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Title 10 — Armed Forces

Part II · Chapter 55 — Medical and Dental Care

§ 1106. Submittal of claims: standard form; time limits

Statutory text

(a)

Standard Form.—

The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe by regulation a standard form for the submission of claims for the payment of health care services provided under this chapter.

(b)

Time for Submission.—

A claim for payment for services provided under this chapter shall be submitted as provided in such regulations as follows:

(1)

In the case of services provided outside the United States, the Commonwealth of Puerto Rico, or the possessions of the United States, by not later than three years after the services are provided.

(2)

In the case of any other services, by not later than one year after the services are provided.

Legislative history

Reconstructed from this section’s Code source credit and amendment notes, resolved against the local Statutes at Large. Editorial notes are evidence, not the law that made the change.

  1. National Defense Authorization Act for Fiscal Years 1992 and 1993

    Pub. L. 102–190 div. A title VII § 716(a)(1) · 105 Stat. 1290

    Enacted · 10 U.S.C. § 1106

    Added Pub. L. 102–190, div. A, title VII, § 716(a)(1), Dec. 5, 1991, 105 Stat. 1403

    Source evidence

    Code source credit
    Added Pub. L. 102–190, div. A, title VII, § 716(a)(1), Dec. 5, 1991, 105 Stat. 1403

    Enacted provision · exact public law section
    (1) Chapter 55 of title 10, United States Code, is amended by adding after section 1105, as added by section 715, the following new section: “§ 1106. Submittal of claims under CHAMPUS “(a) Submittal to Claims Processing Office.—Each provider of services under the Civilian Health and Medical Program of the Uniformed Services shall submit claims for payment for such services directly to the claims processing office designated pursuant to regulations prescribed under subsection (b). A claim for payment for services shall be submitted in a standard form (as prescribed in the regulations) not later than one year after the services are provided. “(b) Regulations.—The regulations required by subsection (a) shall be prescribed by the Secretary of Defense after consultation with the other administering Secretaries. “(c) Waiver.—The Secretary of Defense may waive the requirements of subsection (a) if the Secretary determines that the waiver is necessary in order to ensure adequate access for covered beneficiaries to health care services under this chapter.”.

  2. National Defense Authorization Act for Fiscal Year 1998

    Pub. L. 105–85 div. A title VII § 738(a) · 111 Stat. 1629

    1. Substituted · 10 U.S.C. § 1106

      Pub. L. 105–85 substituted “: standard form; time limits” for “under CHAMPUS” in section catchline

    2. Amended · 10 U.S.C. § 1106

      Pub. L. 105–85 amended text generally. Prior to amendment, text read as follows:

    Source evidence

    Code amendment note
    Pub. L. 105–85 substituted “: standard form; time limits” for “under CHAMPUS” in section catchline and amended text generally. Prior to amendment, text read as follows:

    “(a) Submittal to Claims Processing Office.—Each provider of services under the Civilian Health and Medical Program of the Uniformed Services shall submit claims for payment for such services directly to the claims processing office designated pursuant to regulations prescribed under subsection (b). A claim for payment for services shall be submitted in a standard form (as prescribed in the regulations) not later than one year after the services are provided. “(b) Regulations.—The regulations required by subsection (a) shall be prescribed by the Secretary of Defense after consultation with the other administering Secretaries. “(c) Waiver.—The Secretary of Defense may waive the requirements of subsection (a) if the Secretary determines that the waiver is necessary in order to ensure adequate access for covered beneficiaries to health care services under this chapter.”

    Enacted provision · exact public law section
    (a) Clarification of Existing Requirements.— Section 1106 of title 10, United States Code, is amended to read as follows: “§ 1106. Submittal of claims: standard form; time limits “(a) Standard Form.— The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe by regulation a standard form for the submission of claims for the payment of health care services provided under this chapter. “(b) Time for Submission.— A claim for payment for services provided under this chapter shall be submitted as provided in such regulations not later than one year after the services are provided.”.

  3. National Defense Authorization Act for Fiscal Year 2012

    Pub. L. 112–81 div. A title VII § 712 · 125 Stat. 1298

    1. Substituted · 10 U.S.C. § 1106(b)

      Pub. L. 112–81 substituted “as follows:” for “not later than one year after the services are provided.”

    2. Added · 10 U.S.C. § 1106(b)

      Pub. L. 112–81 added pars. (1) and (2)

    Source evidence

    Code amendment note
    Subsec. (b). Pub. L. 112–81 substituted “as follows:” for “not later than one year after the services are provided.” and added pars. (1) and (2).

    Enacted provision · exact public law section
    SEC. 712. EXTENSION OF TIME LIMIT FOR SUBMITTAL OF CLAIMS UNDER THE TRICARE PROGRAM FOR CARE PROVIDED OUTSIDE THE UNITED STATES.   Section 1106(b) of title 10, United States Code, is amended by striking “not later than” and all that follows and inserting the following: “as follows: “(1) In the case of services provided outside the United States, the Commonwealth of Puerto Rico, or the possessions of the United States, by not later than three years after the services are provided. “(2) In the case of any other services, by not later than one year after the services are provided.” .

5 of 5 references resolved to an enrolled provision

Editorial Notes

Amendments1997–2011 · 2 rounds

2011

Subsec. (b). Pub. L. 112–81 substituted “as follows:” for “not later than one year after the services are provided.” and added pars. (1) and (2).

1997

Pub. L. 105–85 substituted “: standard form; time limits” for “under CHAMPUS” in section catchline and amended text generally. Prior to amendment, text read as follows:

“(a) Submittal to Claims Processing Office.—Each provider of services under the Civilian Health and Medical Program of the Uniformed Services shall submit claims for payment for such services directly to the claims processing office designated pursuant to regulations prescribed under subsection (b). A claim for payment for services shall be submitted in a standard form (as prescribed in the regulations) not later than one year after the services are provided.

“(b) Regulations.—The regulations required by subsection (a) shall be prescribed by the Secretary of Defense after consultation with the other administering Secretaries.

“(c) Waiver.—The Secretary of Defense may waive the requirements of subsection (a) if the Secretary determines that the waiver is necessary in order to ensure adequate access for covered beneficiaries to health care services under this chapter.”

Statutory Notes and Related Subsidiaries

Regulations

Pub. L. 102–190, div. A, title VII, § 716(b), , 105 Stat. 1404, provided that: “The regulations required by section 1106 of title 10, United States Code (as added by subsection (a)), shall be prescribed to take effect not later than 180 days after the date of the enactment of this Act [].”

Establishment of Appeals Process for ClaimCheck Denials

Pub. L. 105–261, div. A, title VII, § 714, , 112 Stat. 2060, provided that:

“(a)

Establishment of Appeals Process.—

Not later than , the Secretary of Defense shall establish an appeals process in cases of denials through the ClaimCheck computer software system (or any other claims processing system that may be used by the Secretary) of claims by civilian providers for payment for health care services provided under the TRICARE program.

“(b)

Report.—

Not later than , the Secretary shall submit to Congress a report on the implementation of this section.”

National Claims Processing System for CHAMPUS

Pub. L. 102–484, div. A, title VII, § 711, , 106 Stat. 2433, provided that:

“(a)

Claims Processing System Required.—

(1)

The Secretary of Defense, in consultation with the other administering Secretaries, shall provide by contract for the operation of a claims processing system to be known as the ‘National Claims Processing System for CHAMPUS’. The Secretary may procure the system in installments, including the use of incremental modules. The system, including completion and integration of all modules, shall be in full operation not later than seven years after the date of the enactment of this Act [].

“(2)

The Secretary shall use competitive procedures for entering into any contract or contracts under paragraph (1).

“(b)

System Functions.—

The claims processing system shall include at least the following functions:

“(1)

The maintenance in electronic or written form, or both, of appropriate information on health care services provided to covered beneficiaries by or through third parties under CHAMPUS or any alternative CHAMPUS program or demonstration project. Such information shall include—

“(A)

the services to which such beneficiaries are entitled or eligible under an insurance plan, medical service plan, or health plan under CHAMPUS;

“(B)

the insurers, medical services, or health plans that provide such services; and

“(C)

the services available to beneficiaries under each insurance plan, medical service plan, or health plan, and the payment required of the beneficiaries and the insurer, medical service, or health plan for such services under the plan.

“(2)

The ability to receive in electronic or written form claims submitted by insurers, medical services, and health plans for services provided to covered beneficiaries.

“(3)

The ability to process, adjudicate, and pay (by electronic or other means) such claims.

“(4)

The provision of the information described in paragraphs (1) and (2) and information on the matters referred to in paragraph (3) by telephone, electronic, or other means to covered beneficiaries, insurers, medical services, and health plans.

“(c)

Consistency with Medicare Claims Requirements.—

The Secretary of Defense shall ensure, to the maximum extent practicable, that claims submitted to the claims processing system conform to the requirements applicable to claims submitted to the Secretary of Health and Human Services with respect to medical care provided under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.).

“(d)

Identification Card.—

The Secretary of Defense shall take appropriate actions to determine whether the use by covered beneficiaries of a standard identification card containing electronically readable information will enhance the capability of the claims processing center to carry out the activities set forth in subsection (b).

“(e)

Transition to System.—

After , any modification or acquisition related to claims processing systems operations in the Office of the Civilian Health and Medical Program of the Uniformed Services shall contain provisions to transfer such operations to the claims processing system required by subsection (a). After , any renewal or acquisition for fiscal intermediary services (including coordinated care implementations in military hospitals and clinics) shall contain provisions to transfer claims processing systems operations related to such fiscal intermediary services to the claims processing system required by subsection (a).

“(f)

Definitions.—

For purposes of this section:

“(1)

The term ‘administering Secretaries’ has the meaning given that term in paragraph (3) of section 1072 of title 10, United States Code.

“(2)

The term ‘CHAMPUS’ means the Civilian Health and Medical Program of the Uniformed Services, as defined in paragraph (4) of such section.

“(3)

The term ‘covered beneficiary’ has the meaning given that term in paragraph (5) of such section.”

Credits

1991–2011 · 3 acts
  1. 1991Added Pub. L. 102–190, div. A, title VII, § 716(a)(1), , 105 Stat. 1403
  2. 1997amended Pub. L. 105–85, div. A, title VII, § 738(a), , 111 Stat. 1815
  3. 2011Pub. L. 112–81, div. A, title VII, § 712, , 125 Stat. 1476.
Show as published

(Added Pub. L. 102–190, div. A, title VII, § 716(a)(1), , 105 Stat. 1403; amended Pub. L. 105–85, div. A, title VII, § 738(a), , 111 Stat. 1815; Pub. L. 112–81, div. A, title VII, § 712, , 125 Stat. 1476.)

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