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TRICARE Policy Manual 6010.60-M, April 1, 2015
Extended Care Health Option (ECHO)
Chapter 9
Section 4.1
Benefit Authorization
Issue Date:  July 3, 1997
Authority:  32 CFR 199.5(h)(3)
Revision:  
1.0  POLICY
1.1  Except as provided in paragraph 1.2, the contractor will provide the required authorization for requested services and items under the Extended Care Health Option (ECHO).
1.2  In the case of beneficiaries residing outside the 50 United States (U.S.) and the District of Columbia, the TRICARE Overseas Program (TOP) contractor is responsible for authorizing ECHO benefits. The TOP contractor shall notify the appropriate TRICARE Area Office (TAO) Director of all ECHO benefit authorizations or authorization waivers.
1.3  The authorization is based upon the following:
1.3.1  The beneficiary is registered in the ECHO; and
1.3.2  The requested service or item is allowable as a ECHO benefit; and
1.3.3  The requested service or item meets the public facility use requirements when applicable.
1.4  The authorization shall specify the services by type, scope, frequency, duration, dates, amounts, requirements, limitations, provider name and address, and all other information necessary to provide exact identification of approved benefits. Claims can not be adjudicated without this information.
1.5  The authorization shall remain in effect until such time as the contractor or TOP contractor determines that:
1.5.1  The beneficiary is no longer eligible for the ECHO; or
1.5.2  The authorized ECHO service or item is no longer appropriate or required by the beneficiary; or
1.5.3  The authorized ECHO service or item becomes a benefit through the TRICARE Basic Program.
1.6  The contractor or TOP contractor may waive the required written authorization for rendered services and items that, except for the absence of the written authorization, would be allowable as an ECHO benefit.
1.7  The contractor or TOP contractor may waive the required public facility use certification when such waiver is appropriate. See Section 5.1.
2.0  EFFECTIVE DATE
September 1, 2005.
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