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10 U.S.C. § 1095c — TRICARE program: facilitation of processing of claims
Federal law — U.S. Code and appendices · legal_authorities
**(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) Except as provided in paragraph (3), 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, 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
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Source file: Laws/federal/codes/united-states-code/title-10/section-1095c-tricare-program-facilitation-of-processing-of-claims--4997097694.md
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Source location: Title 10, Chapter 55, § 1095c; chapter-055-medical-and-dental-care.md
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**(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) Except as provided in paragraph (3), 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, 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.
(3) The Secretary may reduce the nine-month start-up period required under paragraph (1) if—
(A) the Secretary—
(i) determines that a shorter period is sufficient to ensure effective implementation of all contract requirements; and
(ii) submits notification to the Committees on Armed Services of the House of Representatives and the Senate of the Secretary’s intent to reduce the nine-month start-up period; and
(B) 60 days have elapsed since the date of such notification.
**(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.
**(d) Correspondence to Medicare Claims Information Requirements.—** The Secretary of Defense, in consultation with the other administering Secretaries, shall limit the information required in support of claims for payment for health care items and services provided under the TRICARE program to that information that is identical to the information that would be required for claims for reimbursement for those items and services under title XVIII of the Social Security Act ([42 U.S.C. 1395](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395&num=0&edition=prelim) et seq.) except for that information, if any, that is uniquely required by the TRICARE program. The Secretary of Defense shall report to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives any information that is excepted under this provision, and the justification for that exception.
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Federal law — U.S. Code and appendices · legal_authorities
**(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
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1095
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Federal law — U.S. Code and appendices · legal_authorities
This chapter may be cited as the “Social Security Act”.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1305
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Conditions of participation; protection of individual rights; notification of State entities; use of home health aides; medical equipment; individual’s plan of care; compliance with Federal, State, and local laws and regulations** The conditions of participation that a home health agency is required to meet under this subsection are as follows:
(1) The agency protects and promotes the rights of each individual under its care, including each of the following rights:
(A) The right to be fully informed in advance about the care and treatment to be provided by the agency, to be fully informed in advance of any changes in the care or treatment to be provided by the agency that may affect the individual’s well-being, and (except with respect to an individual adjudged incompetent) to participate in planning care and treatment or changes in care or treatment.
(B) The right to voice grievances with respect to treatment or care that is (or fails to be) furnished without discrimination or reprisal for voicing grievances.
(C) The right to confidentiality of the clinical records described in section 1395x(o)(3) of this title.
(D) The right to have one’s property treated with respect.
(E) The right to be fully informed orally and in writing (in advance of coming under the care of the agency) of—
(i) all items and services furnished by (or under arrangements with) the agency for which payment may be made under this subchapter,
(ii) the coverage available for such items and services under this subchapter, subchapter XIX, and any other Federal program of which the agency is reasonably aware,
(iii) any charges for items and services not covered under this subchapter and any charges the individual may have to pay with respect to items and services furn
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395
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Federal law — U.S. Code and appendices · legal_authorities
Page 1145
TITLE 10—ARMED FORCES
§ 1095c
under the TRICARE program that pays a claim de-
scribed in subsection (a)(2) shall have the right to col-
lect from the third-party payer the costs incurred by
such contractor on behalf of the covered beneficiary.
The contractor shall have the same right to collect
such costs under this subsection as the right of the
United States to collect costs under section 1095 of this
title.’’
§ 1095c. TRICARE program: facilitation of proc-
essing of claims
(a) REDUCTION OF PROCESSING TIME.—(1) With
respect to claims for payment for medical care
provided under the TRICARE program, the Sec-
retary 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 re-
quired by paragraph (1) and consistent with the
provisions in chapter 39 of title 31 (commonly
referred to as the ‘‘Prompt Payment Act’’), re-
quire 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) Except as pro-
vided in paragraph (3), the Secretary of Defense
shall not require that a contractor described in
paragraph (2) begin
Source: Supplied 2024 U.S. Code historical extraction · 10 U.S.C. § 1095c
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.
Federal law — U.S. Code and appendices · legal_authorities
Page 2893
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395a
(i) shared savings and competitive bidding in FFS
Medicare;
(ii) use of MA-negotiated rates to set FFS Medicare
rates; and
(iii) novel approaches to information development
and sharing that may enable markets to lower cost and
improve quality for FFS Medicare beneficiaries.
SEC. 10. Reducing Obstacles to Improved Patient Care.
Within 1 year of the date of this order, the Secretary
shall propose regulatory changes to the Medicare pro-
gram to reduce the burden on providers and eliminate
regulations that create inefficiencies or otherwise un-
dermine patient outcomes.
SEC. 11. Maximizing Freedom for Medicare Patients and
Providers. (a) Within 180 days of the date of this order,
the Secretary, in coordination with the Commissioner
of Social Security, shall revise current rules or policies
to preserve the Social Security retirement insurance
benefits of seniors who choose not to receive benefits
under Medicare Part A, and propose other administra-
tive improvements to Medicare enrollment processes
for beneficiaries.
(b) Within 1 year of the date of this order, the Sec-
retary shall identify and remove unnecessary barriers
to private contracts that allow Medicare beneficiaries
to obtain the care of their choice and facilitate the de-
velopment of market-driven prices.
SEC. 12. General Provisions. (a) Nothing in this order
shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive de-
partment or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Man-
agement and Budget relating to budgetary, administra-
tive, or legislative proposals.
(b) This order shall be implemented consistent with
applicable law and subject to the
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1395. This identifies an authority to review, not proof of applicability.