TRICARE Reimbursement Manual 6010.58-M


The TRICARE Reimbursement Manual (TRM) is incorporated by reference in the Managed Care Support Services (MCSS) contracts and is the principal vehicle for operating guidelines and instructions. The TRM provides a mechanism for keeping the contracts current by clarifying or modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information. The TRM, in conjunction with the February 2008 TRICARE Policy Manual (TPM), provides guidance, policy interpretation, and decisions implementing TRICARE, including those policies and procedures applicable to the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). The TRM contains operational policy necessary to implement Title 32 to the Code of Federal Regulations Part 199 (32 CFR 199). This manual augments the 32 CFR 199 and must be used in conjunction for complete policy 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The MCS Manuals for contracts prior to 06/26/2008 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each manuals' web page. Select the desired manual below, then proceed to the "Superseded" manual(s) that exist below the "Current" manual.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 Reimbursement Manual (TRM), 6010.57-M, is available online.
All future changes will be published to this edition.
Last Updated: June 29, 2017
Most Recent Change Number: Change 145

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Page Count: 1,040
Summary of Changes: This change removes “urgently needed care” from the Emergency Services benefits chart, adds “urgent care” to the Individual Provider Services and Outpatient Hospital Departments sections, which revises the policy to clearly note urgent care co-pays as $12.


August 1, 2002 edition - Superseded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 Reimbursement Manual (TRM), 6010.55-M, is available online. This edition supersedes the March 15, 2002 edition. All changes to the March 15, 2002 edition (through Change 37 dated October 22, 2004) have been incorporated.
No future changes will be published to this edition.
Last Updated: April 3, 2013
Most Recent Change Number: Change 159

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Page Count: 1,490
Summary of Changes: See the Change Transmittal. This change is published in conjunction with Aug 2002 TPM Change 175 and Aug 2002 TSM Change 102.


March 15, 2002 edition - Superseded

This manual is valid for contracts awarded on or before April 30, 2003.
The August 1, 2002 edition of the TRICARE Reimbursment Manual (TRM), 6010.53-M, is available online.
This TRICARE Reimbursement Manual (TRM) was created to allow TMA to make distinctions between TRICARE reimbursement policies and TRICARE coverage/benefit policies. The initial publication of the TRICARE Reimbursement Manual (which is being done simultaneously with the reissue of the March 2002 TRICARE Policy Manual) makes no changes to reimbursement policies in existence at the time of its publication--it simply removes from the TPM; Chapter 13; Addendums; Appendices; Chapter 6, Section 6.1; Chapter 11, Section 5.1; and MCSC Operations Manual, Chapters 9 and 10 and places it all within the TRICARE Reimbursement Manual.
No future changes will be published to this edition.
Last Updated: October 22, 2004
Most Recent Change Number: Change 37

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Page Count: 1,034
Summary of Changes: This change provides the FY 2005 updates to the DRG and reimbursement systems. This change is published in conjunction with May 1999 ADP Change 51.