The Military Health System (MHS) oversees and provides quality medical care for the uniformed services, military retirees and eligible beneficiaries.
Through the various cost recovery programs, Third Party Collection Program (TPCP), Medical Services Accounts (MSA), and Medical Affirmative Claims (MAC), the Department of Defense (DoD) is entitled to recover the cost of care provided to patients from health insurance carriers, other government agencies, and individual patients.
The TRICARE Management Activity (TMA) Uniform Business Office (UBO) supports compliant billing operations through policy analysis; standard business processes; rate development; education and training; and management of the various rate packages: outpatient, inpatient, elective cosmetic surgery and pharmacy.
Outpatient Itemized Billing (OIB) rates are used to determine charges for medical and dental services provided on an outpatient basis in the Military Treatment Facilities (MTFs). These rates are used to submit claims for reimbursement for the cost of services provided.
The TRICARE reimbursement methodology is primary, but other options are considered as necessary. Rates for inpatient professional and institutional services, Adjusted Standardized Amounts (ASAs), are the basis for reimbursement for all inpatient medical care provided. These rates apply to reimbursement from all sources, not just third party payers.
Elective cosmetic procedures are not TRICARE covered benefits. Elective procedures provided in MTFs are restricted to TRICARE-eligible beneficiaries on a “space-available” basis. Patients receiving elective cosmetic procedures are responsible for charges for all services associated with the procedure(s).