Release of Physician Profile Information to Title XIX Agencies

470.1 - Release of Physician Profile Information to Title XIX Agencies and to TRICARE Fiscal Intermediaries - (Rev. 1, 08-30-02) B1-4603.1 Medicare carriers are authorized to release physician charge information to State agencies that need this data to make medical assistance payments under title XIX, and to TRICARE fiscal intermediaries for use in administering the Civilian Health and Medical Program of the Uniformed Services. (See The Medicare General Information, Eligibility and Entitlement Manual, Chapter 6, for disclosure requirements.) The State agency and/or TRICARE fiscal intermediary should reach an agreement with the Medicare carrier on the cost involved prior to furnishing the data. Extra and identifiable costs associated with the retrieval and transfer of information include such things as programming, assembling the data, handling, correspondence, files search and copying. These costs will be charged to the State agency and to TRICARE. (In the Final Administrative Cost Proposal, notation should be made if information was furnished to title XIX agencies or the TRICARE fiscal intermediaries and the cost of retrieving and furnishing the information should be shown.) A carrier may have an integrated claims process; that is, it may process title XVIII and title XIX claims concurrently and mutual benefit may be derived from various operations in the claims process. In such cases, cost allocation is required in accordance with §470.2. In any case in which determination of the actual cost of disclosing information would interfere with efficient administration, such cost may be fixed at an amount estimated not to exceed actual cost. The information may be released after payment of such amount. If collection costs are disproportionately high or would interfere with efficient administration, payment of up to $300 per annum may be waived.