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10 U.S.C. § 1095b — TRICARE program: contractor payment of certain claims

Federal law — U.S. Code and appendices · legal_authorities

10 U.S.C. § 1095b — TRICARE program: contractor payment of certain claims

**(a) Payment of Claims.—** (1) The Secretary of Defense may authorize a contractor under the TRICARE program to pay a claim described in paragraph (2) before seeking to recover from a third-party payer the costs incurred by the contractor to provide health care services that are the basis of the claim to a beneficiary under such program. (2) A claim under this paragraph is a claim— (A) that is submitted to the contractor by a provider under the TRICARE program for payment for services for health care provided to a covered beneficiary; and (B) that is identified by the contractor as a claim for which a third-party payer may be liable. **(b) Recovery From Third-Party Payers.—** The United States shall have the same right to collect charges related to claims described in subsection (a) as charges for claims under [section 1095 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1095&num=0&edition=prelim). **(c) Definition of Third-Party Payer.—** In this section, the term “third-party payer” has the meaning given that term in [section 1095(h) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1095/h&num=0&edition=prelim), except that such term excludes primary medical insurers.

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Source file: Laws/federal/codes/united-states-code/title-10/section-1095b-tricare-program-contractor-payment-of-certain-claims--4e679c2a20.md
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Source location: Title 10, Chapter 55, § 1095b; chapter-055-medical-and-dental-care.md

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Federal law — U.S. Code and appendices · legal_authorities

10 U.S.C. § 1095 — Health care services incurred on behalf of covered beneficiaries: collection from third-party payers

**(a)** (1) In the case of a person who is a covered beneficiary, the United States shall have the right to collect from a third-party payer reasonable charges for health care services incurred by the United States on behalf of such person through a facility of the uniformed services to the extent that the person would be eligible to receive reimbursement or indemnification from the third-party payer if the person were to incur such charges on the person’s own behalf. If the insurance, medical service, or health plan of that payer includes a requirement for a deductible or copayment by the beneficiary of the plan, then the amount that the United States may collect from the third-party payer is a reasonable charge for the care provided less the appropriate deductible or copayment amount. (2) A covered beneficiary may not be required to pay an additional amount to the United States for health care services by reason of this section. **(b)** No provision of any insurance, medical service, or health plan contract or agreement having the effect of excluding from coverage or limiting payment of charges for certain care shall operate to prevent collection by the United States under subsection (a) if that care is provided— (1) through a facility of the uniformed services; (2) directly or indirectly by a governmental entity; (3) to an individual who has no obligation to pay for that care or for whom no other person has a legal obligation to pay; or (4) by a provider with which the third party payer has no participation agreement. **(c)** Under regulations prescribed under subsection (f), records of the facility of the uniformed services that provided health care services to a beneficiary of an insurance, medical service, or health plan of a third-party payer shall be mad

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Federal law — U.S. Code and appendices · legal_authorities

10 U.S.C. § 1095b — TRICARE program: contractor payment

Page 1144 TITLE 10—ARMED FORCES § 1095a by subsection (a) [amending this section] shall apply with respect to health care services provided in a med- ical facility of the uniformed services after the date of the enactment of this Act [Nov. 5, 1990], but not with respect to collection under any insurance, medical service, or health plan agreement entered into before the date of the enactment of this Act that the Sec- retary of Defense determines clearly excludes payment for such services. Such an exception shall apply until the amendment or renewal of such agreement after that date.’’ EFFECTIVE DATE OF 1989 AMENDMENT Pub. L. 101–189, div. A, title VII, § 727(b), Nov. 29, 1989, 103 Stat. 1480, provided that: ‘‘The amendment made by this section [amending this section] shall take effect on October 1, 1989, and shall apply to amounts collected under section 1095 of title 10, United States Code, on or after that date.’’ EFFECTIVE DATE Pub. L. 99–272, title II, § 2001(b), Apr. 7, 1986, 100 Stat. 101, provided that: ‘‘Section 1095 of title 10, United States Code, as added by subsection (a), shall apply with respect to inpatient hospital care provided after September 30, 1986, but only with respect to an insur- ance, medical service, or health plan agreement en- tered into, amended, or renewed on or after the date of the enactment of this Act [Apr. 7, 1986].’’ PILOT PROGRAM ON INCREASED THIRD-PARTY COLLEC- TION REIMBURSEMENTS IN MILITARY MEDICAL TREAT- MENT FACILITIES Pub. L. 113–66, div. A, title VII, § 712, Dec. 26, 2013, 127 Stat. 793, required the Secretary of Defense, in coordi- nation with the Secretaries of the military depart- ments, to conduct a three-year pilot program to dem- onstrate and assess the feasibility of implementing commercially ava

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