The allowable charge inquiry
must be received or postmarked within 90 days from the date of the
Explanation Of Benefits (EOB) or it may be denied for lack of timeliness.
If the inquiry is in writing and the issue is not clearly a question
of allowable charge, any doubt must be resolved in favor of handling
the case as an appeal under
Chapter 12.
The contractor shall respond only to a person entitled to the information;
i.e., beneficiary, parent/guardian, participating provider, other
TRICARE contractors, or Defense Health Agency (DHA). Allowable charge
complaints shall be reported on the workload report as required
by the contract.