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-Date
2.1.1 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-Dated
2.2.1 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
Representatives
2.3.1 Legal
Representative Of Estate Of Decedent
2.3.1.1 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 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.
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
Requirements
2.4.1 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 Contractor
The contractor shall process
all payment reissue requests within 15 business days.
3.0 Contractor
Loss Of Funds While Making Payments
3.1 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.
3.4 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 10 business days
after loss identification.
3.5 The
contractor shall notify DHA, CRM and the Contracting Officer (CO)
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.
3.6 The contractor shall, for underwritten
and non-underwritten claims, cancel all associated TED record payment
data submitted to DHA within five 10 business
days after loss identification of
receipt of the liability determination notification or as DHA determines.
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 10 business
days, DHA will charge interest and a penalty beginning the third 11th 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 continue until
the contractor returns the missing funds to DHA and
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.