
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 10USC1106]

 
                         TITLE 10--ARMED FORCES
 
                    Subtitle A--General Military Law
 
                           PART II--PERSONNEL
 
                   CHAPTER 55--MEDICAL AND DENTAL CARE
 
Sec. 1106. Submittal of claims: standard form; time limits

    (a) Standard Form.--The Secretary of Defense, after consultation 
with the other administering Secretaries, shall prescribe by regulation 
a standard form for the submission of claims for the payment of health 
care services provided under this chapter.
    (b) Time for Submission.--A claim for payment for services provided 
under this chapter shall be submitted as provided in such regulations 
not later than one year after the services are provided.

(Added Pub. L. 102-190, div. A, title VII, Sec. 716(a)(1), Dec. 5, 1991, 
105 Stat. 1403; amended Pub. L. 105-85, div. A, title VII, Sec. 738(a), 
Nov. 18, 1997, 111 Stat. 1815.)


                               Amendments

    1997--Pub. L. 105-85 substituted ``: standard form; time limits'' 
for ``under CHAMPUS'' in section catchline and amended text generally. 
Prior to amendment, text read as follows:
    ``(a) Submittal to Claims Processing Office.--Each provider of 
services under the Civilian Health and Medical Program of the Uniformed 
Services shall submit claims for payment for such services directly to 
the claims processing office designated pursuant to regulations 
prescribed under subsection (b). A claim for payment for services shall 
be submitted in a standard form (as prescribed in the regulations) not 
later than one year after the services are provided.
    ``(b) Regulations.--The regulations required by subsection (a) shall 
be prescribed by the Secretary of Defense after consultation with the 
other administering Secretaries.
    ``(c) Waiver.--The Secretary of Defense may waive the requirements 
of subsection (a) if the Secretary determines that the waiver is 
necessary in order to ensure adequate access for covered beneficiaries 
to health care services under this chapter.''


                               Regulations

    Section 716(b) of Pub. L. 102-190 provided that: ``The regulations 
required by section 1106 of title 10, United States Code (as added by 
subsection (a)), shall be prescribed to take effect not later than 180 
days after the date of the enactment of this Act [Dec. 5, 1991].''


         Establishment of Appeals Process for ClaimCheck Denials

    Pub. L. 105-261, div. A, title VII, Sec. 714, Oct. 17, 1998, 112 
Stat. 2060, provided that:
    ``(a) Establishment of Appeals Process.--Not later than January 1, 
1999, the Secretary of Defense shall establish an appeals process in 
cases of denials through the ClaimCheck computer software system (or any 
other claims processing system that may be used by the Secretary) of 
claims by civilian providers for payment for health care services 
provided under the TRICARE program.
    ``(b) Report.--Not later than March 1, 1999, the Secretary shall 
submit to Congress a report on the implementation of this section.''


              National Claims Processing System for CHAMPUS

    Pub. L. 102-484, div. A, title VII, Sec. 711, Oct. 23, 1992, 106 
Stat. 2433, provided that:
    ``(a) Claims Processing System Required.--(1) The Secretary of 
Defense, in consultation with the other administering Secretaries, shall 
provide by contract for the operation of a claims processing system to 
be known as the `National Claims Processing System for CHAMPUS'. The 
Secretary may procure the system in installments, including the use of 
incremental modules. The system, including completion and integration of 
all modules, shall be in full operation not later than seven years after 
the date of the enactment of this Act [Oct. 23, 1992].
    ``(2) The Secretary shall use competitive procedures for entering 
into any contract or contracts under paragraph (1).
    ``(b) System Functions.--The claims processing system shall include 
at least the following functions:
        ``(1) The maintenance in electronic or written form, or both, of 
    appropriate information on health care services provided to covered 
    beneficiaries by or through third parties under CHAMPUS or any 
    alternative CHAMPUS program or demonstration project. Such 
    information shall include--
            ``(A) the services to which such beneficiaries are entitled 
        or eligible under an insurance plan, medical service plan, or 
        health plan under CHAMPUS;
            ``(B) the insurers, medical services, or health plans that 
        provide such services; and
            ``(C) the services available to beneficiaries under each 
        insurance plan, medical service plan, or health plan, and the 
        payment required of the beneficiaries and the insurer, medical 
        service, or health plan for such services under the plan.
        ``(2) The ability to receive in electronic or written form 
    claims submitted by insurers, medical services, and health plans for 
    services provided to covered beneficiaries.
        ``(3) The ability to process, adjudicate, and pay (by electronic 
    or other means) such claims.
        ``(4) The provision of the information described in paragraphs 
    (1) and (2) and information on the matters referred to in paragraph 
    (3) by telephone, electronic, or other means to covered 
    beneficiaries, insurers, medical services, and health plans.
    ``(c) Consistency with Medicare Claims Requirements.--The Secretary 
of Defense shall ensure, to the maximum extent practicable, that claims 
submitted to the claims processing system conform to the requirements 
applicable to claims submitted to the Secretary of Health and Human 
Services with respect to medical care provided under part A of title 
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.).
    ``(d) Identification Card.--The Secretary of Defense shall take 
appropriate actions to determine whether the use by covered 
beneficiaries of a standard identification card containing 
electronically readable information will enhance the capability of the 
claims processing center to carry out the activities set forth in 
subsection (b).
    ``(e) Transition to System.--After January 1, 1996, any modification 
or acquisition related to claims processing systems operations in the 
Office of the Civilian Health and Medical Program of the Uniformed 
Services shall contain provisions to transfer such operations to the 
claims processing system required by subsection (a). After January 1, 
1999, any renewal or acquisition for fiscal intermediary services 
(including coordinated care implementations in military hospitals and 
clinics) shall contain provisions to transfer claims processing systems 
operations related to such fiscal intermediary services to the claims 
processing system required by subsection (a).
    ``(f) Definitions.--For purposes of this section:
        ``(1) The term `administering Secretaries' has the meaning given 
    that term in paragraph (3) of section 1072 of title 10, United 
    States Code.
        ``(2) The term `CHAMPUS' means the Civilian Health and Medical 
    Program of the Uniformed Services, as defined in paragraph (4) of 
    such section.
        ``(3) The term `covered beneficiary' has the meaning given that 
    term in paragraph (5) of such section.''
