PRIA, Government Policy, Made Personal

Summary

The Secretary of Defense can allow a TRICARE contractor to pay a provider’s bill for a covered beneficiary before the contractor tries to recoup the cost from another insurer. That applies when a provider files a claim for services and the contractor thinks a third party might be responsible. The United States has the same right to collect those costs as it does for claims under section 1095. “Third-party payer” means what section 1095(h) defines, but it excludes primary medical insurers.

Title 10, §1095b

Armed Forces, Source: USLM XML via OLRC

(a)Payment of Claims.—

(1)The Secretary of Defense may authorize a contractor under the TRICARE program to pay a claim described in paragraph (2) before seeking to recover from a third-party payer the costs incurred by the contractor to provide health care services that are the basis of the claim to a beneficiary under such program.

(2)A claim under this paragraph is a claim—

(A)that is submitted to the contractor by a provider under the TRICARE program for payment for services for health care provided to a covered beneficiary; and

(B)that is identified by the contractor as a claim for which a third-party payer may be liable.

(b)Recovery From Third-Party Payers.—

The United States shall have the same right to collect charges related to claims described in subsection (a) as charges for claims under section 1095 of this title.

(c)Definition of Third-Party Payer.—

In this section, the term “third-party payer” has the meaning given that term in section 1095(h) of this title, except that such term excludes primary medical insurers.

Notes & Related Subsidiaries

Editorial Notes

Amendments

1999—Subsec. (b). Pub. L. 106–65 substituted “The United States shall have the same right to collect charges related to claims described in subsection (a) as charges for claims under section 1095 of this title.” for “A contractor for the provision of health care services under the TRICARE program that pays a claim described in subsection (a)(2) shall have the right to collect from the third-party payer the costs incurred by such contractor on behalf of the covered beneficiary. The contractor shall have the same right to collect such costs under this subsection as the right of the United States to collect costs under section 1095 of this title.”

§1095b Tricare Program: Contractor Payment of Certain Claims

Summary

Title 10, §1095b

Notes & Related Subsidiaries

Editorial Notes

Amendments

Citations & Metadata