When a Waiver of Non-Covered Services is Needed
3/12/2007
A TRICARE network provider can utilize the Waiver of Non-Covered Services when the beneficiary is properly informed, in advance, that TRICARE does not cover a particular service and the beneficiary agrees in writing to be financially responsible for that specific service.
A waiver of non-covered services must be in writing and include the following information:
- Indication that the beneficiary is enrolled in TRICARE Prime or using TRICARE Extra coverage
- Reference to the specific non-covered service or procedure that is not covered. If an appropriate CPT code exists that covers several procedures rendered, the provider must use the all-inclusive procedure code and not bill for each procedure separately.
- Notice that the service or procedure is not covered
- A written agreement that the beneficiary is to be financially responsible for non-covered services prior to the date of service
- The beneficiary’s signature
- The date signed
This waiver may not be used for TRICARE services that are not payable for other than benefit reasons (e.g., ClaimCheck edits, administrative expenses, and the difference between the allowed amount and paid amount).
Providers must maintain copies of the waiver in their office and fully inform beneficiaries in advance when specific services or procedures are not covered. See the Medical Coverage section in the Provider Handbook for a summary of TRICARE-covered and non-covered services and benefits. A general statement of financial liability does not satisfy this requirement.
Please note: Active Duty Service Members (ADSMs) cannot waive or be billed for any non-covered service.