1.0 General
Under the authority of Title 10, United States
Code (USC), Section 1096, the Department of Defense (DoD) may implement
a Partnership Program if it is determined that it will result in
the delivery of health care to TRICARE beneficiaries in a more effective,
efficient, or economical manner. By policy (DoD Instruction (DoDI)
6010.12, “Military-Civilian Health Services Partnership Program,”
October 22, 1987) and regulation (paragraph 199.1(p) of reference
(c)), DoD implemented the Partnership Program in all overseas locations
and Alaska to integrate specific health care resources between facilities
of the Uniformed Services and providers in the civilian health care
community. It allowed, in part, TRICARE beneficiaries to receive
inpatient care and outpatient services through the TRICARE civilian
purchased health care program from civilian providers of health
care in Military Treatment Facilities (MTFs). MTF Commanders rely
on these Agreements to augment their staffing during deployments
and staffing shortfalls. By utilizing Internal Partnership Agreements,
MTFs are able to:
• Supplement MTF services/capabilities.
• Improve availability
of services impacted during contingency operations.
• Provide convenient
access at MTFs to health care services by civilian providers of
care.
• Provide
cost-effective delivery of health care services when compared to
purchased care sector rates or with CMAC rates in high-cost locations
in the state of Alaska.
2.0 Claims
Submission
The TOP contractor shall process
Partnership Provider claims in accordance with the following guidelines:
2.1 Each claim
shall be identified by a large, bold “Partnership” stamp that does
not obscure the claim information. If claims are not identified
in this manner, they will be processed as TRICARE claims since it
is impossible for the Defense Health Agency (DHA) claims processor
to otherwise distinguish them.
2.2 All Partnership claims shall
be submitted on either a Centers for Medicare and Medicaid Services
(CMS) 1500 Claim Form or DD 2642 claim form. No beneficiary-submitted
claims will be processed.
2.3 The claim form must clearly
indicate that it is from a participating provider by checking the “Yes”
block next to “participating” on the appropriate TRICARE-approved
claim form.
2.4 Only TRICARE-approved procedure codes shall
be used to bill for all services provided.
2.5 Only procedures/services that
are within the scope of the approved Agreement are to be billed.
2.6 The procedures/services
billed to TRICARE are only those provided to TRICARE-eligible beneficiaries.
2.7 All partnership
procedures/services shall be performed within the MTF, and the appropriate block
on the TRICARE claim form must indicate that the procedures/services
were provided in the MTF.
2.8 If a beneficiary has Other
Health Insurance (OHI), the claims for Partnership procedures/services shall
first be filed with the other coverage before being submitted to
TRICARE. Documentation of the action taken by the OHI plan shall
accompany the partnership claim submitted to TRICARE.
2.9 The beneficiary
shall not be billed for any deductibles or cost-shares.
2.10 Only the
fees specified in the Partnership Agreement shall be billed to TRICARE.