Title 32 National Defense Civilian Health And Medical Program Of The Uniformed Services (CHAMPUS) Part 199.7 Claims Submission, Review, And Payment Revision: Rule: (a) General. (1) CHAMPUS identification card required. (2) Claim required. (3) Responsibility for perfecting claim. (4) Obtaining appropriate claim form. (5) Prepayment not required. (6) Deductible certificate. (7) Nonavailability Statement (DD Form 1251). (i) Rules applicable to issuance of Nonavailability Statement. (ii) Beneficiary responsibility. (iii) Rules in effect at time civilian care is provided apply. (iv) Nonavailability Statement must be filed with applicable claim. (b) Information required to adjudicate a CHAMPUS claim. (1) Patient’s identification information. (2) Patient treatment information. (i) Diagnosis. (ii) Source of care. (iii) Full address of source of care. (iv) Attending physician. (v) Referring physician. (vi) Status of patient. (vii) Dates of service. (viii) Inpatient stay. (ix) Physicians or other authorized individual professional providers. (x) Hospitals or other authorized institutional providers. (xi) Prescription drugs and medicines (and insulin). (xii) Other authorized providers. (xiii) Nonparticipating providers. (3) Medical records/medical documentation. (4) Double coverage information. (i) Name of other coverage. (ii) Source of double coverage. (iii) Employer information. (iv) Identification number. (5) Right to additional information. (c) Signature on CHAMPUS Claim Form-- (1) Beneficiary signature. (i) Certification of identity. (ii) Certification of medical care provided. (iii) Authorization to obtain or release information. (iv) Certification of accuracy and authorization to release double coverage information. (v) Exceptions to beneficiary signature requirement. (2) Provider’s signature. (i) Certification. (ii) Physician or other authorized individual professional provider. (iii) Hospital or other authorized institutional provider. (d) Claims filing deadline. (1) Claims returned for additional information. (2) Exception to claims filing deadline. (i) Types of exception. (A) Retroactive eligibility. (B) Administrative error. (C) Mental incompetency. (D) Delays by other health insurance. (E) Other waiver authority. (ii) Request for exception to claims filing deadline. (e) Other claims filing requirements. (1) Continuing care. (2) [Reserved] (3) Claims involving the services of marriage and family counselors, pastoral counselors, and supervised mental health counselors. (f) Preauthorization. (1) Preauthorization must be granted before benefits can be extended. (i) Specifically preauthorized services. (ii) Time limit on preauthorization. (2) Treatment plan. (3) Claims for services and supplies that have been preauthorized. (4) Advance payment prohibited. (g) Claims review. (h) Benefit payments. (1) Benefit payments made to beneficiary or sponsor. (2) Benefit payments made to participating provider. (3) CEOB. (4) Benefit under $1. (i) Extension of the Active Duty Dependents Dental Plan to areas outside the United States. (j) General assignment of benefits not recognized.