TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC)
Chapter 20
Section 2
Jurisdiction
Revision:
1.0 Regional Boundaries
1.1 For claims processing jurisdiction
purposes, TRICARE regional boundaries do not apply under the TRICARE
Dual Eligible Fiscal Intermediary Contract (TDEFIC). The TDEFIC
contractor shall be responsible for processing all medical claims
for services, except retail pharmaceuticals, rendered to TRICARE/Medicare
dual eligible individuals within the 50 United States (U.S.) and
the District of Columbia, as well as Puerto Rico, Guam, the U.S.
Virgin Islands, American Samoa, and the Northern Mariana Islands.
1.2 Medicare claims processing
jurisdiction is based on place of service. The TDEFIC contractor shall
contract with the Medicare Coordination of Benefits Contractor (COBC)
to ensure that Medicare claims for all TRICARE dual eligible beneficiaries
receiving care within the respective carrier’s/FI’s state(s) are
electronically forwarded to the TDEFIC contractor. The cross-over
claims agreement shall include all TRICARE dual-eligible beneficiaries
regardless of the beneficiary’s status (Active Duty Dependent, retiree,
survivor, etc.).
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