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PubMed2001

Internet-based eligibility verification lowers costs, improves payment timeliness.

Verification of claims eligibility traditionally is performed either through telephone communication between the payer's and provider's staff or through an EDI clearinghouse. These forms of verification offer inconsistent quality, often use out-of-date information, cost time and money, and may financially harm payers and providers by leading to delays in payments or claims denied after care has been rendered. Internet-based eligibility verification software reduces the number of rejected claims because it can access current information without using a clearinghouse. The software also allows earlier collection of copayments because these obligations can be identified accurately when care is rendered. By offering Internet-based eligibility verification, payers can help providers achieve financial benefits while gaining such benefits themselves.

Boston↗
PubMed2001

TRICARE; Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); eligibility and payment procedures for CHAMPUS beneficiaries age 65 and over. Interim final rule.

This interim final rule implements Section 712 of the Floyd D.Spence National Defense Authorization Act for Fiscal Year 2001. Section 712 extends TRICARE eligibility to persons age 65 and over who would otherwise have lost their TRICARE eligibility due to attainment of entitlement to hospital insurance benefits under Part A of Medicare. In order for these individuals to retain their TRICARE eligibility, they must be enrolled in the supplementary medical insurance program under Part B of Medicare. In general, in the case of medical or dental care provided to these individuals for which payment may be made under both Medicare and TRICARE, Medicare is the primary payer and TRICARE will normally pay the actual out-of-pocket costs incurred by the person. This rule prescribes TRICARE payment procedures and makes revisions to TRICARE rules to accommodate Medicare-eligible CHAMPUS beneficiaries. The Department is publishing this rule as an interim final rule in order to meet the statutorily required effective date. Public comments, however, are invited and will be considered when the rule is published as a final rule.

Eligibility Determination↗