1.0 STALE-DATED
CHECKS AND RETURNED ELECTRONIC FUNDS TRANSFER (EFT) (UNRELATED TO CONTRACTOR
LOSS OR KNOWN FRAUD)
1.1 The contractor shall, for stale-dated
checks, submit a TRICARE Encounter Data (TED) record cancellations no
sooner than 10 business days but within 20 business days after the
120 calendar day stale-date (to allow for checks that have been
presented by the 120th day to clear the banking system).
1.2 The contractor shall, for returned
EFTs immediately issue a check. TED record update and the Defense Health
Agency (DHA) Budget Officer payment release authorization is not
required.
1.3 The contractor shall not submit
a TED record cancellation if the contractor is actively attempting
to locate the payee.
2.0 REQUESTS FOR REPLACEMENT PAYMENTS
RECEIVED PRIOR TO THE CHECK PAYMENT REACHING THE STALE-DATE
2.1 The contractor
shall obtain a written and signed statement from the payee:
• Stating they have not received
payment;
• Description of the circumstances
for the loss or destruction or non-receipt of the check or EFT (if
known);
• Request that a new payment
be issued; and
• A statement the payee will
destroy the original check or return funds if received at a later
date.
2.2 The payee may request the replacement
payment be made either by check or EFT. The contractor shall reissue
payment from the same bank account the original payment was issued
from. TED record update and DHA Budget Officer payment release authorization
is not required. If the replacement payment request is related to:
3.0 REQUESTS
FOR REPLACEMENT PAYMENTS RECEIVED AFTER THE CHECK PAYMENT HAS STALE-DATED
3.1 The contractor shall not reissue
payment after the check stale-dates, the payee must refile their previously
paid claim with the current contractor. The payee shall have six
years after the original check stale-dated to refile their previously
paid claim. Previously adjudicated claims, where payment was not
received by payee, after the 6th year shall be rejected.
3.2 The contractor shall, when
a previously received claim is refiled for non-receipt of payment,
create a new TED record (as the TED related to the stale dated check
has been canceled), receive DHA Budget Officer authority to release
payment and reattempt payment. The reissue of payment shall not
restart the six year refiling deadline for claims where payment
was not received. If the replacement payment request is related
to:
3.3 Replacement Payments To Legal
Representatives
3.3.1 Legal
Representative of Estate of Decedent
3.3.1.1 The contractor shall, when
making a payment to the Legal Representative of the estate of a
decedent, issue a check named person, “Executor of the Estate of
the decedent” (e.g., “John K. Smith, Executor of the estate of Albert
R. Jones”).
3.3.1.2 The contractor shall not make
a check payable “to the estate of” a decedent or to a deceased person.
3.3.2 Committee or Guardian
The contractor shall, with
the properly filed legal documents, make payments to legally appointed
committee, guardian, or other legal representative of a mentally
incompetent payee.
3.3.3 Power of Attorney (POA)
3.3.3.1 The payee of a check may authorize
another person to receive a check by execution of a specific POA that
clearly states the holder is entitled to receive the check on the
payee’s behalf. The person receiving the check signs his or her
own name on the voucher followed by the words “Attorney-in-Fact
for” and the name of the person granting the POA.
3.3.3.2 The contractor shall verify
the identity of the holder and retain a copy of the POA documentation.
3.3.3.3 The contractor shall, after
verifying the POA, honor a check presented under POA on behalf of
the payee.
4.0 CONTRACTOR LOSS OF FUNDS WHILE
MAKING PAYMENTS
4.1 The contractor shall be financially
liable for all amounts billed to DHA for health care cost reimbursement or
drawn by them from the Federal Reserve Bank (FRB) until paid to
the authorized payee.
4.2 The contractor
shall immediately notify DHA Contract Resource Management (CRM)
of any loss or suspected loss of DHA funds where:
4.2.1 Payments
were attempted by the contractor but were not received by the authorized
payee; or
4.2.2 Unauthorized payments were
made due to contractor error (e.g., duplicate payment files sent
out, test files resulting in actual payment, etc.).
4.3 The contractor shall immediately
refund to the DHA:
• All funds related to lost or
misdirected health care payments reimbursed by DHA; and
• All unauthorized amounts drawn
on the US Treasury within two business days after identification
of the loss.
4.4 The contractor
shall, for underwritten and non-underwritten claims, cancel all
associated TED record payment data submitted to DHA within two business
days after identification of the loss.
4.5 The contractor
shall, for non-underwritten payments, deposit an amount equal to
the amount drawn on the United States (US) Treasury by unauthorized
individuals. Cancellation of underwritten claims in accordance with
paragraph 3.3.1 will
result in funds being returned to DHA via payment offset.
4.6 If the funds are not returned
to DHA within two business days, interest and a penalty will be
charged beginning the third business day after the loss of DHA funds
is identified and interest will continue until the missing funds
are returned to DHA. Interest will accrue daily and is based on
the Treasury Current Value of Funds Rate. The penalty is a one-time
payment and is based on the penalty rate in the Code of Federal
Regulations (CFR), Title 31, Chapter IX, paragraph 901.9. DHA CRM
may initiate immediate payment offset against any payments to the contractor
involved for the interest, penalties and any unpaid amount due DHA.
4.7 The contractor shall, once
the funds have been returned to the DHA, reissue payment to the
authorized payees (as needed) at such time the contractor is confident
the payments will arrive securely to the intended recipient.
4.8 The contractor may appeal its
liability for the loss of funds to the Contracting Officer (CO)
if it can demonstrate that the loss was caused by erroneous information
provided to the contractor by the:
• TRICARE beneficiary; or
• Department of Defense (DoD);
or
• Department of Veterans Affairs/Veterans
Health Administration (DVA/VHA); or
• Centers for Medicare and Medicaid
Services (CMS).
4.9 If the
loss occurred because of the actions taken by a federal agency not
listed above, the contractor remains liable for the loss to DHA,
and the contractor must pursue recovery of funds with the federal
agency involved.
4.10 The contractor
is financially liable for all amounts collected on behalf of DHA
until deposited into the FRB.