DoD) For Medical Treatment Provided To Active Duty Service Members (ADSMs) With Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), Blindness, Or Polytraumatic Injuries
Change 140 (May 1, 2012)
Baseline (August 1, 2002)
Chap 20 -- Demonstrations
Change 145 (September 11, 2012)
Change 134 (January 10, 2012)
Change 125 (September 14, 2011)
Change 84 (July 17, 2009)
Change 82 (July 2, 2009)
Change 69 (September 10, 2008)
Change 67 (June 20, 2008)
Change 64 (April 22, 2008)
Change 60 (February 29, 2008)
Change 50 (June 4, 2007)
Change 31 (November 9, 2005)
Change 20 (January 28, 2005)
Change 11 (May 19, 2004)
Change 10 (April 14, 2004)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 1 -- General
Baseline (August 1, 2002)
Sect 2 -- Department Of Defense Cancer Prevention And Treatment Clinical Trials Demonstration
Change 59 (February 25, 2008)
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Department Of Defense In-Utero Fetal Surgical Repair Of Myelomeningocele Clinical Trial Demonstration
Change 52 (July 17, 2007)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Sect 4 -- Operation Noble Eagle/Operation Enduring Freedom Reservist And National Guard Benefits Demonstration
Change 72 (September 29, 2008)
Change 63 (April 8, 2008)
Change 30 (October 11, 2005)
Change 16 (November 15, 2004)
Change 10 (April 14, 2004)
Baseline (August 1, 2002)
Sect 5 -- Department Of Defense Weight Management Demonstration
Change 134 (January 10, 2012)
Change 20 (January 28, 2005)
Change 11 (May 19, 2004)
Baseline (August 1, 2002)
Sect 6 -- Department Of Defense Tobacco Cessation Demonstration
Change 134 (January 10, 2012)
Change 35 (August 4, 2006)
Change 31 (November 9, 2005)
Baseline (August 1, 2002)
Sect 7 -- Department Of Defense Alcohol Abuse Prevention And Education Demonstration
Change 134 (January 10, 2012)
Change 35 (August 4, 2006)
Change 31 (November 9, 2005)
Baseline (August 1, 2002)
Sect 8 -- TRICARE Demonstration Project For The State Of Alaska - Critical Access Hospital (CAH) Payment Rates
Change 134 (January 10, 2012)
Change 31 (November 9, 2005)
Baseline (August 1, 2002)
Sect 9 -- Department Of Defense (DoD) Enhanced Access To Autism Services Demonstration
Change 150 (February 6, 2013)
Change 136 (February 27, 2012)
Change 134 (January 10, 2012)
Change 86 (August 19, 2009)
Change 84 (July 17, 2009)
Change 67 (June 20, 2008)
Change 53 (July 30, 2007)
Change 50 (June 4, 2007)
Baseline (August 1, 2002)
Sect 10 -- Web-Based TRICARE Assistance Program (TRIAP) Demonstration
Change 134 (January 10, 2012)
Change 106 (September 13, 2010)
Change 95 (April 7, 2010)
Change 77 (March 6, 2009)
Change 69 (September 10, 2008)
Change 64 (April 22, 2008)
Change 62 (March 20, 2008)
Change 60 (February 29, 2008)
Baseline (August 1, 2002)
Sect 11 -- TRICARE South Region United States Coast Guard (USCG) Access To Care (ATC) Demonstration For TRICARE Prime/TRICARE Prime Remote (TPR) Beneficiaries
Change 134 (January 10, 2012)
Change 116 (March 16, 2011)
Change 103 (August 30, 2010)
Change 96 (April 15, 2010)
Change 85 (August 14, 2009)
Change 82 (July 2, 2009)
Baseline (August 1, 2002)
Sect 12 -- TRICARE Evaluation Of Centers For Medicare And Medicaid Services (CMS) Approved Laboratory Developed Tests (LDTs) Demonstration Project
Change 145 (September 11, 2012)
Change 125 (September 14, 2011)
Baseline (August 1, 2002)
Addendum A -- Participation Agreement For Autism Demonstration Corporate Services Provider (ACSP)
Change 134 (January 10, 2012)
Change 69 (September 10, 2008)
Change 64 (April 22, 2008)
Change 62 (March 20, 2008)
Change 60 (February 29, 2008)
Baseline (August 1, 2002)
Chap 21 -- Health Insurance Portability And Accountability Act of 1996 (HIPPA)
Change 135 (February 21, 2012)
Change 109 (December 28, 2010)
Change 45 (March 9, 2007)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- General
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Standards For Electronic Transactions
Change 135 (February 21, 2012)
Change 112 (January 28, 2011)
Change 109 (December 28, 2010)
Change 9 (March 2, 2004)
Change 6 (December 31, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 3 -- Privacy Of Individually Identifiable Health Information
Change 81 (June 12, 2009)
Change 72 (September 29, 2008)
Change 32 (March 31, 2006)
Change 6 (December 31, 2003)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Health And Human Services (HHS) Standard Unique Health Identifier For Health Care Providers Final Rule
Change 45 (March 9, 2007)
Baseline (August 1, 2002)
Addendum A -- HIPAA Definitions
Change 81 (June 12, 2009)
Change 45 (March 9, 2007)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum B -- Additional Supporting Information Pertaining To The Transaction And Code Sets Final Rule
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum C -- Reports
Change 72 (September 29, 2008)
Change 6 (December 31, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Chap 22 -- TRICARE Dual Eligible Fiscal Intermediary Contract
Change 15 (October 12, 2004)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- General
Change 105 (September 7, 2010)
Change 27 (August 1, 2005)
Change 6 (December 31, 2003)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 2 -- Jurisdiction
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 3 -- Claims Processing for Dual Eligibles
Change 144 (August 13, 2012)
Change 123 (June 24, 2011)
Change 72 (September 29, 2008)
Change 32 (March 31, 2006)
Change 15 (October 12, 2004)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 4 -- Other Contract Requirements
Change 72 (September 29, 2008)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 5 -- Transition
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Chap 23 -- TRICARE Alaska
Change 144 (August 13, 2012)
Change 108 (December 15, 2010)
Change 5 (November 27, 2002)
Change 4 (November 12, 2002)
Baseline (August 1, 2002)
Sect 1 -- TRICARE Alaska
Change 144 (August 13, 2012)
Change 108 (December 15, 2010)
Change 27 (August 1, 2005)
Change 5 (November 27, 2002)
Change 4 (November 12, 2002)
Baseline (August 1, 2002)
Chap 24 -- Reserve Component Health Coverage Plans
Change 144 (August 13, 2012)
Change 101 (August 24, 2010)
Change 100 (August 17, 2010)
Change 58 (November 30, 2007)
Change 48 (May 2, 2007)
Change 33 (May 10, 2006)
Change 18 (January 12, 2005)
Baseline (August 1, 2002)
Sect 1 -- TRICARE Reserve Select
Change 149 (January 10, 2013)
Change 148 (December 17, 2012)
Change 147 (September 21, 2012)
Change 144 (August 13, 2012)
Change 143 (June 21, 2012)
Change 142 (June 7, 2012)
Change 141 (May 7, 2012)
Change 122 (May 31, 2011)
Change 101 (August 24, 2010)
Change 100 (August 17, 2010)
Change 72 (September 29, 2008)
Change 58 (November 30, 2007)
Change 48 (May 2, 2007)
Change 33 (May 10, 2006)
Change 18 (January 12, 2005)
Baseline (August 1, 2002)
Sect 2 -- TRICARE Retired Reserve
Change 148 (December 17, 2012)
Change 144 (August 13, 2012)
Change 143 (June 21, 2012)
Change 142 (June 7, 2012)
Change 141 (May 7, 2012)
Change 122 (May 31, 2011)
Change 100 (August 17, 2010)
Baseline (August 1, 2002)
Addendum A -- Figures
Change 100 (August 17, 2010)
Change 58 (November 30, 2007)
Baseline (August 1, 2002)
Chap 25 -- TRICARE Young Adult (TYA)
Change 144 (August 13, 2012)
Change 139 (April 10, 2012)
Change 127 (September 22, 2011)
Change 115 (March 14, 2011)
Baseline (August 1, 2002)
Sect 1 -- TRICARE Young Adult (TYA)
Change 148 (December 17, 2012)
Change 144 (August 13, 2012)
Change 142 (June 7, 2012)
Change 141 (May 7, 2012)
Change 139 (April 10, 2012)
Change 127 (September 22, 2011)
Change 117 (March 19, 2011)
Change 115 (March 14, 2011)
Baseline (August 1, 2002)
Chap 26 -- Continued Health Care Benefit Program (CHCBP)
Change 137 (February 29, 2012)
Baseline (August 1, 2002)
Sect 1 -- Continued Health Care Benefit Program (CHCBP), Eligibility And Coverage
Change 147 (September 21, 2012)
Change 144 (August 13, 2012)
Change 137 (February 29, 2012)
Baseline (August 1, 2002)
Acronyms And Definitions
Baseline (August 1, 2002)
Acronyms And Definitions
Change 141 (May 7, 2012)
Change 128 (November 14, 2011)
Change 118 (March 23, 2011)
Change 61 (March 14, 2008)
Change 47 (March 27, 2007)
Change 38 (August 31, 2006)
Change 32 (March 31, 2006)
Change 27 (August 1, 2005)
Change 26 (May 18, 2005)
Change 23 (March 29, 2005)
Change 21 (February 14, 2005)
Change 19 (January 20, 2005)
Change 17 (December 7, 2004)
Change 8 (March 1, 2004)
Change 6 (December 31, 2003)
Change 5 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
MEPRS Manual Definition Of “Visit”
Change 6 (December 31, 2003)
Baseline (August 1, 2002)
Obsolete Files
Change 57 (November 21, 2007)
Baseline (August 1, 2002)
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