1.0 APPLICABILITY
The policy is mandatory for
reimbursement of services provided by either network or non-network
providers. However, alternative network reimbursement methodologies
are permitted when approved by the Defense Health Agency (DHA) and
specifically included in the network provider agreement.
3.0 POLICY
Providers may incur administrative
expenses during the course of doing business. Most of these expenses
are normal and payment for them is included in the payments made
for the medical services rendered by the provider. Others are not
covered because they are not medical services related to the treatment
of an illness or injury. In either case, separate charges for administrative
expenses are not allowed. Such expenses include:
3.1 Penalty or interest charges
imposed on a beneficiary by a provider because of failure to make
timely payment on a bill are not covered.
3.2 Provider
administrative expenses such as charges for claims completion and
furnishing medical records are not separately allowable.