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DOD/DODOASHA RIN: 0720-AA50 Publication ID: Fall 2011 
Title: Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Double Coverage 
Abstract: This rule clarifies our double coverage policy for non-institutional claims for beneficiaries with primary health insurance. TRICARE network, non-network but participating, and non-participating providers are all reimbursed differently under current procedures. This has had the unintended effect of discouraging TRICARE network participation since non-network but participating providers receive the most favorable treatment with respect to double coverage calculations. The Department proposed to revise double coverage reimbursement calculations by reimbursing all providers up to 100 percent of the CHAMPUS Maximum Allowable Charge after the primary health insurance has paid or 115 percent for non-participating providers. 
Agency: Department of Defense(DOD)  Priority: Substantive, Nonsignificant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: No  Unfunded Mandates: No 
CFR Citation: 32 CFR 199   
Legal Authority: 10 USC ch 55    5 USC 301   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  06/17/1999  64 FR 32451   
NPRM Comment Period End  08/16/1999    
Final Action  03/00/2012    
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Small Entities Affected: No  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
Gary Whittaker
Department of Defense
Office of Assistant Secretary for Health Affairs
1200 Defense Pentagon,
Washington, DC 20301
Phone:703 681-0039
Email: gary.whittaker@tma.osd.mil