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Appeals, Hearings and Claims Collections Division

The Appeals, Hearings and Claims Collections Division is responsible for the following:

Formal Review Process 

Reviews and determines legal sufficiency of adverse contractor decisions on beneficiary claims. Issues decisions based on medical review, application of law and regulation, or other agency review.

Subpoenas

The Office of General Counsel accepts subpoenas and requests for medical claim records. However, OGC is not able to accept subpoenas from state courts because these courts do not have jurisdiction over the federal government.  The following content may be appropriate:

1. Beneficiary Authorization for the Defense Health Agency to Release TRICARE Medical Claims Records

Authorization For Disclosure Of Medical Or Dental Information

2. Submitting Subpoenas to the Defense Health Agency Office of General Counsel regarding TRICARE Beneficiary Medical Claim Records

When seeking claims records pertaining to TRICARE beneficiaries from the Defense Health Agency, Department of Defense, a federal executive agency, the provisions of the Privacy Act of 1974 apply.  The Privacy Act generally prohibits the disclosure of records containing personal information pertaining to an individual to any person or agency without a written request by the individual to whom the record pertains.  Certain exceptions to the consent requirement are recognized, including the exception covered by Section 552a(b)(11) of the Act which authorizes an agency to disclose personal records without consent pursuant to the order of a court of competent jurisdiction.  The court in Doe v. DiGenova, held that a subpoena routinely issued is not a “court order” within the meaning of the exception because it is not “specifically approved” by a judge.  779 F. 2d 74, 77-85 (D.C. Cir. 1985), See DEPARTMENT OF JUSTICE, OVERVIEW OF THE PRIVACY ACT OF 1974, 2015 EDITION.

Upon written consent from the beneficiary, we will be pleased to furnish these records to you.  In order to retrieve beneficiary records, the sponsor’s full social security number is also required.  The sponsor is the person who is or was in the military.  Written consent can be provided with a completed TRICARE Authorization for Disclosure of Medical or Dental Information (DD Form 2870).  The form can be found on the TRICARE website here. Please understand our need to protect the privacy of our Department of Defense beneficiaries and comply with the provisions of the Privacy Act.

If you elect to send written consent, please fax it to (303) 676-3616 or mail to the above-listed address.  You should also be aware that if any TRICARE payments have been made for medical care the plaintiff obtained for injuries that were caused by the negligence of the defendant, that under the Federal Medical Care Recovery Act (42 U.S.C. §§ 2651-2653) the United States has a right of recovery from the tortfeasor for those payments. 

Recoupment Process

Represents the DHA/DoD in all hearings before an independent hearing officer.

Recoupment Process

Administer the recoupment process which involves numerous actions required to collect outstanding beneficiary and provider debts as mandated by the Federal Claims Collection Act (FCCA) and the Federal Medical Care Recovery Act.

Related Links

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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