In order to control costs, reduce
aberrant billing activity, and eliminate balance billing issues
for TRICARE Select beneficiaries, the Defense Health Agency (DHA)
implemented an approved provider network in the Philippines. With
establishment of the TRICARE Select option by the National Defense Authorization
Act (NDAA) for Fiscal Year (FY) 2017, it has been determined economically
in the best interest of the DoD to transition the approved provider
network in the Philippines to a TRICARE Select PPN effective January
1, 2018. A PPN provider will be available to, and be a participating
provider on claims for, all TRICARE eligible beneficiaries, whether
they are TRICARE Prime, TRICARE Select, or TRICARE for Life. In
addition to PPN providers, TRICARE authorized providers in the Philippines
include certified providers as defined in
paragraph 2.2. TRICARE beneficiaries
who travel to the Philippines and seek urgent/emergent care will
be able to get care from any PPN provider or certified provider,
but may be subject to higher cost-shares and copays for care rendered
by non-PPN providers. Locations for PPN providers will be developed
and maintained by the TRICARE Overseas Program (TOP) contractor;
the government will work with the TOP contractor to identify other
locations in the Philippines where the PPN may be expanded. Locations
may be added or deleted on an annual basis, as warranted. PPN providers
will abide by a set foreign fee schedule, accept payment from the
TOP contractor, and not balance bill the TRICARE beneficiaries.
This will be accomplished by the establishment of a dedicated list
of providers who agree to comply with these requirements and business
processes as outlined below.