1.0 POLICY
1.1 Except
as provided in
paragraph 1.2, the contractor will provide
the required authorization for requested services and items under
the Extended Care Health Option (ECHO).
1.2 In
the case of beneficiaries residing outside the 50 United States
(U.S.) and the District of Columbia, the TRICARE Overseas Program
(TOP) contractor is responsible for authorizing ECHO benefits. The
TOP contractor shall notify the appropriate TRICARE Area Office
(TAO) Director of all ECHO benefit authorizations or authorization
waivers.
1.3 The authorization is based upon the following:
1.3.1 The beneficiary
is registered in the ECHO; and
1.3.2 The requested service or item
is allowable as a ECHO benefit; and
1.3.3 The requested service or item
meets the public facility use requirements when applicable.
1.4 The authorization
shall specify the services by type, scope, frequency, duration,
dates, amounts, requirements, limitations, provider name and address,
and all other information necessary to provide exact identification
of approved benefits. Claims can not be adjudicated without this
information.
1.5 The authorization shall remain in effect until
such time as the contractor or TOP contractor determines that:
1.5.1 The beneficiary
is no longer eligible for the ECHO; or
1.5.2 The authorized ECHO service
or item is no longer appropriate or required by the beneficiary;
or
1.5.3 The authorized ECHO service or item becomes
a benefit through the TRICARE Basic Program.
1.6 The contractor
or TOP contractor may waive the required written authorization for
rendered services and items that, except for the absence of the
written authorization, would be allowable as an ECHO benefit.
1.7 The contractor
or TOP contractor may waive the required public facility use certification
when such waiver is appropriate. See
Section 5.1.