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

are made to a foreign government for trauma-related care provided to individuals whose medical treatment is the
responsibility of the U.S. Army.
Chapter 14
Third Party Collection Program
14–1. Policy
a. The cost of medical services provided to DOD beneficiaries will be collected from third party payers to the fullest
extent allowed under 10 USC 1095 and according to DODI 6015.23.
b. Each MTF commander must designate an office responsible for TPCP implementation to include program
awareness, identifying and collecting insurance information, billing third party payers, collecting and depositing funds,
training, and reporting TPCP status.
c. Effective TPCP implementation necessitates the participation of many elements within the MTF including
physician and nursing staffs, admissions, medical records, utilization review, ancillary departments, management
information, legal, and fiscal offices.
d. The TPCP will, as a minimum, identify those Uniformed Services beneficiaries with third party payer plan
coverage, submit all claims to third party payers, ensure that collections are made, and document and report collection
activities.
e. The MTF commander will ensure compliance outlined for third party payers under 32 CFR 220 and DOD 6010.
15-M.
f. For inpatient hospital care, authority to collect applies to an insurance, medical service, or health plan agreement
entered into, amended, or renewed on or after April 7, 1986. For Medicare supplemental plans, automobile liability
(including uninsured/underinsured) and no-fault (for example, personal injury protection) insurance plans, outpatient
care and ambulatory surgical care, authority to collect also applies to an insurance, medical service, or health plan
agreement entered into, amended, or renewed on or after November 5, 1990. An amendment may include, but is not
limited to, premium rate changes, benefit changes, carrier changes, or conversions from insured plans to self-insured
plans or the reverse.
14–2. Health care plans not subject to the Third Party Collection Program
a. The TPCP will not file claims to Medicare, Medicaid, or TRICARE Programs. Additionally, it will not file claims
with supplemental insurance plans designed to cover the patient’s cost share of the TRICARE Program or to income
(or wage) supplemental plans.
b. The MTF will file claims to Medicare supplemental plans according to the current applicable CFR.
14–3. Medical services billed
MTFs are authorized to file health benefits claims only for the health care services authorized in the current CFR or
more recent Federal register.
14–4. Medical services not billed
Claims will not be filed for health care services for which rates have not yet been established by OASD(HA). MTFs
are not authorized to establish rates in the absence of DOD provided rates. Rates are also published annually in the
Federal register.
14–5. Identification of beneficiaries who have other health insurance
a. Timely and accurate identification of beneficiaries who have other health insurance is crucial to a successful
TPCP.
b. Each MTF commander will ensure that beneficiaries who have other health insurance are informed of legislative
requirements and benefits of the TPCP, types of insurance plans subject to collection, and the patient’s responsibility,
as applicable.
c. Pre-admission, admission, and outpatient staff will—
(1) Ascertain Medicare enrollment status for all patients age 65 and older including Medicare Part A (hospitalization,
skilled nursing care, and home health care) and Medicare Part B (ancillary and professional services) enrollment.
(2) Ascertain Medicare enrollment status for all patients under age 65 entitled to Medicare on the basis of disability
or end-stage renal disease (that is, kidney failure).
(3) Obtain a completed, signed DD Form 2569 at the time of preadmission, admission, or outpatient visit/encounter.
In addition, TPCP pre-certification or other TPCP staff must check the DD Form 2569 and complete any missing fields
(for example, patient insurance/employer information) prior to patient discharge or release. The MTF must obtain a
yearly, updated, signed DD Form 2569 for every patient.
86 AR 40–400 27 January 2010