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to the TMEP unless specifically changed, waived, or superseded by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
8.8.3.2,
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.