TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC)
Chapter 20
Section 2
Jurisdiction
Revision:
1.0 Regional
Boundaries
1.1 For claims processing jurisdiction purposes,
TRICARE regional boundaries do not apply under the TRICARE Dual
Eligible Fiscal Intermediary Contract (TDEFIC). The TDEFIC contractor
shall be responsible for processing all medical claims for services,
except retail pharmaceuticals, rendered to TRICARE/Medicare dual
eligible individuals within the 50 United States (U.S.) and the
District of Columbia, as well as Puerto Rico, Guam, the U.S. Virgin
Islands, American Samoa, and the Northern Mariana Islands.
1.2 Medicare
claims processing jurisdiction is based on place of service. The
TDEFIC contractor shall contract with the Medicare Coordination
of Benefits Contractor (COBC) to ensure that Medicare claims for
all TRICARE dual eligible beneficiaries receiving care within the
respective carrier’s/FI’s state(s) are electronically forwarded
to the TDEFIC contractor. The cross-over claims agreement shall
include all TRICARE dual-eligible beneficiaries regardless of the
beneficiary’s status (Active Duty Dependent, retiree, survivor,
etc.).
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