1.0 POLICY
1.1 Only Extended
Care Health Option (ECHO) authorized benefits may be processed as
an ECHO claim. Benefits that are available through the TRICARE Basic
Program are not eligible to be cost-shared through the ECHO.
1.2 Government and beneficiary
cost-share liability for ECHO benefits are indicated in
Section 16.1.
1.3 Pricing
of ECHO services and items shall be determined in accordance with
the TRICARE Reimbursement Manual (TRM).
1.4 All ECHO
claims must have a valid written authorization. The contractor or Executive Director, TRICARE
Area Office (TAO) may waive the requirement
for a written authorization for rendered ECHO services/items that,
except for the absence of the written authorization, would be allowable
as an ECHO benefit.
1.5 Services
or items on an ECHO claim which do not have a corresponding line
item on an authorization document shall be denied.
1.6 Charges for Basic Program benefits
and ECHO benefits shall be split as individual line items on ECHO
and ECHO Home Health Care (EHHC) claims.
1.7 The “billed
amount” for ECHO procedures or items is the actual billed amount,
not the applicable ECHO benefit limits indicated in this chapter.
1.8 ECHO claims shall be paid the
amount authorized, as indicated on the ECHO authorization, or the
benefit limit, whichever is lower.
1.9 The reimbursement
rate for the use of a privately-owned vehicle, regardless of the
number of ECHO family members being transported, is limited to the
Federal Government employee mileage reimbursement rate in effect
on the trip date.