Researching TRICARE Manuals

If you have a question(s) on any TRICARE policies and procedures, you can research the TRICARE Manuals developed by the TRICARE Management Activity. These manuals are located on www.tricare.mil.

There are four TRICARE Manuals:

• TRICARE Operations Manual – has information pertaining to how the TRICARE program should be administered by the managed care support contractors (MCSC). TriWest is the MCSC for the TRICARE West Region.
• TRICARE Policy Manual – has information regarding TRICARE’s benefits. For example, this Manual would describe TRICARE’s coverage policy on home health services.
• TRICARE Reimbursement Manual – has information regarding TRICARE’s reimbursement methodologies for TRICARE benefits. For example, this Manual would show how an institution would be reimbursed for their services.
• TRICARE Systems Manual – has information on system set-up and reporting requirements for MCSCs.

Here is an example of how to research the TRICARE Manuals on TRICARE policy on balance billing:

• Go to www.tricare.mil
• Click on the "TRICARE Providers Enter Here" link
• Click on the drop down menu in the box on the top, right-hand side that says "jump to..." Go down and click on "Manuals (TRICARE)"
• The TRICARE Manuals home page will display, showing availability of all TRICARE Manuals listed above as well as the Code of Federal Regulations (CFR) section that pertains to TRICARE.
• Under the "Current TRICARE Program Manuals" header, click on the TRICARE Policy Manual 6010.54M, August 2002
• There is a Navigation header where you can View, Download or Search
  • You can "View" the entire Manual by chapter, but the quicker way to get your information is to choose the "Search" option.
  • If the "Search" option is chosen, type in the words ‘balance billing" in the ‘Search for" area.
  • You will now see all policy references containing the search words "balance billing" in them. Browse through each reference until you obtain the information you need.
    • Here, you can choose to search the references with your search words of "balance billing" highlighted by choosing "Document (Highlight Search Words)" or choose to search the documents without your search words highlighted by choosing "Document (No Highlights)"

Search Tips

• When using the search option, be very specific with your search words.
• Sometimes you will find that your chosen search words do not bring up any references. In these cases, try alternative words or use just one word instead of two or more. You should also try searching another manual in case the information is actually contained in a manual other than the one you are searching.
• If you want to search another manual, you cannot just enter new search words after your initial search. You must first click on "New Basic Search" on the top, left-hand corner of the displayed page. This will bring you to a page where you will see all manuals displayed. You can choose to click on just one manual or click on several manuals to do another search. If you choose several manuals, you will be provided with references to all manuals in your results page.
• Sometimes information is contained in both the Policy and Reimbursement Manuals, so you may need to search more than one manual at a time. To search more than one manual, you must first choose the manuals in which to do your search and then follow the guidelines outlined in the sub-bullet just above.