PROVIDERS

TRICARE authorizes TRICARE Prime contractors to reimburse hospitals for allowed capital and direct medical education costs. Reimbursement is subject to the following regulations as outlined in the TRICARE Policy Manual.

1. Any hospital subject to the TRICARE DRG-based payment system that wants to be reimbursed for allowed capital and direct medical education costs must submit a request for reimbursement to the TRICARE contractor.

2. The hospital must submit its initial request on or before the last day of the 12th month following the close of the hospital's cost-reporting period. The request must correspond to the hospital's Medicare cost-reporting period (dates and costs). The hospital must submit its Reimbursement of Capital and Direct Medical Education Costs and applicable pages from its Medicare Cost Reports to the TRICARE contractor. Hospitals that are not Medicare participating providers are to use the October 1 through September 30 fiscal year for reporting capital and DME Costs.

3. After a Medicare desk review, audit or appeal, a hospital may find it needs to amend its initial request. All amended requests must be submitted to the TRICARE/CHAMPUS Contractor within 30 days of the date the hospital is notified of the change. A copy of the Notice of Program Report (NPR) and the applicable pages from the amended Medicare Cost Report should be included. Failure to promptly report changes resulting from a Medicare desk review, audit or appeal is considered a misrepresentation of the cost report information. Such a practice can be considered fraudulent, and may result in criminal and civil penalties or administrative sanctions of suspension or exclusion as an authorized provider.

Properly completed requests will be processed within 30 days – 45 days, based upon the information submitted on the Reimbursement of Capital and Direct Medical Education Costs. The request must include the applicable pages from the Medicare Cost Report. The request must also include an original signature of a hospital official, certifying that the information is accurate and based upon the Medicare Cost Report. Copied signatures will not be accepted.

If you have questions or if you need to change your facility name or address, please contact:

Humana Military Healthcare Services

Attn: Claims Oversight Department

500 W Main Street

Louisville, KY 40202

Point of Contact: Vicki Shipp

Phone: (502)-301-6420

Fax: (502) 508-9708

Email: HMHSCapitalDirectMedED@Humana.com