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TRICARE Operations Manual 6010.62-M, April 2021
Financial Administration
Chapter 3
Section 2
Payments To Beneficiaries And Providers
Revision:  
1.0  CHECKS
1.1  The contractor shall use the following formats and statements when issuing checks for payments to beneficiaries and providers:
1.1.1  The words “TRICARE Payment” shall be printed in at least 18-point font at the top of the check.
1.1.2  The TRICARE logo and the contractor’s name and address shall be on the check.
1.1.3  The following endorsement statement shall be printed using four- or five-point font in the 1.5 inches allotted on the reverse side of all checks funded by the Government (i.e., non-underwritten, not-at-risk, pass-through, Automated Standard Application for Payment (ASAP), Letter of Credit (LOC) payments). This will comply with Federal Reserve Bank Regulation CC (Availability of Funds and Collection of Checks) regarding check endorsements. The endorsement shall read as follows:
“This payment is made with Federal funds. Fraud in procuring, forging of signature or endorsement, or materially altering this check is punishable under the US Criminal Code. IF PAYABLE TO A PARTICIPATING PROVIDER OF SERVICES - By endorsing this check, the undersigned payee agrees that he or she is subject to the terms of the participating agreement (assignment) as set forth in the TRICARE regulation.”
1.1.4  The following endorsement statement shall be printed using four- or five-point type in the 1.5 inches allotted on the reverse side of all checks funded by the contractor (i.e., underwritten health care or at-risk payments). This will comply with Federal Reserve Bank Regulation CC (Availability of Funds and Collection of Checks) regarding check endorsements. The endorsement shall read as follows:
“IF PAYABLE TO A PARTICIPATING PROVIDER OF SERVICES - By endorsing this check, the undersigned payee agrees that he or she is subject to the terms of the participating agreement (assignment) as set forth in the TRICARE regulation.”
1.1.5  A statement that the check must be negotiated within 120 calendar days.
1.2  The contractor shall mail underwritten health care checks prior to submission of the related TRICARE Encounter Data (TED) record to the Defense Health Agency (DHA).
1.3  The contractor shall release non-underwritten health care checks in accordance with Section G of the contract (Authority to Release Non-Underwritten Payments).
1.4  The contractor may pay rejected checks by Electronic Funds Transfer (EFT). If the EFT or check is returned as undeliverable and the contractor is unable to locate the payee, an adjustment or cancellation TED record shall be initiated in accordance with Chapter 3, Section 4.
2.0  EFT
(TRICARE Overseas Program (TOP)/foreign contractor, see Chapter 24, Section 3.)
The contractor shall, upon request by the provider or beneficiary, make EFT payments to a provider’s United States (US) bank account or the other US financial institution.
2.1  The contractor shall ensure EFTs for underwritten health care have been sent to the payee’s financial institution prior to submission of the related TED record to DHA.
2.2  The contractor shall release non-underwritten health care EFTs in accordance with Section G of the contract (Authority to Release Non-Underwritten Payments).
2.3  The contractor may pay rejected EFTs by check. If the EFT or check is returned as undeliverable and the contractor is unable to locate the payee, an adjustment or cancellation TED record shall be initiated in accordance with Chapter 3, Section 4.
3.0  INTEREST PAYMENTS (EXCLUDES TOP AND TRICARE Pharmacy (TPHARM))
3.1  The contractor shall, in accordance with 10 United States Code (USC) 1095c(a)(2), pay interest to providers or beneficiaries in accordance with the conditions detailed under paragraph 3.0 on all “clean claims” that have not been processed in a timely manner for both underwritten and non-underwritten payments.
Note:  The term “clean claim” means a claim that has no defect, impropriety (including a lack of any required substantiating documentation), or particular circumstance requiring special treatment external to the contractor’s prepayment operation that prevents timely payment on the claim under this section.
3.1.1  The contractor shall process all clean claims to completion not later than 30 calendar days after the date that such claims are received by the claims processor. Interest shall not be paid on:
•  Claims processed by the TOP contractor or the TPharm contractor.
•  Total interest due less than $1.00 shall not be paid.
•  Claims pended at Government direction that the Government has specifically directed the contractor to hold for an extended period of time.
•  Claims requiring Government intervention.
•  Claims requiring development for potential Third Party Liability (TPL).
•  Claims requiring an action/interface with another TRICARE Prime contractor (as defined at https://manuals.health.mil/pages/DownloadManualFile.ashx?Filename=Definitions.pdf).
•  Full denials.
•  Claims on which no payment is due.
•  Claims requiring external investigation or development.
•  Any claim pended for recoupment or future offset.
3.1.2  The contractor shall compute simple interest beginning with the 31st day following the date of claim receipt until paid. Simple interest shall be calculated during the month, at the end of each month the total interest due (if still unpaid) shall be added to the principle with simple interest calculated on the new principal amount.
3.1.3  The contractor shall use the interest rate based upon the Prompt Payment Act (PPA) (31 USC Chapter 39) Interest Rate in effect on the date payment is made. The current and prior PPA interest rates can be found at https://www.fiscal.treasury.gov/fsservices/gov/pmt/promptPayment/rates.htm.
3.1.4  The contractor shall include interest in the benefit check/EFT regardless of which bank account (contractor’s or Governments) is used to make payment.
3.1.4.1  The contractor shall pay interest to the nearest penny.
3.1.4.2  The contractor shall not pay interest in excess of one year.
3.1.4.3  The contractor shall pay interest to the recipient of the benefit check/EFT; however, if a payment is split as a result of a beneficiary overpaying a provider, the interest payment shall be made, in total, to the provider.
3.2  The contractor shall report interest penalty payments and reasons for interest penalty on their TED submission in a separate field as specified in the TRICARE Systems Manual (TSM), Chapter 2, Section 2.3.
3.2.1   The contractor shall not include the amount of the interest paid in the “Total Government Dollars Paid” field.
3.2.2  The contractor shall include interest paid in the “Total Amount Paid” as reported on the voucher header. The “Total Government Dollars Paid” plus “Interest Payment” shall equal the “Total Amount Paid” in the voucher header.
3.3  The contractor shall be fiscally responsible for all interest payments made under 10 USC 1095c(a)(2).
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