Diagnosis Related Groups (DRG) Reimbursement (Two Parts)

OMB 0720-0017

Hospitals subject to the TRICARE DRG-based payment system who wish to be reimbursed for Allowed Capital and Direct Medical Education costs (as outlined in the TRICARE Reimbursement Manual) must submit a request for reimbursement to the appropriate TRICARE/CHAMPUS authorized contractors of Managed Care Support Contracts.

The latest form for Diagnosis Related Groups (DRG) Reimbursement (Two Parts) expires 2022-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
0720-0017_SS-A_3.28.22.docx Supporting Statement A
Diagnosis Related Groups (DRG) Reimbursement (Two Parts) Other-Letter with instructions

202203-0720-001 Approved without change	Revision of a currently approved collection	2022-03-29
201812-0720-001 Approved without change	Revision of a currently approved collection	2019-01-18
201510-0720-001 Approved without change	Reinstatement with change of a previously approved collection	2015-10-27
201207-0720-004 Approved without change	Reinstatement without change of a previously approved collection	2012-07-05
200708-0720-004 Approved without change	Extension without change of a currently approved collection	2007-08-31
200401-0720-001 Approved with change	Reinstatement without change of a previously approved collection	2004-01-29
199711-0720-001 Approved without change	Existing collection in use without an OMB Control Number	1997-11-10