General
Chapter 1
Section 19
Charges For Provider Administrative
Expenses
Issue Date: August 26, 1985
Revision:
1.0 APPLICABILITY
The policy is mandatory for reimbursement of
services provided by either network or non-network providers. However,
alternative network reimbursement methodologies are permitted when approved
by the Defense Health Agency (DHA) and specifically included in
the network provider agreement.
2.0 ISSUE
Can penalty charges for providers’ administrative
expenses be allowed?
3.0 POLICY
Providers may incur administrative expenses
during the course of doing business. Most of these expenses are
normal and payment for them is included in the payments made for
the medical services rendered by the provider. Others are not covered
because they are not medical services related to the treatment of
an illness or injury. In either case, separate charges for administrative
expenses are not allowed. Such expenses include:
3.1 Penalty
or interest charges imposed on a beneficiary by a provider because
of failure to make timely payment on a bill are not covered.
3.2 Provider
administrative expenses such as charges for claims completion, furnishing
medical records, etc., are not separately allowable.
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