Government: TRICARE Sanction Authority for Third-Party Billing Agents


Back Arrow

Back To The Calendar


Topic Government: TRICARE Sanction Authority for Third-Party Billing Agents
Background TRICARE will have the authority to sanction third-party billing agents by invoking the administrative remedy of exclusion or suspension from the TRICARE program. Such sanctions may be invoked in situations involving fraud or abuse on the part of third-party billing agents that prepare or submit claims presented to TRICARE for payment.
Regulating Body Federal Register
Compliance Date 3/28/2013
Consequences If a sanction is invoked on a third-party billing agency, any claims submmited will be denied and a notice sent to the physician that he or she must use another entity to submit TRICARE claims.
Next Steps Physicians should speak with their billing company to see if they are under a sanction, and if so, they should find another source for submission of their TRICARE claims.
Find out how TMA can help!