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TRICARE Policy Manual 6010.60-M, April 1, 2015
Providers
Chapter 11
Section 9.1
Other Provider Certification
Issue Date:  June 20, 1988
Authority:  32 CFR 199.6(d)
Revision:  C-43, March 19, 2019
1.0  ISSUE
How are other providers certified such as ambulance companies, laboratories, pharmacies, etc.?
2.0  POLICY
2.1  Certifying authority. Each contractor is the certifying authority for the following categories of ancillary service or supply providers located within their geographical jurisdiction:
•  Ambulance company.
•  Independent laboratory.
•  Medical equipment firm.
•  Medical supply firm.
•  Pharmacy.
•  Portable x-ray service.
•  Mammography suppliers.
•  State Vaccine Programs or State Vaccine Program entities (SVPs) as suppliers of vaccines (see Chapter 11, Section 9.2).
2.2  Vendors of medical supplies, vaccines, Durable Equipment (DE), or Durable Medical Equipment (DME) are covered as a Basic Program benefit or Assistive Technology (AT), which is covered as an or Extended Care Health Option (ECHO) benefit.
2.2.1  The types of vendors which may be approved for medical supplies, vaccines, DE, DME, or AT include, but are not limited to, the following:
2.2.1.1  Any firm, supplier, or provider that is authorized under Medicare.
2.2.1.2  Any commissary under the jurisdiction of the Defense Commissary Agency.
2.2.1.3  Any Post Exchange, Base Exchange, or Station Exchange under the jurisdiction of:
•  The Army/Air Force Exchange Service (AAFES); or
•  The Department of the Navy; or
•  The United States (U.S.) Marine Corps; or
•  The U.S. Coast Guard.
2.2.1.4  Any civilian retail store.
2.2.1.5  Any civilian retail pharmacy.
2.2.1.6  An SVP that meets the requirements of Chapter 11, Section 9.2.
2.2.1.7  Human Milk Banking Association of North America (HMBANA)-accredited donor milk banks.
2.2.2  A photocopy of a printed receipt which identifies the vendor as an allowable type of vendor is sufficient evidence of provider status for those listed that are not Medicare-authorized.
2.3  Ambulance company. An ambulance company may be approved as a provider when:
2.3.1  The company meets the requirements of state and local laws in the jurisdiction in which the ambulance firm is licensed.
2.3.2  The company provides:
2.3.2.1  A photocopy of the company’s current license to provide ambulance services; or
2.3.2.2  A signed and dated statement on letterhead by an official of the organization operating the ambulance service stating that:
•  There is no license requirement for the operation of an ambulance service within the geographic area served by the ambulance service; or
•  That the organization is exempt from a license requirement for the operation of an ambulance service with an explanation of the legal basis for exemption.
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