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TriWest Healthcare Alliance Not Selected for Third TRICARE Contract

From: Triwest Healthcare Alliance Website – 3/16/12

Article Excerpt:

TriWest Healthcare Alliance today learned it was not awarded the contract to continue to manage the 21-state TRICARE West Region for the Department of Defense (DoD). This announcement comes after TriWest secured the contract in July 2009. 

“We are extremely disappointed that the Department of Defense chose to reverse their decision. For the past 16 years, we have worked tirelessly and with the highest levels of respect to meet the healthcare needs of West Region military families who have very much become our family,” said David J. McIntyre, Jr., TriWest’s President and CEO. 

Consistent with federal regulations, TriWest expects to learn more about the government’s decision in an upcoming debriefing. At this time, we will seek to ascertain whether it was appropriate and fair, and to determine our future course of action.

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News from King & Spaulding:

Last week TRICARE, the health care program of the Department of Defense, began issuing letters to hospitals notifying them of an opportunity to participate in an “untimely but discretionary appeal” under the TRICARE appeal procedures in order to obtain “discretionary net adjusted payments” for outpatient radiology claims.  According to the more detailed discussion on the TRICARE Management Activity website, the agency has identified approximately $98 million in potential underpayments for outpatient radiology claims for services during the period between August 1, 2003 to May 1, 2009.  The website contains a detailed description of the data analysis and calculation process that will be used to process appeals.  (more…)