claims-program-guidelines_1650x360

Guidelines for the Extended Care Health Option (ECHO)

All claims for ECHO and the DoD Enhanced Access to Comprehensive Autism Care Demonstration (CACD) must have a valid written authorization, and the beneficiary must show as enrolled in ECHO in DEERS.
  • All claims for ECHO-authorized care (including ECHO Home Health Care and the DoD CACD) must be billed on individual line items. Unauthorized ECHO claims will be denied.
  • ECHO claims will be reimbursed for the amount negotiated, the Fiscal Year (FY) benefit limit or the TRICARE allowable charge, whichever is lower.
  • Each line item on an ECHO claim must correspond to a line item on the service authorization, or the claim may be denied or delayed due to research and reconciliation.
  • The billed amount for procedures must reflect the service, not the applicable ECHO benefit limits. Pricing of ECHO services and items is determined in accordance with the TRICARE Reimbursement Manual.
  • Refer to the TRICARE Policy Manual, Chapter 9, Sections 4.1, 11.1,14.1 and 18.1 at manuals.TRICARE.osd.mil.