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TRICARE Operations Manual 6010.62-M, April 2021
Financial Administration
Chapter 3
Section 4
Lost, Stolen, Stale-Dated, Damaged, Misdirected, Or Returned Payments
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.
2.1  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:
•  Known fraud, refer to Chapter 13, Section 5; or
•  Contractor loss of funds, refer to paragraph 3.0.
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:
•  Known fraud, refer to Chapter 13, Section 5; or
•  Contractor loss of funds, refer to paragraph 3.0.
3.3  Replacement Payments To Legal Representatives
3.3.1  Legal Representative of Estate of Decedent  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”).  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)  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.  The contractor shall verify the identity of the holder and retain a copy of the POA documentation.  The contractor shall, after verifying the POA, honor a check presented under POA on behalf of the payee.
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.
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