1.0 Stale
-dated
Checks
And Returned Electronic Funds Transfers (EFTS)1.1 The contractor
shall, for stale-dated checks, submit a TRICARE Encounter Data (TED)
record(s) cancellation within 60 days after the 120 day stale-date
on a no-less-than monthly basis.
1.2 The contractor
shall, for returned EFTs, immediately issue a check utilizing the
same Fiscal Yearly (FY) bank account used for the returned EFT payment.
The contractor shall not update the TED record. The contractor shall
not request an “authorization to release payment” action from the
Defense Health Agency (DHA) Budget Officer. If the contractor is
unable to use the same FY bank account, then the contractor shall
cancel the TED Record associated with the returned EFT payment and
submit a new TED Record for the check payment following all underwritten
or non-underwritten (as applicable) TED data submission requirements
and check release procedures outlined in Section G of the contract.
1.3 For returned
EFTs, the contractor is authorized to reissue payment from a Prior
Year (PY) bank account provided the account is still available for
use and a TED Record update is not required.
2.0
Request
For Replacement Checks
2.1 Requests Received
Prior To The Check Payment Reaching The Stale-Date2.1.1 When the contractor
receives a request (written, electronic or by phone) from a payee requesting
reissuance of a check prior to stale-date, the contractor shall
issue a replacement check, provided the payee provides the following:
• A description
of the circumstances for the loss, destruction or non-receipt of
the check (if known), and
• The damaged check,
or certification from payee (written, electronic or verbal) they
will destroy the damaged check (if available), and
• A request for
new payment to be issued, and
• A certification
(written, electronic or verbal) stating they will not present the
original check, if found, for payment after requesting a check to
be reissued, and they will void the original check.
2.1.2 The contractor
shall cancel payment on the lost or damaged check prior to reissuing
a new check. If the damaged check is returned to the contractor
uncashed, then the contractor is not required to order a stop payment.
2.1.3 The contractor
shall reissue payment from the account payment was originally issued
from. If the contractor is unable to use the same FY bank account,
then the contractor shall cancel the TED Record associated with
the returned EFT payment and submit a new TED Record for the check
payment following all underwritten or non-underwritten (as applicable)
TED data submission requirements and check release procedures outlined
in Section G of the contract.
2.1.4 The contractor
shall not, if using the same FY bank account, submit a TED record
update or request an “authorization to release payment” from the
DHA Budget Officer.
2.1.5 If the replacement
payment request is related to:
2.2 Requests Received
After The Check Payment Has Stale-Dated2.2.1 The contractor
shall follow their standard business practices when reissuing a
payment.
2.2.2 The contractor
shall allow the payee to have six years after the ORIGINAL check
stale-dated to request a replacement check or to refile their previously
paid claim (depending on the contractor’s business practices). If
a payment has been reissued and lost, the six year period does not
start over. The contractor shall reject requests received after
the sixth year.
2.2.3 The contractor
shall, when reissuing payment:
• Follow all underwritten
or non-underwritten (as applicable) TED data submission requirements
and check release procedures outlined in Section G of the contract.
• For non-underwritten
payment(s) - use the current fiscal year bank account assigned to
the contractor for non-underwritten payments.
• For underwritten
payment(s) - use the Contract Line Item Number (CLIN) used to make
the original payment. If closed or payment was issued by a previous
contractor, then the contractor shall use the current fiscal year
bank account for non-underwritten payments.
2.2.4 The contractor
shall, if the claim history is not available, submit a request check
release approval to DHA/Contract Resource Management (CRM). The
contractor shall ensure supporting documentation includes:
• The original
check (if available), and
• The sponsor’s
Social Security Number (SSN), and
• The payee’s Tax
Identification Number (TIN) if sponsor is not payee, and
• A copy of the
Explanation of Benefits (EOB) (if available) or other documentation
showing the computation and payment of the original check, and
• The check, a
copy, or statement of loss or non-receipt.
2.2.5 If the replacement
payment request is related to:
2.3 Replacement Payments
To Legal Representatives2.3.1 Legal Representative
Of Estate Of Decedent2.3.1.1 The contractor
shall, when making a payment to the legal representative of the
estate of a decedent:
• If payment is
made by check, issue a check to the person concerned with an additional
line stating “For the estate of _____”.
• If payment is
made by EFT, issue payment to the person concerned with “For the
estate of _____” statement added to the ADDENDA RECORD (7 Record,
Field 3, Positions 4-83).
2.3.1.2 The contractor
shall not make the check or EFT payable to the “estate of” a decedent,
nor to a deceased person. The contractor shall deliver payment to
the named payee’s address of record.
2.3.2 Committee or
GuardianThe
contractor shall, with the properly filed legal documents, make
payments to legally appointed committee, guardian, or other legal
representative of a mentally incompetent payee.
2.3.3 Power of Attorney
(POA)2.3.3.1 The payee may
authorize another person to receive payment by execution of a specific
POA that clearly states the holder is entitled to receive the payment
on the payee’s behalf. The person receiving the payment 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.
2.3.3.2 The contractor
shall verify the identity of the holder and retain a copy of the
POA documentation.
2.3.3.3 The contractor
shall, after verifying the POA, honor a check presented under POA
on behalf of the payee.
2.4 Reporting Requirements2.4.1 The contractor
shall, for a voided or stale-dated payment in excess of $10, submit
a TED record credit voucher in accordance with the TRICARE Systems
Manual (TSM), Chapter 1, Section 1.1. If the payment was
issued using a manual voucher, the contractor shall submit credit
as a similar manual voucher.
2.4.2 The contractor
shall for voided/stale-dated payments of $10.00 or less, either:
• Affect a credit
voucher for the check in accordance with paragraph 2.4.1, or
• Include a memorandum
record with the Non-Underwritten Funds Bank Account Reconciliation Report
supporting the under $10 voided or stale-dated transactions reported.
2.4.3 The contractor
shall, when reissuing payment for a previously voided or stale-dated payment,
submit a TED record or manual voucher (as appropriate). If the payment
has not voided or stale-dated, then the contractor shall not submit
a TED record or manual voucher.
2.4.4 The contractor
shall report the reissuance using the same procedure used to report
the original payment.
2.5 Other Instructions
To The ContractorThe contractor
shall process all payment reissue requests within 15 business days.
3.0
Contractor
Loss Of Funds While Making Payments3.1 The contractor
shall properly safeguard all Government funds entrusted to them
until the funds are either returned to the Government or paid to
the authorized payee.
3.2 The contractor
shall be financially liable for all amounts collected on behalf
of DHA until deposited into the Federal Reserve Bank (FRB) or paid
to DHA and for all amounts billed to DHA or drawn by them from the
FRB for health care cost reimbursement until paid to the authorized
payee.
3.3 Requirements
under paragraph 3.0 do not apply to individual claims
for lost, damaged or misdirected payments covered under paragraphs 1.0 and 2.0.
If the contractor is uncertain a loss is covered under paragraph 3.0,
the contractor shall contact DHA, CRM for determination.
3.4 The contractor
shall notify DHA CRM within two business days of any loss or suspected
loss of DHA funds, examples include but are not limited to:
• ACH or EFT payments
were attempted by the contractor but were intercepted by persons
other than the authorized payees prior to arriving at the address
(electronic) provided by the payee, or
• Unauthorized
payments were made due to contractor error (e.g., duplicate payment
files sent out, test files resulting in actual payment, data breaches,
etc.).
• Payments made
by the contractor expressly prohibited under the terms of the contract.
• Funds entrusted
to the contractor were embezzled or stolen by a third party.
3.5 The contractor
shall refund to the DHA:
• Payments made
by the contractor expressly prohibited under the terms of the contract,
and
• All
lost or misdirected collections made on behalf of DHA, and
• All funds related
to lost or misdirected health care payments reimbursed by DHA, and
• All unauthorized
amounts drawn on the U.S. Treasury, and
• All funds embezzled
or stolen by a third party, and
• All amounts directed
by DHA, CRM and authorized under paragraph 3.0.
within five business
days after loss identification.
3.6 The contractor
shall, for underwritten and non-underwritten claims, cancel all
associated TED record payment data submitted to DHA within five
business days after loss identification.
3.7 The contractor
shall, for non-underwritten payments, deposit an amount equal to
the amount drawn on the U.S. Treasury by unauthorized individuals.
Cancellation of underwritten claims in accordance with paragraph 3.2 will
result in the return of funds to DHA via payment offset.
3.8 The contractor
shall cancel payment on any uncashed checks associated with the
misdirected payments.
3.9 If the funds
are not returned to DHA within five business days, DHA will charge
interest and a penalty beginning the third business day after the
loss of DHA funds is identified and interest will continue until
the contractor returns the missing funds 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.
3.10 After the funds
have been returned to the DHA and the contractor is confident the
payments will arrive securely to the intended recipient, the contractor
shall reissue payment to the authorized payees (as needed). If the
contractor cannot reissue payment within 30 days of loss, the contractor
shall notify the Contracting Officer (CO) for guidance.
3.11 The contractor
may appeal its liability for the loss of funds to the CO if the
contractor can demonstrate that the loss was caused by erroneous
information provided to them by:
• TRICARE beneficiary,
or
• TRICARE
certified provider, or
• Department of
Defense (DoD), or
• Department of
Veterans Affairs (DVA), or
• Centers for Medicare
and Medicaid Services (CMS).
If the loss occurred
because of the actions taken by a federal agency not listed above,
the contractor shall be liable for the loss to DHA, and the contractor
shall pursue recovery of funds with the federal agency involved.
3.12 The contractor
shall not be liable for payments;
• That are sent
to the physical address specified by the payee and are subsequently
lost or stolen.
• That arrive at
the electronic address specified by the payee and are subsequently
lost or stolen.
• Lost or stolen
by a third party hired or appointed by the payee to process their
payments (e.g. financial institution, collection agency, accounting
billing services, employee, etc.).
• Lost due to erroneous
information provided by the payee.