Effective Oct. 28, 2019, TRICARE offers reimbursement for reasonable and necessary organ acquisition services and costs in support of quality organ transplant programs. Under Medicare, Certified Transplant Centers (CTC) and Organ Procurement Organizations (OPO) report these costs using the Centers for Medicare and Medicaid Services (CMS) Forms 2552 and 216. TRICARE will use the Medicare Standard Acquisition Charges (SAC) to determine reimbursement amounts.
Humana Military is tasked each year with surveying all hospitals that had an organ acquisition cost and providing this information to the Defense Health Agency (DHA) for the TRICARE East Region.
To remain compliant, providers should return the following documents before July 31, 2023:
Please use the form referenced above and do not submit D-4 worksheets.
Please note: the address submitted on the form will be used for the annual correspondence for SAC rates.
Failure to return this information will result in TRICARE’s use of a provider facility’s overall operation cost-to-charge ratio to reduce charges, per the TRICARE Reimbursement Manual. If a facility does not have any SAC rates for the year, providers should provide an explanation.
Please return the required information, including any relevant point of contact to HMHSPricingMailbox@humana.com.
