jebond123
Networker
Hello,
I am being told by Tricare West (TriWest) and now another 3rd party administrator that I need to use the Medicare Fee Schedule to figure out what they will allow for
procedure codes and I am at a loss to figure it out.
Tricare contract states the following:
Provider agrees to accept the lesser of a 20% discount off of the TRICARE Allowable
Charge/CHAMPUS Maximum Allowable Charge (CMAC) or a 35% discount off of Provider’s
billed charge as the Reimbursement Rate for the provision of TRICARE Covered Services
except for applicable Beneficiary Liability.
The other 3rd party administrator (Personify Health thru HealthComp) states that they will reimburse 120% to 160% of the Medicare allowable.
Can anyone help me by explaining what this means and how to come to a concrete figure to give the doctor?
Thank you in advance for any help.
Janet
I am being told by Tricare West (TriWest) and now another 3rd party administrator that I need to use the Medicare Fee Schedule to figure out what they will allow for
procedure codes and I am at a loss to figure it out.
Tricare contract states the following:
Provider agrees to accept the lesser of a 20% discount off of the TRICARE Allowable
Charge/CHAMPUS Maximum Allowable Charge (CMAC) or a 35% discount off of Provider’s
billed charge as the Reimbursement Rate for the provision of TRICARE Covered Services
except for applicable Beneficiary Liability.
The other 3rd party administrator (Personify Health thru HealthComp) states that they will reimburse 120% to 160% of the Medicare allowable.
Can anyone help me by explaining what this means and how to come to a concrete figure to give the doctor?
Thank you in advance for any help.
Janet