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TRICARE Operations Manual 6010.62-M, April 2021
Financial Administration
Chapter 3
Section 3
Claim Refund And Collection Procedures
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 health care costs under the terms of the contract.
The contractor shall follow the requirements listed in Chapter 10.
2.1  Underwritten Health Care Refunds and Collections
2.1.1  Collections Occurring on Active Underwritten Health Care Contract Line Item Numbers (CLINs)
The contractor shall submit, upon identification of debt, a credit TRICARE Encounter Data (TED) record citing the CLIN/Automated Standard Application for Payment (ASAP) Account Number the contractor originally billed within two business days.
Note:  Exception to this requirement: credits related to good faith payments as defined in Chapter 10, Section 3 may be submitted upon collection of funds.
2.1.2  Collections Occurring on Closed Underwritten Health Care CLINs  Closed underwritten CLINs are defined in Section G of the contract (TED Underwritten CLIN Closure Procedures).  The contractor shall, upon closure of the underwritten health care CLIN, process all collections for debt incurred after CLIN closure in accordance with Chapter 10, Section 3. Collections of debt incurred prior to CLIN closure remain underwritten debt and shall be collected in accordance with Chapter 10, Section 2.  The contractor shall submit credit TED records for all underwritten debt (paragraph 2.1.1) prior to CLIN closure.
2.2  Non-Underwritten Health Care Refunds and Collections
2.2.1  The contractor shall deposit refunds and collections to the applicable non-underwritten bank account no later than close of the next business day upon receipt of funds from beneficiaries, providers, or other entities.
2.2.2  The contractor shall submit, upon deposit of funds from providers, beneficiaries, or other entities, a credit TED record within two business days citing the appropriate current fiscal year non-underwritten CLIN/ASAP Account Number. See the TRICARE Systems Manual (TSM), Chapter 2, Section 1.1.
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