Updated OPPS Information Available

TRICARE Management Activity (TMA) recently announced that the implementation of the TRICARE Outpatient Prospective Payment System (OPPS) reimbursement methodology has been postponed from June 1, 2007 to late 2007. TriWest is awaiting a determination from TRICARE Management Activity (TMA) on the revised effective date and will notify providers accordingly.

TRICARE OPPS applies to all hospitals participating in the Medicare program and hospital-based partial hospitalization programs subject to TRICARE authorization requirements. TRICARE OPPS also applies to hospitals or distinct parts of hospitals that are excluded from the inpatient Diagnostic Related Group (DRG) Based Payment System, to the extent that the hospital or distinct part furnishes outpatient services. Some organizations, as defined by TRICARE policy, are exempt from OPPS.

TriWest has updated the OPPS Frequently Asked Questions and the OPPS Fact Sheet, which are located in the Provider Connection area of www.triwest.com in the Claims & Reimbursement section.