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TRICARE Operations Manual 6010.59-M

Each TRICARE Manual posted on the website incorporates all published changes. Although changes are published, they are not implemented by the contractors until they receive direction to do so by the Contracting Officer. Each TRICARE Manual on the web incorporates all changes by the date of publication. Although changes are published, they may not be implemented by the contractor until directed to do so by the Contracting Officer.
The TRICARE Operations Manual (TOM) is incorporated by reference into the Managed Care Support Contracts (MCSCs) and is the primary vehicle for operational guidelines and instructions to the contractor. The TOM provides a mechanism for clarifying and modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information. All or portions of the TOM may also be incorporated by reference into other TRICARE contracts.

NOTE

The Managed Care Support (MCS) Manuals (T-3) for contracts prior to 07/21/2016 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each manuals' web page. Select the desired manual below, then proceed to the "Superseded" manual(s) that exist below the "Current" manual.

  • April 1, 2015 Edition
    Last Updated: May 21, 2024
    Most Recent Change Number: Change 138
    These manuals are applicable to the East and West Regional Managed Care Support Contracts awarded on or after 07/21/2016. Upon direction of the Contracting Officer, all or portions of these manuals may also apply to the TRICARE Quality Monitoring Contract (TQMC), TRICARE Claims Audit Review Services (TCARS), TRICARE Overseas Program (TOP), TRICARE Pharmacy (TPharm), TRICARE Dental Program (TDP), and TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC).
    This edition reissued the February 1, 2008 edition. All changes to the February 1, 2008 edition of the TOM (through Change 291 dated August 30, 2022) have been incorporated.
    All future changes will be published to this edition.

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    This change clarifies direction to contractors regarding PCM changes versus when dis-enrollment is appropriate, as well as understanding contractor responsibilities for split claims. This change is published in conjunction with TRICARE Policy Manual 6010.60-M, April 2015 Change 126.
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  • February 1, 2008 Edition - Superseded
    Last Updated: August 30, 2022
    Most Recent Change Number: Change 291
    This manual is valid for contracts awarded on or after June 27, 2008 for the North, South, and West Regions along with TQMC, CARS, TOP, and TPharm. The manuals will apply to the TDEFIC contract upon direction of the Contracting Officer.
    This edition supersedes the August 1, 2002 edition. All changes to the August 1, 2002 edition (through Change 151 dated February 12, 2013) have been incorporated.
    No future changes will be published to this edition.

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    Page Count: 1,684
    This change establishes 2023 premium rates for TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and the Continued Health Care Benefit Program.
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  • August 1, 2002 Edition - Superseded
    Last Updated: February 12, 2013
    Most Recent Change Number: Change 151
    This manual is valid for contracts awarded on or after May 1, 2003 through June 26, 2008 for the North, South, and West Regions along with TDEFIC, NQMC, CARS, Retail, and TMOP.
    The August 1, 2002 edition of the TRICARE Operations Manual (TOM), 6010.51-M, is available online. This edition reissued the February 18, 2000 edition. Also, the August 1, 2002 edition of the TOM replaces the March 1, 2001 edition of the MCSC Operations Manual (OPM). All changes to the March 1, 2001 edition of the OPM (through Change 38 dated April 30, 2004) have been incorporated.
    No future changes will be published to this edition.

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    Page Count: 1,710
    This change revises records management requirements for transferring electronic records to the electronic Code of Federal Regulations (eFRC) and provides additional guidance and/or clarification on contractor compliance with relevant provisions of applicable federal statutes and regulations.
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