10 U.S.C. § 1106: Submittal of claims: standard form; time limits

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. In the case of services provided outside the United States, the Commonwealth of Puerto Rico, or the possessions of the United States, by not later than three years after the services are provided. In the case of any other services, by not later than one year after the services are provided. 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. Not later than March 1, 1999 , the Secretary shall submit to Congress a report on the implementation of this section.” 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 ]. The Secretary shall use competitive procedures for entering into any contract or contracts under paragraph (1). the services to which such beneficiaries are entitled or eligible under an insurance plan, medical service plan, or health plan under CHAMPUS; the insurers, medical services, or health plans that provide such services; and 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. The ability to receive in electronic or written form claims submitted by insurers, medical services, and health plans for services provided to covered beneficiaries. The ability to process, adjudicate, and pay (by electronic or other means) such claims. 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. 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.). 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). 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). The term ‘administering Secretaries’ has the meaning given that term in paragraph (3) of section 1072 of title 10 , United States Code. The term ‘CHAMPUS’ means the Civilian Health and Medical Program of the Uniformed Services, as defined in paragraph (4) of such section. The term ‘covered beneficiary’ has the meaning given that term in paragraph (5) of such section.”