Those who entered before Jan. 1, 2018, are part of Group A, while those who entered on or after Jan. 1, 2018, are part of Group B. The catastrophic cap for certain active duty family members and working age retirees will increase by about 8.7%. This resource provides an overview of most of your costs and fees for TRICARE health plans, the TRICARE Pharmacy Program, and the TRICARE Dental Program. There are also planned increases in co-payments and annual enrollment fees for retirees, their families and others, according to fee schedules just released by the Defense Health Agency. Such hyperlinks are provided consistent with the stated purpose of this website. CMS issued a CY 2023 Medicare Physician Fee Schedule (PFS) final rule to expand access to behavioral health care, cancer screening coverage, and dental care. TRICARE For Life (TFL) is a benefit available to retired U.S. Military and their families. Please refer to the terms of your contract for information related to schedule usage. Identify the service to include modifier (if applicable). Specialty populations such as reservists, young adults, and transitioning service members will pay more for their prescriptions in 2022. Autism Spectrum Disorder (ASD) Fee Schedule. TRICARE Costs and Fees 021. If you have not already registered your location (s) for electronic claims, please complete the EDI Express Enrollment process. When you get married or move to a new state, updating your health plan probably isnt the first thing on your With the TRICARE Compare Cost Tool, you can look up costs for covered services, enrollment, and more. Enrollees in Tricare Retired Reserve (TRR) will see a 3.6% monthly premium jump to $502.32 from $484.83 for individual coverage. For active duty families in Group B, the catastrophic cap has increased by $97, to $1,217 for both Tricare Prime and Select. You can now check eligibility (PDF) for the flu shot. Download a PDF Reader or learn more about PDFs. TRICARE PRIME (JAN. 1-DEC. 31, 2022) Includes TRICARE Prime, TRICARE Prime Remote, the US Family Health Plan (USFHP), and TYA Prime plans. East Region; West Region; Overseas Need Dental Coverage? Active duty families in Tricare Select dont pay annual enrollment fees either, but working age retirees, their family members and most others do, and those fees are going up. Modified on: Mon, 29 Aug, 2022 at 12:37 PM. Tricare Prime Group A will pay $351.96 per individual, up from $323; and $703.92 per family, up from $647. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. The non-therapy ancillary component will follow PDPM (3.0 for the first three days and 1.0 for all remaining days). This policy memorandum establishes the 2018 monthly premium rates for TRICARE Reserve Select and TRICARE Retired Reserve. The VA will typically reimburse providers at 100% of the CMAC fee schedule whereas Tricare will typically pay a percentage of the CMAC fee schedule. Care referred through CCN in Alaska is billed to and paid by VAs third-party administrator, TriWest. Active duty families in Tricare Select don't pay annual enrollment fees, but they will see small co-payment increases, generally by a few dollars, for most services starting Jan. 1. The April 1, 2022, ASC Fee Schedule (new codes only) is available and can be downloaded using the links provided here. Certain community services provided to Veterans in the state of Alaska are subject to specific fee schedules. An exception to these cost upticks is specialty care outpatient visits, where the co-pay decreases by $1, to $37, for Group A active duty family members in Tricare Select and by $1, to $49, for working age retirees and their families. TRICARE is a registered trademark of the Department of Defense (DoD),DHA. Contact Us. Update Your Other Health Insurance Info for TRICARE. The retiree COLA will not be announced until mid-October 2021. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Alaska Maximum Allowable Charge (MAC), Effective 01/01/2022, CCN R5 Alaska Professional Fee Schedule (01/01/21-05/31/2021), CCN R5 Alaska Professional Fee Schedule (06/01/2021-12/31/2021), Non-CCN R5, Veterans Care Agreement Alaska Professional Fee Schedule (01/01/21-12/31/2021), Alaska Maximum Allowable Charge List (01/01/21-12/31/2021), Alaska Professional Fee Schedule (01/01/2021-12/31/2021), CY20 Geriatric and Extended Care (GEC) Fee Schedule, Call TTY if you You can also see how your plans costs compare to other plans. Tricare CMAC Tool: http://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges, If you want to download a full fee schedule or do a cross code lookup, here is where you can do it: http://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/CMAC-Rates, Does your state provide nurse practitioners with full practice authority? TRICARE Provider Connect - Patient Medication List, Nominate a Beneficiary For Case or Disease Management, 2022 TRICARE West Region Provider Handbook, Summary of 2021 to 2022 Provider Handbook Changes guide, 2022 TRICARE Provider Handbook and Updated Quick Reference Charts Now Available. These account for the unique cost of providing care in that geographic area. Changes to TRICARE programs are continually made as public law, federal regulation, and HNFS managed care support contract are amended. A PDF reader is required for viewing. Generic drug prescriptions at retail pharmacies for all Tricare recipients will cost $14 for a 30-day supply, up from $11. Although the DHA may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. SCDHHS has published fee schedules for codes that have been created during the COVID-19 public health emergency on the agency's COVID-19 website. FALLS CHURCH, Va. Beneficiary out-of-pocket expenses impacted by the 2022 COLA will be posted to the tricare.mil/changes web page before the start of TRICARE Open Season, November 8, 2021 to December 13, 2021. Please enter a valid email address, e.g. And from Youve likely heard the term referral in connection with health care. Clinical Diagnostic Laboratory Test, Upper Payment Limit. A variety of search tools to navigate TRICARE fee schedules, rates, and reimbursement methodologies. Group B members pay $182 per individual, up from $168, and $365 per family, up from $336. With the TRICARE Compare Cost Tool, you can look up costs for covered services, enrollment, and more. To start your search, go to the Medicare Physician Fee Schedule Look-up Tool. In fact, its decreasing.. The catastrophic cap is the maximum amount beneficiaries pay out of pocket in a year for covered services before Tricare will start picking up 100 percent of the cost. Youve likely heard the term referral in connection with health care. 7700 Arlington Boulevard Beginning 2023, the VA Fee Schedule cycle will run Feb. 1 to Jan. 31. The TRICARE allowable charge is tied by law to Medicare's allowable charge whenever practical and may vary based on the prevailing rate in a given location. Information about the code's grouping under Medicare's current ASC fee schedule shall be utilized to support the grouping. email@example.com. Doing Business with the Defense Health Agency, Defense Medical Readiness Training Institute, Defense Health Program Agency Financial Report, 2020 DOD Womens Reproductive Health Survey (WRHS), Conducting Health Care Surveys in the DOD, Transition from CAHPS Version 4.0 to Version 5.0, TRICARE Inpatient Satisfaction Surveys (TRISS), 2018 Health-Related Behaviors Survey (HRBS), 2015 Health-Related Behavior Survey Active Duty, 2014 Health Related Behavior Survey of Reserve Component Leadership Fact Sheet, 2011 Health-Related Behavior Survey Active Duty, 2009 Health-Related Behavior Survey - Reserve Component, Clinical Improvement Priorities for MTF Providers, Small Market and Stand-Alone MTF Organizations, Defense Health Agency Region Indo-Pacific, Comprehensive Changes to the Autism Care Demonstration, Applied Behavior Analysis Maximum Allowed Amounts, Blend Rate Method for Radiology for Cancer and Children's Hospitals, TRICARE CHAMPUS ASA and DRG Weights Summary, TRICARE Rate Variables and Cost-Share Per Diems, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Limits on Number of Services without Override Code, Mental Health and Substance Use Disorder Facility Rates, Military Medical Support Office at DHA, Great Lakes, Information for Patients: TRICARE Pharmacy Program, Information for Pharmaceutical Manufacturers, Contact the TRICARE Retail Refund Team and FAQs, Opioid Overdose Education and Naloxone Distribution Program, DHA Pharmacy Operations Support Contract Data Management Team, Prescription Drug Monitoring Program Procedures, Quality, Patient Safety & Access Information (for Patients), Quality & Safety of Health Care (for Health Care Professionals), Eliminating Wrong Site Surgery and Procedure Events, The Global Trigger Tool in the Military Health System Guide, Patient Safety & Quality Academic Collaborative, Patient Safety Champion Recognition Program, Armed Forces Billing and Collection Utilization Solution, Health Plan and Policy Billing Guidelines, Health Insurance Portability and Accountability Act, UBO Standard Insurance Table (SIT)/Other Health Insurance (OHI), Air Force Wounded Warrior Northeast Warrior CARE Photo Essay, Ensuring Access to Reproductive Health Care, 5 MinuteConsult Mobile App & CME Instructions, ClinicalKey for Nursing Clinical Updates CE Instructions, Applied Behavioral Analysis Maximum Allowed Amounts, Mental Health and Substance Use Disorder Facility List, Calendar Year 2022 TRICARE Prime and TRICARE Select Out-of-Pocket Costs: Active Duty Family Members, Calendar Year 2022 TRICARE Prime and TRICARE Select Out-of-Pocket Costs: Retired Service Members, Their Families, and Others, Memorandum to Establish 2022 Premium Rates, 2020 Billing Rates for Care Provided to Foreign Nationals, TRICARE Prime and TRICARE Select Out-of-Pocket Expenses for Calendar Year 2020, 2019 Billing Rates for Care Provided to Foreign Nationals, 2019 Monthly Premium Rates for TRS, TRR, and TYA, Policy Memorandum to Establish 2018 Monthly Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve, Policy Memorandum to Establish Calendar Year 2018 Premium Rates for the TRICARE Young Adult Program, Memorandum to Establish 2017 TRICARE Reserve Select and TRICARE Retired Reserve Rates, Memorandum to Establish 2017 Premium Rates for the TRICARE Young Adult Program, Memorandum: Medical Billing Rates for Other Than Foreign Nationals 2016, Memorandum: Medical Billing Rates for Foreign Nationals 2016. CMAC Allowable Charge Changes - TRICARE West. Annual Enrollment Fees (TRICARE Select and TOP Select only) No yearly enrollment fee for ADFMs. It is based on region so you have to add your locality before determining rates. Updated Pricing for codes 0596T & 0597T effective February 7, 2022. Applied Behavior Analysis (ABA) Billing. Please provide widest dissemination. Help us improve this article with your feedback. VA Community Nursing Home (CNH) Fee Schedule follows the Prospective Payment System (PPS) billing requirements found in Medicare Claims Processing Manual, Chapter 6Skilled Nursing Facility (SNF) Inpatient Part A Billing and SNF Consolidated Billing with some exceptions. For care rendered in a facility setting, refer to the Yes column for reimbursement rate. Some documents are presented in Portable Document Format (PDF). If you are trying to evaluate a Tricare contract or compare fees under CMAC, the below links are a great place to start. The page you're looking for has either moved or been removed. The maximum allowable rate is generally the applicable Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). Humana tricare east fee schedule Tricare maximum allowable charge . Some examples of in-network co-pays for services: Primary care outpatient visits in the Tricare Select network: For active duty families, the cost increases by $1, to $25, for those in Group A, and by $2, to $18, for those in Group B. You should check out the TRICARE Costs and Fees 2022 Fact Sheet. Thats not sustainable. If yes, Do you need to file a TRICARE Overseas claim for medical care or prescriptions you received overseas? All rights reserved. Dental reimbursement rates are proprietary and are not publicly available. Memo outlining the TRICARE Prime and TRICARE Select beneficiary out-of-pocket expenses for calendar year 2020. The TRR plan is limited to Reserve service members (and their dependents) who are qualified for non-regular retirement, under the age of 60 and are not . 7700 Arlington Boulevard Falls Church, VA 22042-5101, All impacted Army Active Guard and Reserve records and TRICARE health plans have been corrected and reinstated. VA covers some services under CNH authorizations that are not considered part of the nursing home PPS, listed below. These viruses can cause severe illness in some people, so its important to know what to do if you feel under the weather. Medicare Claims Processing Manual, Chapter 6, Optum Customer Service: CCN Region 1: 888-901-7407CCN Region 2: 844-839-6108CCN Region 3: 888-901-6613, Veterans Crisis Line: Select your region to find forms you need to set up allotments, electronic funds transfers and other direct payment methods: Sign up to receive TRICARE updates and news releases via email. There are also increases in the cap for working-age retirees, their families and others in Tricare Select. The handbook is updated annually and contains important information about TRICARE contract requirements along with the most recent updates. TRICARE For Life. Health (Just Now) . Common CPT Codes for psychotherapy include: When looking up these codes, you will typically be consulting the "Non-Physician" and "Non-Facility" price. A referral is when your primary care manager (PCM) or primary care provider sends you to another provider or specialist for care. All rights reserved. Such hyperlinks are provided consistent with the stated purpose of this website. Those in Group A will see an increase of $322, to $4,028. 3/2/2023 Leaders Emphasize Inspiring Change Creating Community at DHAs Black History Month Observance 3/1/2023 Defense Intrepid Network Supports Service Members Across the Continuum 2/27/2023 DHA Supports National Guard and Reserve Deployment Health Needs The Defense Health Agency offers this information as a reference. The VA will typically reimburse providers at 100% of the CMAC fee schedule whereas Tricare will typically pay a percentage of the CMAC fee schedule. Providers will bill fee-for-service using the following procedure code: G0156. Although the DHA may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Here is a link to some tools used to find out the allowable charge for different procedure codes. Some will also see increases in their annual deductible, meaning they will have to spend more out of pocket before Tricare starts to pay. VA will use the Patient Driven Payment Model-based (PDPM) pricing software using the following specifications: CNH day 1-100: multiply physical therapy (PT), occupational therapy (OT), speech language pathology (SLP), nursing, and non-case-mix components by 0.6 in addition to any other adjustment factors. Fact Sheets. Enter the procedure code that you want to look up (i.e. 2023 Alaska VA Fee Schedule (Effective for services on or after Feb. 1, 2023). Enter the procedure code that you want to look up (i.e. For retirees, their families, and others: In the event neither a CMS nor VA Fee Schedule rate is available, Third Party Administrators (TPAs) reimburse a percentage of billed charges. This information can be found at www.tricare.mil/trs and www.tricare.mil/trr. For TYA Select, a 10% increase to $291 a month . Due to potential mail delays caused by COVID-19, we encourage you to use our electronic processes whenever possible. Urgent care center visits in Tricare Prime for working-age retirees: Co-pays increase by $3, to $36. As mentioned in the HELP article, fee schedules, your contract will determine your rates, but this will give you a general idea if you are interested in getting started in with Tricare. This is the only time of year when those eligible for, or enrolled in, Tricare Prime or Tricare Select can make changes to their health care coverage unless they have a qualifying life event during the year, such as a marriage, birth, permanent change of station move or retirement. Active duty families in Tricare Select dont pay annual enrollment fees, but they will see small co-payment increases, generally by a few dollars, for most services starting Jan. 1. But when it comes to your health care coverage, personal milestones like these, as well as many other changes in your life, are known as Qualifying Life Events (QLEs). Schedule of Allowance. We offer a Summary of 2021 to 2022 Provider Handbook Changes guideso you can easily view changes for the new year. When you get married or move to a new state, updating your health plan probably isnt the first thing on your mind. Sorry we couldn't be helpful. The Defense Health Agency held a Black History Month event, themed Inspiring Change, on Feb. 15. Tricare Young Adult: For TYA Prime, an increase of 11% to $570 a month. Because COLA for 2022 is higher than it has been for decades (5.9%), the dollar amounts of TRICARE fee increases will also be higher than we have seen in the recent past. Providers needing assistance with identification of locality and carrier information are encouraged to refer to the appropriate CMS locality and carrier key available at CMS.gov Centers for Medicare & Medicaid Services website. TRICARE is a registered trademark of the Department of Defense (DoD),DHA. For the most accurate information or questions about rates, policies, etc., please contact your managed care support contractor. Wallet Card. Check this page regularly to find the latest rates, and sign up for the. Identify the Medicare locality and carrier for the location where services were rendered. Physician Services: Providers delivering federally mandated or separately authorized services shall bill fee-for-service. In any of these cases, make sure your OHI information with TRICARE is current so your health care claims are processed accurately. You may have had OHI last year, but now no longer. Learn What's New for CY 2023. Nursing homes are required to submit separate claims for these services. Protect Yourself From Respiratory Illness This Winter. Vision and eye health are an important part of supporting an overall healthy lifestyle. If yes, the TRICARE Dental Program (TDP) provides dental coverage around the world. Such links are provided consistent with the stated purpose of this website. Some documents are presented in Portable Document Format (PDF). Its really putting military families with young adult dependents at a huge disadvantage. Dec. 21, 2022. A . ASC file. FALLS CHURCH, Va. Find Your TRICARE Costs With Compare Cost Tool. The fee schedules below are effective for dates of service January 1, 2022, through December 31, 2022. This is a great place to, No one is entirely sure of the extent of these changes but one thing we, Covid-19 has brought about significant changes to patient care and afforded new opportunities for medical, 3 Ways to Assess Viability Number 1: Which insurers are my targeted patient population using?, Starting a practice is an incredibly difficult process and recent panel closures have made it, All Rights Reserved. 2. >>. Urgent care center visits in Tricare Select: For active duty families in Group A, co-pay increases by $1, to $25, and by $2, to $24, for Group B. 2022 Fee Schedules. Access Medi-Span website here , but note that use of this website may require a paid . Falls Church, VA 22042-5101, All impacted Army Active Guard and Reserve records and TRICARE health plans have been corrected and reinstated. Kellen Kroening). Or perhaps youve recently gained or changed OHI. Download a PDF Reader or learn more about PDFs. Topics include verifying eligibility, claims billing tips, how to update demographic information, and other provider resources. FALLS CHURCH, Va. Active duty service members and their families in Tricare Prime (including U.S. Family Health Plan) dont pay annual enrollment fees, annual deductibles or out-of-pocket costs for covered services. VA has adjusted the yearly fee schedule update cycle to ensure rate settings take into account comprehensive data from other sources. Find theright contact infofor the help you need. Fevers and sniffles and coughsoh my! Step 4: Shall compare all procedures assigned to a group under this methodology with the current Medicare ASC payment. Don't forget to look at our updated printablequick reference chartsfor your office use. All rights reserved. Some documents are presented in Portable Document Format (PDF). Find the right contact infofor the help you need. Have Diabetes? 7700 Arlington Boulevard 2021 CHP+ FFS Rate Schedule. reference (b) is department of defense instruction 1241.04, tricare reserve select . These rates will be effective January l, 2020. As announced earlier, the rates have increased for the Tricare premium-based programs Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve as determined earlier by the Defense Health Agency. An official website of the United States government, Family members of 128th Air Refueling Wing Airmen welcome home and embrace their loved ones here at General Mitchell Field, Milwaukee, Wisconsin, Oct. 19, 2021. Identify the setting in which care was rendered. By law, there are differences in some costs based on when the sponsor entered the military. TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. TRICARE Dental Program May Be Right for You. In order to comply with the Protecting Access to Medicare Act (PAMA), Health First Colorado will adjust Clinical Diagnostic Laboratory Test (CDLT) rates on a per-test basis to align with Medicare's quarterly . So, for example, my family's catastrophic cap in 2023 is $4,028 (Group A, retiree, on TRICARE Select.) Tricare fees are based on your region and . Brand-name medications will cost $38, an increase of five dollars from 2021. For Community Care Network (CCN), when there is no Medicare rate available, the VA Fee Schedule dictates the maximum allowable rate where applicable. Did you find it helpful? >>. This memo establishes the 2018 premium rates for the TRICARE Young Adult (TYA) Program. The services will be reimbursed at the lesser of billed charges or the VA Fee Schedule. April. The cap is increasing for some beneficiaries in Prime and Select programs, except for active duty families in Group A, where it remains at $1,000, and retirees in Tricare Prime Group A, where it remains at $3,000. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Updated Pricing for codes 0100T, 0102T, 0650T . See the below for the following updates: Updated Pricing for codes G0339, G0340, 0275T, 0598T & 0599T effective January 1, 2022. Date of service: 8/1/2020. MOAA's 2021-2022 TRICARE Guide] Many TRICARE fees are increased annually by the amount of the military retired pay cost-of-living adjustment (COLA). It is not unusual for us to be asked 3-4 times per week about fees and how much the VA or Tricare pays for a particular procedure. 2021 Physicians' Fee Schedule. * Beginning December 8, 2017, dental offices will be prompted to change their United Concordia online account password every 90 days. 2. TRICARE is a registered trademark of the Department of Defense (DoD),DHA. This amount is known as the catastrophic cap, and it resets every year on Jan. 1. Learn More about COVID-19 and the COVID-19 vaccine. Please enter a valid email address, e.g. Sign up to receive TRICARE updates and news releases via email. It is not unusual for us to be asked 3-4 times per week about fees and how much the VA or Tricare pays for a particular procedure. A PDF reader is required for viewing. Rate: $824. Group B members pay $60 per individual, up from $56, and $121 per family, up from $112. FALLS CHURCH, Va. The2022 TRICARE West Region Provider Handbook, effective Jan. 1, 2022, is available online for providers to view. Hosted by Defense Media Activity - WEB.mil, $250/day up to 25% of hospital charges, plus 20% of separately billed services, $1,034/day up to 25% of hospital charges, plus 25% of separately billed services. FALLS CHURCH, Va. Those increases take effect Jan. 1, 2023. 2022. Although the DHA may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. (except those using TRICARE For Life). . Alaska providers: Please refer to information in Alaska Providers (below) for specifics related to care rendered in the state of Alaska. Such links are provided consistent with the stated purpose of this website. Please continue to visit www.tricare-west.com for the most up-to-date information. Health (7 days ago) WebWednesday, April 13, 2022 The CHAMPUS Maximum Allowable Charge (CMAC), . Active duty family members in Group A, grades E-5 and above, pay $150 per individual and $300 per family (no change). Tricare Open Season runs from Nov. 14 to Dec. 13. Q&A: Getting and Using Referrals With TRICARE. www.tricare.milis an official website of theDefense Health Agency (DHA), a component of theMilitary Health System. Attention A T users. Community Care Network (CCN) is the preferred national network VA uses to purchase care for Veterans in the community. Hit enter to expand a main menu option (Health, Benefits, etc). To be eligible to receive Aged Care in Australia, your loved one must be assessed by the Aged Care Assessment Team (ACAT). www.tricare.milis an official website of theDefense Health Agency (DHA), a component of theMilitary Health System. Suite 5101 Some military families will see a rise in their health care costs come January, even as theyre stretching their dollars to cover higher prices for food, fuel and other necessities. The services will be reimbursed at the lesser of billed charges or the Medicare Physician Fee Schedule. Doing Business with the Defense Health Agency, Defense Medical Readiness Training Institute, Defense Health Program Agency Financial Report, Ensuring Access to Reproductive Health Care, 5 MinuteConsult Mobile App & CME Instructions, ClinicalKey for Nursing Clinical Updates CE Instructions. Escort services: When an escort to a medical appointment is indicated, providers must get prior authorization from VA. Start 2023 Knowing Your TRICARE Plans Catastrophic Cap. You can apply for an assessment through My Aged Care. To enter and activate the submenu links, hit the down arrow. Care referred and/or purchased outside of CCN is billed to and paid by VA. The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U.S. Government sites or the information, products, or services contained therein. Download the 2023 TRICARE Costs and Fees Fact Sheet PDF; May be available in print at your local military hospital or clinic; Updated: February 2023; . For the best experience on this website, please disable all pop-up blockers and use one of the following Web browsers: Microsoft Edge, Safari, or Chrome. Please refer to VA referral for information on how care is referred and where to submit claims.