For TRICARE providers
Federal Law (5 U.S.C. 5536) prohibits medical personnel, who are Active Duty Service Members (ADSM) or civilian employees of the
government, compensation above their normal pay and allowances for medical care rendered. This prohibition applies to TRICARE
benefits whether the claim for reimbursement is filed by the individual who provided the care, the facility in which the care was
rendered, or by the sponsor/beneficiary. Claims for TRICARE benefits will be denied in any situation where either a uniform member
or civilian employee of the uniform services has the opportunity to exert, directly or indirectly, any influence on the referral of TRICARE
beneficiaries to one or more providers on a selective basis.
Please continue to notify us of any changes related to your provider file information (name, address, specialty, tax number, group
affiliations, etc.).
TRICARE Reimbursement Manual (TRM) Ch 1 Sec 18; 32 CFR 199.6 states providers employed or under a contract which provides for payment to the individual professional provider by an institutional provider cannot be considered. Employees reimbursed by the hospital/institution are not eligible for separate reimbursement outside the realm of the hospital.
TRICARE Reimbursement Manual (TRM) Ch 13 Sec 1; 32 CFR 199.2; 199.6 (c) states physicians-in-training, interns, residents, and fellows participating in approved postgraduate training programs and physicians who are not in approved programs but who are authorized to practice only in a hospital or other institutional provider setting, (e.g., individuals with temporary or restricted licenses, or unlicensed graduates of foreign medical schools) are not eligible to be individually certified in these statuses.
