All claims for ECHO and the Autism Care Demonstration (ACD) must have a valid written prior authorization and the beneficiary must show as enrolled in ECHO in DEERS.
All claims for ECHO-authorized care (including ECHO Home Health Care and ACD) that have been authorized under ECHO, must be billed on individual line items. Unauthorized ECHO care claims will be denied.
ECHO claims will be reimbursed for the amount negotiated, the calendar year 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