What if Tricare pays in error?
November 9th, 2009 | TriCare Help | Posted by Military Times
Q. Let’s say Tricare finds out after six months or a year that it paid a claim in error for a dependent. Will it ask for its payment to be returned? If so, who would be responsible for repaying Tricare — the provider or the patient?
If Tricare pays a claim in error, federal law requires it to recoup the money. It will ask the payee on the claim to refund the erroneous payment.
If the provider participated in Tricare on the claim and received payment directly from Tricare, the provider would be asked to refund the payment. If the provider did not participate on the claim, payment would have gone to the adult patient or the custodial parent of a minor child, who would be responsible for repaying Tricare.
When Tricare determines that a claim has been paid in error and requests a refund, it is because the claim was denied. Whoever is asked to return the payment — the adult patient on the claim, the custodial parent if the patient was a minor, or the participating provider — may, and should, file an appeal of the denied claim.
Tricare has only one concern and one responsibility: the return of the full amount of a payment made in error.
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