Skip to main content

Military Health System

Utility Navigation Links

Need larger text?
TRICARE Operations Manual 6010.59-M, April 1, 2015
Administration
Chapter 1
Section 2
Contract Administration And Instructions
Revision:  C-59, September 27, 2019
1.0  TRICARE Manuals
These include the TRICARE Operations Manual (TOM), TRICARE Policy Manual (TPM), TRICARE Reimbursement Manual (TRM), and TRICARE Systems Manual (TSM). The TRICARE Manuals are the principal vehicles for general operating instructions to all health care delivery contractors and may be accessed at https://manuals.health.mil/. The official archive copies of these documents are maintained at Defense Health Agency (DHA). The documents and all official changes to them will be maintained at DHA in an electronic medium using the PDF (Portable Document Format) format, and are available at the above web site. Distribution of paper copies will be on an exception basis. Regardless of publication medium, their printed and displayed appearance will be identical. The principal means of distribution will be via an electronic notification of publication and the contractor’s subsequent download of the manual or change from the above web site. All proposed changes to these documents will be distributed for review and comment in an electronic medium, using PDF as the document format, and comments must be returned to DHA in an acceptable electronic format. Contractors shall furnish the DHA Procuring Contracting Officer (PCO) with designated point(s) of contact and e-mail address(es) for review and comment on proposed manual changes, and notification of the final publication of manual changes.
2.0  Implementation Of Manual Changes
The contractor shall implement changes in requirements as specified by the PCO. If a contractor is unable to comply by the effective date, the PCO shall be notified in writing. The notification shall include the reasons for the noncompliance and a plan for reaching compliance. The proposal shall include milestones, if appropriate, and a firm date for completion.
3.0  Communications With DHA
The contractor shall:
3.1  Provide complete replies to DHA requests for Rough Order Of Magnitude (ROM) estimates, comments, and/or cost estimates on proposed changes to the manuals no later than 30 days from the date of the request. In addition, in the event of an urgent need imposed by law or a program requirement under which significant loss to the Government would result from delay, a period of less than 30 days will be imposed, whether it is a major or minor change.
3.2  Provide timely responses to all requests for information directed to them by DHA.
3.3  Use assigned Contracting Officer’s Representative (COR) at DHA as the initial POC for program interpretation or other forms of operational guidance.
4.0  DHA-Required Meetings
Generally, a 14 calendar day notice will be provided for all meetings hosted by DHA. The contractor shall provide representation at two regional contractors/TRICARE Regional Offices (TROs), meetings/conferences and two regional provider conferences. The contractor shall provide up to four contractor representatives at up to four additional meetings at the direction of the PCO per contract year.
5.0  DHA Delegation Of Responsibility
Responsibility has been delegated to DHA Communications, to perform the following:
•  Grant exceptions to the claims filing deadline.
•  Grant “good faith payments.”
•  Waive the signature requirements on TRICARE claims.
•  Adjudicate and process unique claims requiring special handling, and claims for emergency care provided by a Department of Veterans Affairs (DVA)/Veterans Health Administration (VHA) facility or a facility under the Bureau of Indian Affairs (BIA).
•  Authorize benefits for which the authority has not otherwise been delegated to other DHA officials or contractors.
•  Authorize an “override” of information contained on Defense Enrollment Eligibility Reporting System (DEERS), pending a system update, based on appropriate documentation regarding eligibility under the law, regulation and policy.
- END -
You are leaving Health.mil The appearance of hyperlinks does not constitute endorsement by the Defense Health Agency of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website. You are leaving Health.mil View the external links disclaimer.
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery