
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document affected by Public Law 107-107 Section 708(b)]
[CITE: 10USC1095c]

 
                         TITLE 10--ARMED FORCES
 
                    Subtitle A--General Military Law
 
                           PART II--PERSONNEL
 
                   CHAPTER 55--MEDICAL AND DENTAL CARE
 
Sec. 1095c. TRICARE program: facilitation of processing of 
        claims
        
    (a) Reduction of Processing Time.--(1) With respect to claims for 
payment for medical care provided under the TRICARE program, the 
Secretary of Defense shall implement a system for processing of claims 
under which--
        (A) 95 percent of all clean claims must be processed not later 
    than 30 days after the date that such claims are submitted to the 
    claims processor; and
        (B) 100 percent of all clean claims must be processed not later 
    than 100 days after the date that such claims are submitted to the 
    claims processor.

    (2) The Secretary may, under the system required by paragraph (1) 
and consistent with the provisions in chapter 39 of title 31 (commonly 
referred to as the ``Prompt Payment Act''), require that interest be 
paid on clean claims that are not processed within 30 days.
    (3) For purposes of this subsection, the term ``clean claim'' means 
a claim that has no defect, impropriety (including a lack of any 
required substantiating documentation), or particular circumstance 
requiring special treatment that prevents timely payment on the claim 
under this section.
    (b) Requirement to Provide Start-Up Time For Certain Contractors.--
(1) The Secretary of Defense shall not require that a contractor 
described in paragraph (2) begin to provide managed care support 
pursuant to a contract to provide such support under the TRICARE program 
until at least nine months after the date of the award of the contract. 
In such case the contractor may begin to provide managed care support 
pursuant to the contract as soon as practicable after the award of the 
contract, but in no case later than one year after the date of such 
award.
    (2) A contractor under this paragraph is a contractor who is awarded 
a contract to provide managed care support under the TRICARE program--
        (A) who has not previously been awarded such a contract by the 
    Department of Defense; or
        (B) who has previously been awarded such a contract by the 
    Department of Defense but for whom the subcontractors have not 
    previously been awarded the subcontracts for such a contract.

    (c) Incentives for Electronic Processing.--The Secretary of Defense 
shall require that new contracts for managed care support under the 
TRICARE program provide that the contractor be permitted to provide 
financial incentives to health care providers who file claims for 
payment electronically.

(Added Pub. L. 106-65, div. A, title VII, Sec. 713(a)(1), Oct. 5, 1999, 
113 Stat. 688.)


                             Effective Date

    Pub. L. 106-65, div. A, title VII, Sec. 713(d), Oct. 5, 1999, 113 
Stat. 689, provided that: ``Section 1095c(b) of title 10, United States 
Code (as added by subsection (a)), shall apply with respect to any 
contract to provide managed care support under the TRICARE program 
negotiated after the date of the enactment of this Act [Oct. 5, 1999].''


                     Claims Processing Improvements

    Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 727], Oct. 30, 
2000, 114 Stat. 1654, 1654A-188, provided that: ``Beginning on the date 
of the enactment of this Act [Oct. 30, 2000], the Secretary of Defense 
shall, to the maximum extent practicable, take all necessary actions to 
implement the following improvements with respect to processing of 
claims under the TRICARE program:
        ``(1) Use of the TRICARE encounter data information system 
    rather than the health care service record in maintaining 
    information on covered beneficiaries under chapter 55 of title 10, 
    United States Code.
        ``(2) Elimination of all delays in payment of claims to health 
    care providers that may result from the development of the health 
    care service record or TRICARE encounter data information.
        ``(3) Requiring all health care providers under the TRICARE 
    program that the Secretary determines are high-volume providers to 
    submit claims electronically.
        ``(4) Processing 50 percent of all claims by health care 
    providers and institutions under the TRICARE program by electronic 
    means.
        ``(5) Authorizing managed care support contractors under the 
    TRICARE program to require providers to access information on the 
    status of claims through the use of telephone automated voice 
    response units.''


                       Deadline for Implementation

    Pub. L. 106-65, div. A, title VII, Sec. 713(c), Oct. 5, 1999, 113 
Stat. 689, provided that: ``The system for processing claims required 
under section 1095c(a) of title 10, United States Code (as added by 
subsection (a)), shall be implemented not later than 6 months after the 
date of the enactment of this Act [Oct. 5, 1999].''
