Interim Report on CHAMPUS Payment Practices

HRD-83-89: Published: Sep 8, 1983. Publicly Released: Sep 8, 1983.

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GAO reviewed current payment practices of the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) regarding implementation of prior GAO recommendations and the affect on CHAMPUS of reimbursements by other insurance carriers. Specifically, GAO analyzed: (1) methods to identify whether beneficiaries have other health insurance; (2) the adequacy of these techniques; and (3) additional methods to obtain other insurance carrier information.

GAO found that, although it had recommended changes to the CHAMPUS claim form certification statement concerning other insurance carriers, problems continue due to lack of data on the claim forms. Further, GAO found that CHAMPUS has not updated its forms. GAO suggested that CHAMPUS revise form DA 1863-1 to: (1) elicit a more informative response as to whether beneficiaries have other insurance and, if so, details concerning that insurance; and (2) contain clear instructions on supplying information about other insurance.

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