A network provider may not bill a TRICARE beneficiary for excluded or excludable services (i.e., the beneficiary is held harmless), except in the following circumstances:
A TRICARE beneficiary is held harmless from financial liability for noncovered services. If the beneficiary has agreed in writing (using the TRICARE Noncovered Services Waiver form) in advance of the service/care being performed, the provider may bill the beneficiary directly.
If there is not a TRICARE waiver on file for the patient and the specified date of service and care, then the network provider has no recourse and must uphold the hold-harmless provision according to Title 10 of the Code of Federal Regulations on TRICARE.
TRICARE network providers must file patients’ claims, even when the patient has Other Health Insurance (OHI).