TRICARE Operations Manual 6010.56-M


The TRICARE Operations Manual (TOM) is incorporated by reference in all the Managed Care Support Services (MCSS) contracts and is the principal vehicle for operating guidelines and instructions. The TRICARE Operations Manual (TOM) provides a mechanism for keeping the contracts current by clarifying or modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information.
NOTE
The MCS Manuals for contracts prior to 06/26/2008 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each manuals' web page. Select the desired manual below, then proceed to the "Superseded" manual(s) that exist below the "Current" manual. For the ADP Manual, select the TSM Manual.

February 1, 2008 edition

This manual is valid for contracts awarded on or after June 27, 2008 for the North, South, and West Regions along with TQMC, CARS, TOP, and TPharm. The manuals will apply to the TDEFIC contract upon direction of the Contracting Officer.
The February 1, 2008 edition of the TRICARE Operations Manual (TOM), 6010.56-M, is available online.
All future changes will be published to this edition.
Last Updated: December 11, 2017
Most Recent Change Number: Change 213

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Page Count: 1,606
Summary of Changes: This change removes language that allows the contractor to retain refunds, collections or recoveries made by the contractor on unallowable costs.


August 1, 2002 edition - Superseded

This manual is valid for contracts awarded on or after May 1, 2003 through June 26, 2008 for the North, South, and West Regions along with TDEFIC, NQMC, CARS, Retail, and TMOP.
The August 1, 2002 edition of the TRICARE Operations Manual (TOM), 6010.51-M, is available online. This edition reissued the February 18, 2000 edition. Also, the August 1, 2002 edition of the TOM replaces the March 1, 2001 edition of the MCSC Operations Manual (OPM). All changes to the March 1, 2001 edition of the OPM (through Change 38 dated April 30, 2004) have been incorporated.
No future changes will be published to this edition.
Last Updated: February 12, 2013
Most Recent Change Number: Change 151

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Page Count: 1,710
Summary of Changes: This change revises records management requirements for transferring electronic records to the electronic Code of Federal Regulations (eFRC) and provides additional guidance and/or clarification on contractor compliance with relevant provisions of applicable federal statutes and regulations.


March 1, 2001 edition - Superseded

This manual is valid for contracts awarded on or before April 30, 2003.
The March 1, 2001 edition of the MCSC Operations Manual (OPM), 6010.49-M, is available online. This edition reissued the TRICARE/CHAMPUS Operations Manual and supersedes the July 30, 1992 edition. All changes to the July 27, 1992 edition (through Change 165 dated January 29, 2001) have been incorporated.
No future changes will be published to this edition.
Last Updated: April 30, 2004
Most Recent Change Number: Change 38

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Page Count: 1,400
Summary of Changes: This change adds 2004 CPT coding changes to the TRICARE Manuals. In addition, included in this change package are the policies which required the updated AMA 2004 CPT copyright statement. This change is published in conjunction with May 1999 ADP Change 50, Mar 2002 Policy Change 22, and Mar 2002 TRM Change 32.


July 30, 1992 edition - Superseded

The July 30, 1992 edition of the TRICARE/CHAMPUS Operations Manual (OPM), 6010.49-M, Changes 140 (July 26, 1999) through 165 (January 29, 2001), is available online.
No future changes will be published to this edition.
Last Updated: January 29, 2001
Most Recent Change Number: Change 165

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Page Count: 0
Summary of Changes: This change extends TRICARE Senior Prime (TSP) through December 31, 2001. It also revises the residence requirement, updates the process for retroactive enrollment and revises the length of time an enrollee is allowed to live outside the approved service area. See the summary of changes for a complete list of changes. This change is published in conjunction with May 1999 ADP Change 15.


July 30, 1992 edition - Superseded

The July 30, 1992 edition of the TRICARE/CHAMPUS Operations Manual (OPM), 6010.49-M, Changes 65 (March 1, 1996) through 139 (May 19, 1999), is available online in a limited capacity. These changes are available for viewing/saving due to the changes being a scanned copy.
The "Entire Change Package" option indicates that the entire change package was small enough to be contained in one file; however, if it is a large change package the package will be divided into parts. (Example: Part 1: Pt 2, Chap 1, Sec II - IV, Part 2: Pt 3, Chap, Add A - B, etc.). Legend for abbreviations used below: Part = Pt, Chap = Chapter, Sec = Section, Add = Addendum, Exh = Exhibit, TOC = Table of Contents, Pgs = Pages.
No future changes will be published to this edition.
Last Updated: May 19, 1999
Most Recent Change Number: Change 139

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Page Count: 0
Summary of Changes: This package contains Phase Two of the Work Simplification changes. (See the Summary of Changes for specific changes.) These changes remove prescriptive requirements and allow the contractors to use commercial business practices and industry standards.
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Part 1: Transmittal - Pt 1, Chap 1, Sec I
Part 2: Pt 1, Chap 1, Sec II - Pt 1, Chap 1, Sec IV
Part 3: Pt 1, Chap 1, Sec V - Pt 1, Chap VII
Part 4: Pt 1, Chap 1, Sec VIII
Part 5: Pt 1, Chap 1, Add A - Pt 1, Chap 2, Sec I
Part 6: Pt 1, Chap 2, Sec II - Pt 1, Chap 2, Sec IV
Part 7: Pt 1, Chap 2, Sec V - Pt 1, Chap 3, Sec II
Part 8: Pt 1, Chap 3, Sec III - Pt 1, Chap 3, Add A
Part 9: Pt 2, Chap 1, TOC - Pt 2, Chap 1, Sec IV (pgs 2.1.IV-1 - 4)
Part 10: Pt 2, Chap 1, Sec IV (pgs 2.1.IV-5 - 21)
Part 11: Pt 2, Chap 1, Sec V - Pt 2, Chap 1, Sec VI (pgs 2.1.V1-1 - 10)
Part 12: Pt 2, Chap 1, Sec VI (pgs 2.1.VI-11 - 28)
Part 13: Pt 2, Chap 1, Add A
Part 14: Pt 2, Chap 1, Add C - Pt 2, Chap 3, Sec III
Part 15: Pt 2, Chap 3, Sec IV - Pt 2, Chap 4, TOC
Part 16: Pt 2, Chap 4, Sec I
Part 17: Pt 2, Chap 4, Sec II - Pt 2, Chap 4, Sec III
Part 18: Pt 2, Chap 4, Sec IV - Pt 2, Chap 5, Sec III
Part 19: Pt 2, Chap 5, Sec IV - Pt 2, Chap 8, Sec II
Part 20: Pt 2, Chap 8, Sec III - Pt 2, Chap 8, Sec VIII
Part 21: Pt 2, Chap 8, Sec IX - Pt 2, Chap 16, TOC
Part 22: Pt 2, Chap 16, Sec II - Pt 2, Chap 19, Sec I
Part 23: Pt 2, Chap 20, TOC - Pt 3, Chap 1, TOC
Part 24: Pt 3, Chap 1, Sec I - Pt 3, Chap 1, Sec II
Part 25: Pt 3, Chap 1, Sec III - Pt 3, Chap 2, Sec I
Part 26: Pt 3, Chap 2, Sec II - Pt 3, Chap 2, Sec IV
Part 27: Pt 3, Chap 2, Add B - Pt 3, Chap 2, Add C
Part 28: Pt 3, Chap 3, TOC - Pt 3, Chap 3, Sec I
Part 29: Pt 3, Chap 3, Sec III - Pt 3, Chap 4, Sec I
Part 30: Pt 3, Chap 4, Sec II - Pt 3, Chap 4, Sec V
Part 31: Pt 3, Chap 5, TOC - Pt 3, Chap 6, Sec I
Part 32: Pt 3, Chap 6, Add A - Pt 3, Chap 7, Sec III