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Care in the Philippines












Information for Providers



Fee Schedules

Payment for professional services, such as physicians’ services in the Philippines, will be the lower of the billed charge or the new, country-specific, CHAMPUS Maximum Allowable Charge (CMAC). The change in payment will be effective beginning November 1, 2008. This change will not apply to ancillary services, which includes radiology, pathology and clinical laboratory. These ancillary services will continue to be paid using the lower of the billed charge or the Puerto Rico CMAC. This new payment system will be based on the U.S. National CMAC, adjusted for the country, using the country-specific index factor to account for differences in the cost of living and currency exchange rate.

Payment for hospital inpatient services will also be the lower of the billed charges or an amount calculated using the new, country-specific, inpatient per diems based on the principal diagnosis for an admission. The inpatient per diems will be based on the sum of the average allowed amount per day. It will include an add-on for capital costs for each of the 18 diagnosis groupings adjusted by the country-specific index factor to account for differences in the cost of living and the currency exchange rate. The inpatient per diems will be constructed using the data from TRICARE hospital inpatient claims in the U.S. This change will be effective with hospital admissions beginning November 1, 2008.

The new CMACs and inpatient per diem rates will be updated annually.

Fraud

TMA is committed to preventing, identifying and assisting in the prosecution of health care fraud, not only to save valuable benefit dollars but also to ensure that eligible beneficiaries receive appropriate medical care. The TMA Program Integrity Office is the central coordinating agency for allegations of fraud and abuse within the TRICARE Program. Suspected fraud and abuse in the Philippines may be reported by e-mailing fraudline@tma.osd.mil or reportit@wpsic.com or by writing to either of the following addresses:

TRICARE Management Activity
Attn: Program Integrity
16401 East Centretech Parkway
Aurora, Colorado 80011-9066
Fax: (303) 676-3981
Wisconsin Physicians Service
Attn: Program Integrity
1717 W Broadway
PO BOX 7927
Madison, Wisconsin 53707
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