Provider Network
Agreements with the Managed Care Support Contractors (MCSCs) are
done at a national level. All DVA/ V
HA
facilities with
signed
TRICARE Network Agreements
shall be
included as network providers. See
Chapter 11, Section 2.1, which includes the
Memorandum Of Understanding (MOU) for the policy concerning this
program. Contractors processing claims submitted from
DVA/VHA medical
facilities shall continue to use the usual claims
processing procedures to include medical necessity, Explanation
of Benefits (EOB), Other Health Insurance (OHI) and Third Party
Liability (TPL).
DVA/VHA medical facilities shall
be subject to the same Utilization Management
(UM) and
Quality Assurance
(QA) requirements
applicable to other network providers. The contractor shall ensure
that all
DVA
/VHA Health
Care Finders
, institutional
, and
individual professional providers are properly trained in and comply
with the provisions of TRICARE quality and utilization management
programs. The effective date for TRICARE coverage of service
s provided
by a network
DVA/VHA medical facility is determined
by the agreement between the
DVA/VHA and
the
MCSC. Only services furnished on
or after the effective date will be considered for TRICARE payment.