View Full Version : Tri-Care for Active Duty members Change

02-12-2009, 13:32
Just passing along some general Tri-Care Info that may be helpful

To all:

This is a notice to alert all key VA / VHA staff that DoD / TMA has issued a new Policy regarding TRICARE authorizations for Active Duty Service Members (ADSMs) on Terminal Leave seeking care at VA Medical Centers (VAMCs). Many of you may be on several of the mailgroups listed above - my apologies if you receive multiple copies of this message.

The Department of Defense (DoD) TRICARE Management Activity (TMA) has issued a new policy regarding TRICARE preauthorization for Active Duty Service Members (ADSM) on terminal leave status who seek routine and urgent outpatient care at VA Medical Center (VAMC).

According to the policy, Uniformed Services will advise ADSMs who are enrolled in TRICARE Prime at a Military Treatment Facility (MTF) and are transitioning to terminal leave status how they should access health care services until their separation or retirement date. If the ADSM intends to reside outside of the Prime Service Area (PSA) of the MTF while on terminal leave, the MTF will issue the TRICARE Managed Care Support Contractor (MCSC) a single preauthorization for the ADSM to obtain any necessary routine or urgent outpatient medical care from VA while on terminal leave. This preauthorization is to be sent to the MCSC before the ADSM departs his or her final duty station to commence terminal leave. The preauthorization only applies to medical care received at VAMCs. Any non-emergent care the ADSM requires from the private sector will need a separate preauthorization.

VAMC staff will ensure each ADSM provides a Social Security Number (SSN) and DoD photo identification at registration. VA staff must make a copy of the military identification card and place it in the administrative folder (see VA TRICARE Procedure Guide found on the CBO web page http://vaww1.va.gov/cbo/rcbilling/tricare.asp).

The FIRST time that an ADSM presents to a VAMC for ROUTINE health care services, VAMC staff will check the MCSC’s site to check the status of the authorization for care or call the MCSC to verify that an authorization has been entered into the MCSC’s computer system and to determine the end date of the authorization, or to request an authorization for services. Once this authorization has been provided to VA, then VAMCs may provide care and services, and bill the appropriate TRICARE MCSC for routine outpatient care provided to these ADSMs up until the end date of the authorization.

If an ADSM presents for EMERGENT care, it is VA’s policy not to require VA medical facilities to obtain authorizations prior to providing the needed care, however, VA medical centers should contact the TRICARE MCSC for an authorization for treatment as soon as possible after the care is provided.

Inpatient care for ADSMs on terminal leave status is not included in the authorization provided by the MCSC. As such, any care that a VAMC deems clinically necessary, for any ADSM on an inpatient basis, must be authorized, prior to admission, by the MTF or MCSC in accordance with current VA policy. The exception would be if the admission is required due to an emergent situation. The MCSC must be notified with 24 hours of the admission.

Points of contacts are; Ms. Kendra Drew, Director, Medical Sharing Office (202) 461-6632 or Ms. Felicia A. Lecce, Lead Program Specialist/ HSS, Chief Business Office (202) 461-1588.
Note: Electronic Claims Processing. Claims are to be transmitted to the appropriate TRICARE fiscal intermediary (FI) for processing utilizing the Electronic Data Interchange (EDI). An electronic copy of VA’s “TRICARE and VA Training Guide”, which standardizes administrative and billing processes, can be downloaded from the Veterans Health Information and Technology Architecture (VistA) University web page at: http://vaww.vistau.med.va.gov/vistau/tricare and from the VHA CBO Webpage at: http://vaww1.va.gov/cbo/rcbilling/tricare.asp.

Guidance for specific TRICARE billing has been developed jointly by the Chief Business Office (CBO) (16), and the VA-DoD Liaison and Sharing Office (10D2). This guidance can be found within the VA TRICARE Guide at: http://vaww1.va.gov/cbo/rcbilling/tricare.asp.

TRICARE billing guidance may be found at: http://www.tricare.osd.mil/claims.
VA TRICARE billing guidance can be found at: http://vaww.vistau.med.va.gov/vistau/tricare, and on the VHA CBO Webpage at: http://vaww1.va.gov/cbo/rcbilling/tricare.asp.

(1) VHA Directive 2005-045 Treatment Of Active Duty Service Members In VA Health Care Facilities, dated 10/4/2005
(2) Handbook 1660.06 VA-TRICARE Network Agreements, dated 5/16/2008

02-12-2009, 16:17
What the HELL does all that mean exactly?:confused: