TRICARE Manuals - Display Chap 3 Sect 3 (Change 92, Jul 14, 2021)

Transitions

Chapter 3

Section 3

Claim Refund And Collection Procedures

Revision: C-1, March 10, 2017

1.0 General

This section outlines requirements for claim refunds and installment repayments from providers and beneficiaries. Examples include ineligible beneficiaries, third party insurance, overpayments, duplicate payments, payments to wrong providers or beneficiaries, and any unallowable costs under the terms of the contract.

2.0 Collection And Deposit Procedures

Recoupment procedures shall follow the requirements listed in Chapter 10.

2.1 Non-Underwritten Refunds, Collections, Etc.

The contractor shall make deposits to the applicable non-underwritten bank account as soon as possible but no later than close of the next business day from the time the contractor collects funds from a beneficiary/provider. Upon collection of monies from providers, beneficiaries, or other parties, the contractor shall immediately submit a credit TRICARE Encounter Data (TED) record citing the appropriate current fiscal year non-underwritten Contract Line Item Number (CLIN) Automated Standard Application for Payment (ASAP) Account Number assigned to them by the Defense Health Agency (DHA) Contract Resource Management (CRM) office. See the TRICARE Systems Manual (TSM), Chapter 2, Section 1.1.

2.2 Underwritten Refunds, Collections, Etc.

2.2.1 Collections Occurring Before Administrative Closeout of the Underwritten CLIN

When a contractor has been reimbursed by DHA, a credit TED record is required immediately when an overpayment or otherwise unallowable cost is identified. Credit TED records for voluntary refunds and other unexpected collections will be submitted immediately upon receipt of funds. For “active” underwritten CLINs, all overpayments or unallowable costs shall be credited back to the CLIN the contractor originally billed. The contractor shall cite the current fiscal year underwritten CLIN/ASAP Account Number assigned by DHA/CRM associated with the CLIN billed originally (see TSM, Chapter 2, Section 1.1).

2.2.2 Refunds Related To Underwritten Good Faith Payments

Credit TED records for overpayments that have not been collected and are related to a good faith payment may be done upon collection of funds rather than identification of overpayment (see Chapter 10, Section 3, paragraph 6.7).

2.2.3 Collections Occurring After Administrative Closeout of the Underwritten CLIN

The contractor shall follow the collection and deposit guidance in paragraph 2.1 for all debts incurred after CLIN closeout. All debts incurred prior to CLIN closeout shall remain underwritten debt in accordance with Chapter 10, Section 3.

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