Outpatient Hospital Reimbursement Tool Removed

Several years ago, TriWest developed a tool for institutional providers called the Outpatient Hospital Reimbursement Matrix. This tool outlined TRICARE's method of reimbursement for all revenue codes for services rendered in an outpatient hospital setting or ambulatory surgery setting.

While this tool has proved useful to institutional providers, due to multiple reimbursement policy changes earlier this year, including implementation of Site of Service, and in anticipation of the upcoming conversion to Outpatient Prospective Payment Services (OPPS) in 2006, it has been removed from TriWest's web site.

Institutional providers who have a copy of the Outpatient Matrix should discard it as it contains outdated information. Providers should contact their TRICARE representative with any questions.

TRICARE claims are paid in accordance with TRICARE reimbursement policies, which are clearly outlined in the TRICARE Reimbursement Manual, located at http://manuals.tricare.osd.mil/.

Posted 10/24/2005