Attachment J-4 TMEP 2 Chapter 20 Clean Draft Copy

SECTION J – Attachment J-4
TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Medicare Eligible Program (TMEP)

Chapter 20
Index
TRICARE Medicare Eligible Program (TMEP)
Section/Addendum Subject/Addendum Title

Administration

TRICARE Medicare Eligible Program (TMEP) Transition

Financial Administration

Provider Certifications And Credentialing

Provider Networks

Enrollment

Clinical Operations

Claims Processing Procedures

Records Management (RM)

Claims Adjustments and Recoupments

Communications and Customer Service (C and CS)

Appeals And Hearings

Program Integrity

Reporting Requirements

TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Medicare Eligible Program (TMEP)

Chapter 20
Index
Section/Addendum Subject/Addendum Title

Market Directors/Military Medical Treatment Facilities (MTF) Directors and Contractor Interfaces

TRICARE Prime Remote (TPR) Program

Supplemental Health Care Program (SHCP)

Demonstrations, Pilot Projects, and Value-Based Initiatives

Health Insurance Portability and Accountability Act (HIPAA) of 1996

Other TMEP Requirements

TRICARE Alaska

Reserve Component (RC) Health Coverage Plans

TRICARE Pharmacy (TPharm)

TRICARE Overseas Program (TOP)

TRICARE Young Adult (TYA)

Continued Health Care Benefits Program (CHCBP)

Telehealth

Prescription Monitoring Program (PMP)

A

TRICARE Medicare Eligible Program – TRICARE Operations Manual Exclusion List

TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Medicare Eligible Program (TMEP)
Chapter 20

Section 1

Administration

In addition to the requirements below, all TRICARE requirements noted in Chapter 1 regarding administration shall apply to TMEP unless specifically changed, waived, or superseded by this section.
1.0 The information at Chapter 1, Section 1 is relevant to TMEP.

2.0 CONTRACT ADMINISTRATION AND INSTRUCTIONS

2.1 The contractor shall comply with the requirements in Chapter 1, Section 2. 2.2 The contractor shall submit a quarterly report outlining modifications and implementation dates in addition to the requirements in Chapter 1, Section 2, paragraph 2.0, in accordance with DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the contract.

3.0 TRICARE PROCESSING STANDARDS

3.1 The contractor shall comply with the requirements in Chapter 1, Section 3, except for those paragraphs listed in Addendum A.
3.2 The contractor shall track and report preauthorizations for Skilled Nursing Facilities (SNFs) separate from other preauthorizations noted in Chapter 7, Section 4 and TPM, Chapter 1, Section