Patient Administration - Army Publishing Directorate - U.S. Army

Chapter 1
Introduction
1–1. Purpose
This regulation assigns responsibilities and provides guidance on patient administration in Army regional medical
commands (RMCs) and military treatment facilities (MTFs).
1–2. References
Required and related publications and prescribed and referenced forms are listed in appendix A.
1–3. Explanation of abbreviations and terms
Abbreviations and terms used in this regulation are explained in the glossary.
1–4. Responsibilities
a. The Surgeon General (TSG) develops policies governing the provision of patient administrative services for U.S.
Army MTFs worldwide.
b. Major overseas commanders and commanders of U.S. Army Medical Commands are responsible for the administration
of patients receiving care in MTFs under their jurisdiction.
c. The RMC and MTF commanders are responsible for the administration of patients receiving care under their
jurisdiction.
d. Patient administrators provide guidance on policies, procedures, and practices prescribed in this regulation.
Chapter 2
Patient Policies
2–1. Eligibility verification
The Military Installation Identification Card Issuance Activity establishes an individual’s eligibility for medical care.
The commander of an Army MTF will confirm the patient’s identity and verify entitlement through the Defense
Enrollment Eligibility Reporting System (DEERS) or identification (ID) card verification. Eligibility issues will be
referred to the patient administrator.
2–2. Identification procedures
a. All persons, including Soldiers in uniform, must show satisfactory evidence of their beneficiary status. A valid ID
card and enrollment in DEERS will establish beneficiary status. Children under age 10 must be enrolled in DEERS, but
are not routinely issued an ID card. Secretary of the Army designees are issued a letter from the U.S. Army Medical
Command (USAMEDCOM) or the MTF commander where designee status has been delegated, (see para 3-50) which
establishes their beneficiary status. They are not enrolled in DEERS and will not have an ID card. Discharged female
members who require maternity care establish beneficiary status with a copy of their DD Form 214 (Certificate of
Release or Discharge from Active Duty).
b. The AR 600–8–14 describes the types of Uniformed Services ID cards.
c. The MTF personnel will not provide routine care to patients with questionable eligibility. When proper identification
is not available and no emergency exists, a statement of eligibility should be initiated by the MTF personnel and
signed by the sponsor prior to delivery of care. The statement of eligibility will be forwarded to the MTF medical
services accountable officer (MSAO). If proof of eligibility is not provided within 30 days, the patient will be billed as
an emergency nonbeneficiary. In an emergency, medical care will be rendered before eligibility determination.
Ineligible patients will be treated only during the period of the emergency. (See para 3-55.)
2–3. Priorities
When an MTF commander must refer care to eligible beneficiaries because of a temporary lack of access, a priority
system will be used as specified in a through c below. The MTF commander must coordinate care for all beneficiaries
based upon access and capabilities. Beneficiaries enrolled in the TRICARE Prime option at an MTF are provided
space-required care and not space-available care in compliance with the TRICARE access standards. Beneficiaries
participating in the TRICARE Standard and Extra options are provided space-available care in MTFs. The medical or
dental Army MTF commander will have final authority regarding whether or not a beneficiary will be seen in the
facility. A nonavailability statement for authorized nonemergency inpatient care is required for non-enrolled Civilian
Health and Medical Program of the Uniformed Services (CHAMPUS) beneficiaries. The first level of appeal for
decisions surrounding nonavailability statement issuance is the MTF commander, the second level appeal is the RMC
commander, and the third and final level of appeal is the USAMEDCOM (MCHO-CL-M).
AR 40–400 27 January 2010
1