IMPROVEMENTS TO CLAIMS PROCESSING UNDER THE TRICARE PROGRAM.

SEC. 713. IMPROVEMENTS TO CLAIMS PROCESSING UNDER THE TRICARE PROGRAM. (a) In General.—(1) Chapter 55 of title 10, United States Code, is amended by inserting after section 1095b the following new section: “§ 1095c. TRICARE program: facilitation of processing of claims “(a) Reduction of Processing Time.—(1) With respect to claims for payment for medical care provided under the TRICARE program, the Secretary of Defense shall implement a system for processing of claims under which— “(A) 95 percent of all clean claims must be processed not later than 30 days after the date that such claims are submitted to the claims processor; and “(B) 100 percent of all clean claims must be processed not later than 100 days after the date that such claims are submitted to the claims processor. “(2) The Secretary may, under the system required by paragraph (1) and consistent with the provisions in chapter 39 of title 31 (commonly referred to as the ‘Prompt Payment Act’), require that interest be paid on clean claims that are not processed within 30 days. “(3) For purposes of this subsection, the term ‘clean claim’ means a claim that has no defect, impropriety (including a lack of any required substantiating documentation), or particular circumstance requiring special treatment that prevents timely payment on the claim under this section. “(b) Requirement to Provide Start-Up Time for Certain Contractors.—(1) The Secretary of Defense shall not require that a contractor described in paragraph (2) begin to provide managed care support pursuant to a contract to provide such support under the TRICARE program until at least nine months after the date of the award of the contract. In such case the contractor may begin to provide managed care support pursuant to the contract as soon as practicable after the award of the contract, but in no case later than one year after the date of such award. “(2) A contractor under this paragraph is a contractor who is awarded a contract to provide managed care support under the TRICARE program— “(A) who has not previously been awarded such a contract by the Department of Defense; or “(B) who has previously been awarded such a contract by the Department of Defense but for whom the subcontractors have not previously been awarded the subcontracts for such a contract. “(c) Incentives for Electronic Processing.—The Secretary of Defense shall require that new contracts for managed care support under the TRICARE program provide that the contractor be 113 STAT. 689permitted to provide financial incentives to health care providers who file claims for payment electronically.”. (2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1095b the following new item: “1095c. TRICARE program: facilitation of processing of claims.”. (b) Report.—Not later than 6 months after the date of the enactment of this Act, the Secretary of Defense shall submit to Congress a report on— (1) the status of claims processing backlogs in each TRICARE region; (2) the estimated time frame for resolution of such backlogs; (3) efforts to reduce the number of change orders with respect to contracts to provide managed care support under the TRICARE program and to make such change orders in groups on a quarterly basis rather than one at a time; (4) the extent of success in simplifying claims processing procedures through reduction of reliance of the Department of Defense on, and the complexity of, the health care service record; (5) application of best industry practices with respect to claims processing, including electronic claims processing; and (6) any other initiatives of the Department of Defense to improve claims processing procedures. (c) Deadline for Implementation.—The system for processing claims required under section 1095c(a) of title 10, United States Code (as added by subsection (a)), shall be implemented not later than 6 months after the date of the enactment of this Act— (d) Applicability.—Section 1095c(b) of title 10, United States Code (as added by subsection (a)), shall apply with respect to any contract to provide managed care support under the TRICARE program negotiated after the date of the enactment of this Act.