Payments > Insurance Payments

UNLAWFUL CHARGING???

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aremy44:
I was elated, but now some new information has me a bit baffled once again. I found a letter from Tricare stating that our provider was no longer an authorized Tricare provider as of 2002, but he has been accepting Tricare payments as of that date from patients who have Tricare as a secondary to Medicare (whom he is contracted with). Does such a letter affect his status with Tricare as a secondary?

RichardP:
If he is not contracted with Tricare, he is not contracted with Tricare.  Period.  Unless there is some formal agreement to the contrary, it doesn't matter whether the patient has Tricare as primary or secondary.  Your provided is not contracted with Tricare.

rdmoore2003:
Are you accepting assignments on these claims?

aremy44:
Regina, the only time he accepts assignment is when Tricare is secondary to Medicare. After finding a letter yesterday from Tricare stating that he is no longer an authorized provider; it raised the concern that he has been accepting payment from them for the last 13 years. Can they legally request the monies that they paid out to him back?

PMRNC:
I know it's possible, but doubtful that they would go on and pay him for 13 years..So, I'm thinking there was a contract somewhere within those 13 years. Maybe the letter is old and after that somehow he contracted with again? I'm thinking there is a par contract somewhere someone is overlooking. Call Tricare provider relations ASAP to confirm. IF they did pay him as non contracted provider, well they could ask for monies back, however if I were the provider I would counter/appeal that legally as they set the precedence and it could be past a statute of limitations or recoupment period. Not sure..but I would def call them and find out ASAP

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