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.