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TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Medicare Eligible Program (TMEP)
Chapter 20
Section 18
Demonstrations and Pilot Projects (Except Value-Based Initiatives)
All TRICARE requirements in Chapter 18 regarding Demonstrations and Pilot Projects shall apply to the TMEP unless specifically changed, waived, or superseded by this section (as indicated below), the TRICARE Policy Manual (TPM), TRICARE Reimbursement Manual (TRM), TRICARE Systems Manual (TSM), or TMEP contract.
1.0  General
The provisions of Chapter 18 are applicable to TMEP with the following exceptions:
1.1  The provisions of Chapter 18, Section 3, paragraphs 8.8.1 through, referral and authorizations requirements will be conducted by the regional contractors. The regional contractor will submit the authorization for TRICARE/Medicare dual eligible beneficiaries to the TMEP contractor as established in the Memorandum of Understanding (MOU). The TMEP contractor will contact the regional contractor regarding referral and authorizations for claims received without an authorization.
1.2  The provisions of Chapter 18, Section 4, paragraphs 15.1, 15.6, and 15.8 are not applicable to TMEP.
1.3  The provisions of Chapter 18, Section 4, paragraphs 3.0 and 6.0 apply to TMEP. All other requirements for this Pilot Project do not apply.
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