1.0 APPLICABILITY
This 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 Defense Health Agency (DHA) and specifically
included in the network provider agreement.
3.0 POLICY
3.1 Forensic
examinations, including evidence collection kits, are covered when
provided in Civilian Health Care (CHC) facilities following a sexual
assault or domestic violence.
3.2 Claims
must contain one or more diagnosis codes that indicate the purpose
of the visit or inpatient admission is directly related to services
for an examination or treatment resulting from sexual assault or
domestic violence.
3.3 Reimbursement
for forensic examinations and evidence collection kits shall be
made according to the appropriate type of provider, type of service,
and place of service in effect at the time services are rendered.