1.0 POLICY
1.1 Only Extended
Care Health Option (ECHO) authorized benefits may be processed as
an ECHO claim. Benefits that are available through the TRICARE Basic
Program are not eligible to be cost-shared through the ECHO.
1.2 Government
and beneficiary cost-share liability for ECHO benefits are indicated
in
Section 16.1.
1.3 Pricing of ECHO services and
items shall be determined in accordance with the TRICARE Reimbursement
Manual (TRM).
1.4 All ECHO claims must have a valid written authorization.
The contractor or Director, TRICARE Area Office may waive the requirement
for a written authorization for rendered ECHO services/items that,
except for the absence of the written authorization, would be allowable
as an ECHO benefit.
1.5 Services or items on an ECHO
claim which do not have a corresponding line item on an authorization
document shall be denied.
1.6 Charges for Basic Program
benefits and ECHO benefits shall be split as individual line items
on ECHO and ECHO Home Health Care (EHHC) claims.
1.7 The “billed
amount” for ECHO procedures or items is the actual billed amount,
not the applicable ECHO benefit limits indicated in this chapter.
1.8 ECHO claims
shall be paid the amount authorized, as indicated on the ECHO authorization,
or the benefit limit, whichever is lower.
1.9 The reimbursement rate for
the use of a privately-owned vehicle, regardless of the number of ECHO
family members being transported, is limited to the Federal Government
employee mileage reimbursement rate in effect on the trip date.