[Title 32 CFR 732]
[Code of Federal Regulations (annual edition) - July 1, 2002 Edition]
[Title 32 - NATIONAL DEFENSE]
[Subtitle A - Department of Defense (Continued)]
[Chapter Vi - DEPARTMENT OF THE NAVY]
[Subchapter C - PERSONNEL]
[Part 732 - NONNAVAL MEDICAL AND DENTAL CARE]
[From the U.S. Government Printing Office]
32NATIONAL DEFENSE52002-07-012002-07-01falseNONNAVAL MEDICAL AND DENTAL CARE732PART 732NATIONAL DEFENSEDepartment of Defense (Continued)DEPARTMENT OF THE NAVYPERSONNEL
PART 732--NONNAVAL MEDICAL AND DENTAL CARE--Table of Contents
Subpart A--General
Sec.
732.1 Background.
732.2 Action.
Subpart B--Medical and Dental Care from Nonnaval Sources
732.11 Definitions.
732.12 Eligibility.
732.13 Sources of care.
732.14 Authorized care.
732.15 Unauthorized care.
732.16 Emergency care requirements.
732.17 Nonemergency care requirements.
732.18 Notification of illness or injury.
732.19 Claims.
732.20 Adjudication authorities.
732.21 Medical board.
732.22 Recovery of medical care payments.
732.23 Collection for subsistence.
732.24 Appeal procedures.
Subpart C--Accounting Classifications for Nonnaval Medical and Dental
Care Expenses and Standard Document Numbers
732.25 Accounting classifications for nonnaval medical and dental care
expenses.
732.26 Standard document numbers.
Authority: 5 U.S.C. 301; 10 U.S.C. 1071-1088, 5031, 6148, 6201-6203,
and 8140; and 32 CFR 700.1202.
Source: 52 FR 32297, Aug. 27, 1987, unless otherwise noted.
Subpart A--General
Sec. 732.1 Background.
When a U.S. Navy or Marine Corps member or a Canadian Navy or Marine
Corps member receives authorized care from other than a Navy treatment
facility, care is under the cognizance of the uniformed service medical
treatment facility (USMTF) providing care, the USMTF referring the
member to another treatment source, or under the provisions of this
part. If such a member is not receiving care at or under the auspices of
a Federal source, responsibility for health and welfare, and the
adjudication of claims in connection with their care, remains within the
Navy Medical Department. Part 728 of this chapter and NAVMEDCOMINST
6320.18 contain guidelines concerning care for other eligible
beneficiaries, not authorized care by this part.
Sec. 732.2 Action.
Ensure that personnel under your cognizance are made aware of the
contents of this part. Failure to comply with contents may result in
delayed adjudication and payment or may result in denial of Navy
financial responsibility for expenses of maternity, medical, or dental
care obtained.
Subpart B--Medical and Dental Care From Nonnaval Sources
Sec. 732.11 Definitions.
Unless otherwise qualified in this part the following terms when
used throughout are defined as follows:
(a) Active duty. Full-time duty in the active military service of
the United States. Includes full-time training duty; annual training
duty; and attendance, while in the active military service, at a school
designated as a service school by law or by the Secretary of the
military department concerned.
(b) Active duty for training. A specified tour of active duty for
Reserves for training under orders that provides for automatic reversion
to non-active duty status when the specified period of active duty is
completed. It includes annual training, special tours, and the initial
tour performed by enlistees without prior military service. The period
of duty includes travel to and from training duty, not in excess of the
allowable constructive travel time prescribed by SECNAVINST 1770.3 and
paragraphs 10242 and 10243 of DOD Military Pay and Allowances
Entitlements Manual.
(c) Constructive return. For purposes of medical and dental care, an
unathorized absentee's return to military control may be accomplished
through notification of appropriate military authorities as outlined
below.
(1) For members in an unauthorized absentee (UA) status,
constructive return to military control for the purpose of providing
medical or dental care at Navy expense is effected when one of the
following has occurred:
(i) A naval activity informs a civilian provider of medical or
dental care that
[[Page 349]]
the Navy accepts responsibility for a naval member's care. The naval
activity providing this information must also provide documentation of
such notification to the appropriate adjudication authority in
Sec. 732.20.
(ii) A member has been apprehended by civil authorities at the
specific request of naval authorities and naval authorities have been
notified that the member can be released to military custody.
(iii) A naval member has been arrested, while in a UA status, by
civil authorities for a civil offense and a naval authority has been
notified that the member can be released to military control.
(2) When a naval member has been arrested by civil authorities for a
civil offense while in a UA status and the offense does not allow
release to military control, constructive return is not accomplished.
The individual is responsible for medical and dental care received prior
to arrest and the incarcerating jurisdiction is responsible for care
required after arrest.
(d) Designated Uniformed Services Treatment Facilities (Designated
USTFs). Under Pub. L. 97-99, the following facilities are ``designated
USTFs'' for the purpose of rendering medical and dental care to all
categories of individuals entitled to care under this part.
(1) Sisters of Charity of the Incarnate Word Health Care System,
6400 Lawndale, Houston, TX 77058 (713) 928-2931 operates the following
facilities:
(i) St. John Hospital, 2050 Space Park Drive, Nassau Bay, TX 77058,
telephone (713) 333-5503. Inpatient and outpatient services.
(ii) St. Mary's Hospital Outpatient Clinic, 404 St Mary's Boulevard,
Galveston, TX 77550, telephone (409) 763-5301. Outpatient services only.
(iii) St. Joseph Hospital Ambulatory Care Center, 1919 La Branch,
Houston, TX 77002, telephone (713) 757-1000. Outpatient services only.
(iv) St Mary's Hospital Ambulatory Care Center, 3600 Gates
Boulevard, Port Arthur, TX 77640 (409) 985-7431. Outpatient services
only.
(2) Inpatient and outpatient services. (i) Wyman Park Health System,
Inc., 3100 Wyman Park Drive, Baltimore, MD 21211, telephone (301) 338-
3693.
(ii) Alston-Brighton Aid and Health Group, Inc., Brighton Marine
Public Health Center, 77 Warren Street, Boston, MA 02135, telephone
(617) 782-3400.
(iii) Bayley Seton Hospital, Bay Street and Vanderbilt Avenue,
Staten Island, NY 10304, telephone (718) 390-5547 or 6007.
(iv) Pacific Medical Center, 1200 12th Avenue South, Seattle, WA
98144, telephone (206) 326-4100.
(3) Outpatient services only. (i) Coastal Health Service, 331
Veranda Street, Portland, ME 04103 (207) 774-5805.
(ii) Lutheran Medical Center, Downtown Health Care Services, 1313
Superior Avenue, Cleveland, OH 44113, telephone (216) 363-2065.
(e) Duty status. The situation of the claimant when maternity,
medical, or dental care is received. Members, including reservists, on
leave or liberty are considered in a duty status. Reservists, performing
active duty for training or inactive duty training, are also considered
in a duty status during their allowable constructive travel time to and
from training.
(f) Emergency care. Medical treatment of severe life threatening or
potentially disabling conditions which result from accident or illness
of sudden onset and necessitates immediate intervention to prevent undue
pain and suffering or loss of life, limb, or eyesight and dental
treatment of painful or acute conditions.
(g) Federal facilities. Navy, Army, Air Force, Coast Guard, Veterans
Administration, and USTFs (former U.S. Public Health Service facilities
listed in Sec. 732.11(d).
(h) Inactive duty training. Duty prescribed for Reserves by the
Secretary of the Navy under Section 206 of Title 37, United States Code,
or any other provision of law. Also includes special additional duties
authorized for Reserves by an authority designated by the Secretary of
the Navy and performed by Reserves on a voluntary basis in connection
with the prescribed training or maintenance activities of units to which
they are assigned.
(i) Maternity emergency. A condition commencing or exacerbating
during pregnancy when delay caused by referral to a uniformed services
medical
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treatment facility (USMTF) or designated USTF would jeopardize the
welfare of the mother or unborn child.
(j) Member. United States Navy and Marine Corps personnel,
Department of National Defence of Canada Navy and Marine Corps
personnel, and Navy and Marine Corps personnel of other NATO Nations
meeting the requirements for care under this part.
(k) Non-federal care. Maternity, medical, or dental care furnished
by civilian sources (includes State, local, and foreign MTFs).
(l) Nonnaval care. Maternity, medical, or dental care provided by
other than Navy MTFs. Includes care in other USMTFs, designated USTFs,
VA facilities, as well as from civilian sources.
(m) Office of Medical Affairs (OMA) or Office of Dental Affairs
(ODA). Designated offices, under program management control of
COMNAVMEDCOM and direct control of regional medical commands,
responsible for administrative requirements delineated in this part.
Responsibilities and functional tasks of OMAs and ODAs are outlined in
NAVMEDCOMINST 6010.3.
(n) Prior approval. Permission granted for a specific episode of
necessary but nonemergent maternity, medical, or dental care.
(o) Reservist. A member of the Naval or Marine Corps Reserve.
(p) Supplemental care--(1) Operation and maintenance funds, Navy.
Supplemental care of all uniformed services members, at Navy expense,
encompasses only inpatient or outpatient care augmenting the capability
of a naval MTF treating a member. Such care is usually obtained from
civilian sources through referral by the treating naval MTF. If a
member, authorized care under this part, is admitted to or is being
treated on an outpatient basis at any USMTF, all supplemental care is
the financial responsibility of that facility regardless of whether the
facility is organized or authorized to provide needed health care. The
cost of such care is chargeable to operation and maintenance funds
(OM&N) available for operation of the USMTF requesting the care
regardless of service affiliation of the member (see part 728 of this
chapter for such care under Navy Medical Department facilities).
(2) Nonnaval medical and dental care program funds. Adjudication
authorities will pay claims, under this part, for care received as a
result of a referral when:
(i) A United States Navy or Marine Corps member or a Canadian Navy
or Marine Corps member requires care beyond the capability of the
referring USMTF and care is obtained for such a member not admitted to
or not being treated on an outpatient basis by a USMTF, and
(ii) The referring USMTF is not organized nor authorized to provide
the needed health care.
(3) Other uniformed services supplemental care programs. In addition
to services that augment other USMTF's capabilities, supplemental care
programs of the other uniformed services include care and services
comparable to those authorized by this part, e.g., emergency care and
pre-approved nonemergency care.
(q) Unauthorized absence. Absence or departure without authority
from a member's command or assigned place of duty.
(r) Uniformed Services Medical Treatment Facilities (USMTF). Health
care facilities of the Navy, Army, Air Force, Coast Guard, and the
former U.S. Public Health Service facilities listed in paragraph (d) of
this section designated as USTFs per DOD and Department of Health and
Human Services directives.
Sec. 732.12 Eligibility.
(a) Regular members. To be eligible for non-Federal medical, dental,
or emergency maternity care at Government expense, Regular active duty
United States naval members and Canadian Navy and Marine Corps members
must be in a duty status when care is provided.
(b) Reservists. (1) Reservists on active duty for training and
inactive duty training, including leave and liberty therefrom, are
considered to be in a duty status while participating in training.
Accordingly, they are entitled to care for illnesses and injuries
occurring while in that status.
(2) Reservists are entitled to care for injuries and illnesses
occurring during
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direct travel enroute to and from active duty training (ACDUTRA) and to
and from inactive duty training.
(c) NATO naval members. Naval members of the NATO Status of Forces
Agreement (SOFA) nations of Belgium, Denmark, Federal Republic of
Germany, France, Greece, Iceland, Italy, Luxembourg, the Netherlands,
Norway, Portugal, Spain, Turkey, and the United Kingdom, are authorized
outpatient care only under the provisions of this part when stationed in
or passing through the United States in connection with official duties.
Public Law 99-591 prohibits inpatient care of these foreign military
members in the United States at the expense of the United States
Government. The other NATO SOFA Nation, Canada, entered into a
comparable care agreement with the United States requiring the United
States to provide inpatient and outpatient care under the provisions of
this part to members of the Department of National Defence of Canada
receiving care in the United States.
(d) Absent without authority. Naval members absent without authority
during an entire episode of treatment are not eligible for non-Federal
medical, dental, or emergency maternity care at Government expense. The
only exception occurs when a member's illness or injury is determined to
have been the direct cause of the unauthorized absentee status. In such
an instance, eligibility will be:
(1) Determined to have existed from the day and hour of such injury
or illness provided the member was not in an unauthorized absentee
status prior to the onset of the illness or injury and initiation of
treatment.
(2) Retained when the member is returned directly to military
control.
(3) Terminated should the member return to an unauthorized absentee
status immediately after completion of treatment. Departmental level
(MEDCOM-333 for medical and MEDCOM-06 for dental) review is required
before benefits may be extended.
(e) Constructive return. When constructive return, defined in
Sec. 732.11(c), is effected, entitlement will be determined to have
existed from 0001 hours of the day of constructive return, not
necessarily the day and hour care was initiated.
Sec. 732.13 Sources of care.
(a) Initial application. If a member requires maternity, medical, or
dental care and naval facilities are unavailable, make initial
application to other available Federal medical or dental facilities or
USTFs. When members are stationed in or passing through a NATO SOFA
nation and U.S. facilities are unavailable, ensure that members make
initial application for emergency and nonemergency care to military
facilities of the host country, or if applicable, to civilian sources
under the NATO SOFA nation's health care program. When hospitalized in
Hawaii, Alaska, or in a foreign medical facility, members and
responsible commands will comply with OPNAVINST 6320.6.
(b) Secondary sources. When either emergency or nonemergency care is
required and there are no Federal or NATO SOFA facilities available,
care may be obtained from non-Federal sources under this part.
Sec. 732.14 Authorized care.
(a) Medical. (1) Consultation and treatment provided by physicians
or at medical facilities, and procedures not involving treatment when
directed by COMNAVMEDCOM, are authorized. Such care includes, but is not
limited to: treatment by physicians, hospital inpatient and outpatient
care, surgery, nursing, medicine, laboratory and x-ray services,
physical therapy, eye examinations, etc. See Sec. 732.17 for prior
approval of these services in nonemergency situations.
(2) When transplant (including bone-marrow) is the treatment of
choice, COMNAVMEDCOM approval is required. If time permits, telephone
(A) 294-1102, (C) (202) 653-1102 during regular hours or (A) 294-1327,
(C) 653-1327 after regular duty hours, and followup with a message.
Request approval via message in nonemergency situations.
(b) Maternity episode. If a member authorized care under this part
qualifies for care under the provisions of Sec. 732.17(c) and delivers
in a civilian hospital, routine newborn care (i.e., nursery, newborn
examination, PKU test,
[[Page 352]]
etc.) is a part of the mother's admission expenses. Regardless of
circumstances necessitating delivery in a civilian facility or how
charges are separated on the bill, charges will be paid from funds
available for care of the mother. If the infant becomes a patient in his
or her own right--through an extension of the birthing hospital stay
because of complications, transfer to another facility, or subsequent
admission--the provisions of part 728 of this chapter and NAVMEDCOMINST
6320.18 are applicable, and the sponsor becomes responsible for a part
of the medical expenses incurred.
(c) Dental. (1) With prior approval, the following may be provided:
(i) All types of treatment (including operative, restorative, and
oral surgical) to relieve pain and abort infection.
(ii) Prosthetic treatment to restore extensive loss of masticatory
function or the replacement of anterior teeth for esthetic reasons.
(iii) Repair of existing dental prostheses when neglect of the
repair would result in unserviceability of the appliance.
(iv) Any type of treatment adjunctive to medical or surgical care.
(v) All x-rays, drugs, etc., required for treatment or care in
paragraphs (c)(1) (i) through (iv) of this section.
(2) In emergencies (no prior approval), only measures appropriate to
relieve pain or abort infection are authorized.
(d) Eye refractions and spectacles. Includes refractions of eyes by
physicians and optometrists and furnishing and repairing spectacles.
(1) Refractions. A refraction may be obtained from a civilian source
at Government expense only when Federal facilities are not available, no
suitable prescription is in the member's Health Record, and the
cognizant OMA or referring USMTF has given prior approval.
(2) Spectacles. When a member has no suitable spectacles and the
lack thereof, combined with the delay in obtaining suitable ones from a
Federal source would prevent performance of duty; repair, replacement,
or procurement from a civilian source may be authorized upon initiation
of an after-the-fact request per Sec. 732.17. Otherwise, the
prescription from the refractionist, with proper facial measurements,
must be sent for fabrication to the appropriate dispensing activity set
forth in NAVMED COMINST 6810.1. See Sec. 732.15(g) concerning contact
lenses.
Sec. 732.15 Unauthorized care.
The following are not authorized by this part:
(a) Chiropractic services.
(b) Vasectomies.
(c) Tubal ligations.
(d) Breast augmentations or reductions.
(e) Psychiatric care, beyond the initial evaluation.
(f) Court ordered care.
(g) Contact lenses.
(h) Other elective procedures.
Sec. 732.16 Emergency care requirements.
Only in a bona fide emergency will medical, maternity, or dental
services be obtained under this part by or on behalf of eligible
personnel without prior authority as outlined below.
(a) Medical or dental care. A situation where the need or apparent
need for medical or dental attention does not permit obtaining approval
in advance.
(b) Maternity care. When a condition commences or exacerbates during
pregnancy in a manner that a delay, caused by referral to a USMTF or
USTF, would jeopardize the welfare of the mother or unborn child, the
following constitutes indications for admission to or treatment at a
non-Federal facility:
(1) Medical or surgical conditions which would constitute an
emergency in the nonpregnant state.
(2) Spontaneous abortion, with first trimester hemorrhage.
(3) Premature or term labor with delivery.
(4) Severe pre-eclampsia.
(5) Hemorrhage, second and third trimester.
(6) Ectopic pregnancy with cardiovascular instability.
(7) Premature rupture of membrames with prolapse of the umbilical
cord.
(8) Obstetric sepsis.
(9) Any other obstetrical condition that, by definition, constitutes
an emergency circumstance.
[[Page 353]]
Sec. 732.17 Nonemergency care requirements.
Members are cautioned not to obtain nonemergency care from civilian
sources without prior approval from the cognizant adjudication authority
in Sec. 732.20. Obtaining nonemergency care, other than as specified
herein, without documented prior approval may result in denial by the
Government of responsibility for claims arising from such care.
(a) Individual prior approval. (1) Submit requests for prior
approval of nonemergency care (medical, dental, or maternity) from non-
Federal sources to the adjudication authority (Sec. 732.20) serving the
geographic area where care is to be obtained. When the requirements of
Sec. 732.14(d)(2) are met and spectacles have been obtained, request
after-the-fact approval per this paragraph.
(2) Submit requests on a NAVMED 6320/10. Statement of Civilian
Medical/Dental Care, with blocks 1 through 7 and 19 through 25
completed. Assistance in completing the NAVMED 6320/10 can be obtained
from the health benefits advisor (HBA) at the nearest USMTF.
(3) Upon receipt, the adjudication authority will review the request
and, if necessary, forward it to the appropriate chief of service with
an explanation of non-Federal care regulations pertaining to the
request. The chief of service will respond to the request within 24
hours. The adjudication authority will then complete blocks 26 and 27,
and return the original of the approved/disapproved NAVMED 6320/10 to
the member.
(b) Blanket prior approval. (1) Recruiting offices and other
activities far removed from USMTFs, uniformed services dental treatment
facilities (USDTFs), designated USTFs, and VA facilities may request
blanket approval for civilian medical and dental care of assigned active
duty personnel. Letter requests should be submitted to the adjudication
authority (Sec. 732.20) assigned responsibility for the geographic area
of the requestor.
(2) With full realization that such blanket approval is an
authorization to obligate the Government without individual prior
approval, adjudication authorities will ensure that:
(i) Each blanket approval letter specifies a maximum dollar amount
allowable in each instance of care.
(ii) The location of the activity receiving blanket approval
authority is clearly delineated.
(iii) Travel distance and time required to reach the nearest USMTF,
USDTF, designated USTF, or VA facility have been considered.
(iv) Certain conditions are specifically excluded, e.g., psychiatric
care and elective surgical procedures. These conditions will continue to
require individual prior approval.
(v) COMNAVMEDCOM (MEDCOM-333) is made an information addressee on
each letter of authorization.
(c) Maternity care. (1) Pregnant active duty members residing
outside Military Health Services System (MHSS) inpatent catchment areas
of uniformed services facilities (including USTFs), designated in
Volumes I, II, and III of MHSS Catchment Area Directories, are permitted
to choose whether to deliver in a closer civilian hospital or travel to
a USMTF or USTF for delivery. If the Government is to assume financial
responsibility for non-Federal maternity care of any member regardless
of where she resides, the member must obtain individual prior approval
as outlined in paragraph (a) of this section. Adjudication authorities
should not approve requests from members residing within an inpatient
MHSS catchment area unless:
(i) Capability does not (did not) exist at the USMTF or other
Federal MTF serving her catchment area.
(ii) An emergency situation necessitated delivery or other treatment
in a non-Federal facility (Sec. 732.16(b)).
(2) Normal delivery at or near the expected delivery date should not
be considered an emergency for members residing within an MHSS inpatient
catchment area where delivery was expected to occur and, unless provided
for in this part, will not be reason for delivery in a civilian facility
at Government expense.
(3) When granted leave that spans the period of an imminent
delivery, the pregnant member should request a copy of her complete
prenatal care
[[Page 354]]
records from the prenatal care physician. The physician should note in
the record whether the member is clear to travel. If receiving prenatel
care from a USMTF, the HBA will assist the member in obtaining a
statement bearing the name of the MTF (may be an OMA) with
administrative responsibility for the geographic area of her leave
address, including the telephone number of the head of the patient
administration department or HBA, if available. If a member is receiving
prenatal care from other than a USMTF, she should avail herself of the
services of the nearest HBA to effect the aforestated services. This
statement should be attached to the approved leave request. In normal
deliveries, requests for after-the-fact approval should be denied when
members have not attempted to adhere to the provisions of this part.
(4) Upon arrival at the designated leave address, members should
contact the MTF indicated on the statement attached to their leave
request. The MTF will make a determination whether the member's leave
address falls within the inpatient catchment area of a USMTF or USTF
with the capability of providing needed care. If no such USMTF or USTF
exists, the member will be given the opportunity to choose to deliver in
a civilian hospital closer to her leave address or travel to the most
accessible USMTF or USTF with capability for maternity care.
(5) Upon determination that civilian sources will be used for
maternity care, the MTF listed on the attachment to the leave papers
will inform the member that she (or someone acting in her behalf) must
notify that MTF of the member's admission for delivery or other
inpatient care so that medical cognizance can be initiated.
(6) Automatically grant prior or retroactive approval, as the
situation warrants, to members requiring maternity care while in a
travel status in the execution of permanent change of station (PCS)
orders.
(d) Nonemergency care without prior approval. (1) If it becomes
known that a member intends to seek medical or dental care (inpatient or
outpatient) from a non-Federal source and prior approval has not been
granted for the use of the Nonnaval Medical and Dental Care Program, the
member must be counseled by, or in the presence of, a Medical Department
officer. Request that the member sign a statement on an SF 600,
Chronological Record of Medical Care, or an SF 603 or 603A, Health
Record, Dental as appropriate, for inclusion in the member's Health
Record. The statement must specify that counseling has been
accomplished, and that the member understands the significance of
receiving unauthorized civilian care. This must be accomplished when
either personal funds or third party payor (insurance) funds are
intended to be used to defray the cost of care. Counseling will include:
(i) Availability of care from a Federal source.
(ii) The requirement for prior approval if the Government may be
expected to defray any of the cost of such care.
(iii) Information regarding possible compromise of disability
benefits should a therapeutic misadventure occur.
(iv) Notification that should hospitalization become necessary, or
other time is lost from the member's place of duty, such lost time may
be chargeable as ``ordinary leave.''
(v) Notification that the Government cannot be responsible for out-
of-pocket expenses which may be required by the insurance carrier or
when the member does not have insurance which covers the cost of
contemplated care.
(vi) Direction to report to a uniformed services medical officer
(preferably Navy) upon completion of treatment for determination of
member's fitness for continued service.
(2) If it becomes known that a member has already received non-
Federal medical care without prior authorization, refer the member to a
uniformed services medical officer (preferably Navy) to determine
fitness for continued service. At this time, counseling measures
delineated in paragraph (d)(1)(iii), (iv), and (v) of this section must
be taken.
Sec. 732.18 Notification of illness or injury.
(a) Member's responsibility. (1) If able, members must notify or
cause their
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parent command, the nearest naval activity, or per OPNAVINST 6320.6, the
nearest U.S. Embassy or consulate when hospitalized in a foreign medical
facility to be notified as soon as possible of the circumstances
requiring medical or dental attention in a non-Federal facility. The
member will also assure (request the facility to make notification if
unable to do so personally) that the following information is passed to
the adjudication authority serving the area of the source of care
(Sec. 732.20). This notification is in addition to the requirements of
article 4210100 of the Military Personnel Command Manual (MILPERSMAN) or
Marine Corps Order 6320.3B, as appropriate. The adjudication authority
will then arrange for transfer of the member and, if appropriate,
newborn infant(s), to a Federal facility or for such other action as is
appropriate.
(i) Name, grade or rate, and social security number of patient.
(ii) Name of non-Federal medical or dental facility rendering
treatment.
(iii) Date(s) of such treatment.
(iv) Nature and extent of treatment or care already furnished.
(v) Need or apparent need for further treatment (for maternity
patients, need or apparent need for further care of infant(s) also).
(vi) Earliest date on which transfer to a Federal facility can be
effected.
(vii) Telephone number of attending physician and patient.
(2) Should movement be delayed due to actions of the member or the
member's family, payment may be denied for all care received after
provision of written notification by the adjudication authority.
(3) The denial is Sec. 732.18(a)(2) will be for care received after
the member's condition has stabilized and after the cognizant
adjudication authority has made a request to the attending physician and
hospital administration for the member's release from the civilian
facility. This notification must specify:
(i) Date and time the Navy will terminate its responsibility for
payment.
(ii) That care rendered subsequent to receipt of the written
notification is at the expense of the member.
(b) Adjudication authority. As soon as it is ascertained that a
member is being treated in a nonnaval facility, adjudication authorities
must make the notifications required in MILPERSMAN, article 4210100.11.
See part 728 of this chapter on message drafting and information
addressees.
(1) Article 4210100.11 of the MILPERSMAN requires submission of a
personnel casualty report, by priority message, to the primary and
secondary next of kin (PNOK/SNOK) of Navy members seriously or very
seriously ill or injured, and on those terminally ill (diagnosed and
confirmed). While submission of the personnel casualty report to the
PNOK and SNOK is a responsibility of the member's command, adjudication
authorities must advise the member's command when such a member is being
treated or diagnosed by non-Federal sources. The message will also
request forwarding of the member's service and medical records to the
personnel support detachment (PSD) supporting the activity in which the
OMA is located. Additionally, the notification should contain a request
for appropriate orders, either temporary additional duty (TEMADD) or
temporary duty (TEMPDU).
(i) Request TEMADD orders if care is expected to terminate within
the time constraints imposed for these orders.
(ii) Request TEMDU Under Treatment orders for members hospitalized
in a NMTF within the adjudication authority's area of responsibility.
(2) Make prompt message notification to the member's commanding
officer when apprised of any medical condition, including pregnancy,
which will now or in the foreseeable future result in loss of a member's
full duty services in excess of 72 hours. Mark the message ``Commanding
Officer's Eyes Only.''
Sec. 732.19 Claims.
(a) Member's responsibility. Members receiving care are responsible
for preparation and submission of claims to the cognizant adjudication
authority identified in Sec. 732.20. A complete claim includes:
(1) NAVMED 6320/10, Statement of Civilian Medical/Dental Care. In
addition to its use as an authorization document, the original and three
copies of a
[[Page 356]]
NAVMED 6320/10 are required to adjudicate claims in each instance of
sickness, injury, or maternity care when treatment is received from a
non-Federal source under the provisions of this part. The form should be
prepared by a naval medical or dental officer, when practicable, by the
senior officer present where a naval medical or dental officer is not on
duty, or by the member receiving care when on detached duty where a
senior officer is not present.
(i) For nonemergency care with prior approval, submit the NAVMED
6320/10 containing the prior approval, after completing blocks 8 through
18.
(ii) For emergency care (or nonemergency care without prior
approval), submit a NAVMED 6320/10 after completing blocks 1 through 18.
Assure that the diagnosis is listed in block 10. If prior approval was
not obtained, state in block 11 circumstances necessitating use of non-
Federal facilities.
(iii) Signature by the member in block 17 implies agreement for
release of information to the responsible adjudication authority
receiving the claim for processing. Signature by the certifying officer
in block 18 will be considered certification that documentation has been
entered in the member's Health Record as directed in article 16-24 of
MANMED.
(2) Itemized bills. The original and three copies of itemized bills
to show:
(i) Dates on or between which services were rendered or supplies
furnished.
(ii) Nature of and charges for each item.
(iii) Diagnosis.
(iv) Acknowledgment of receipt of the services or supplies on the
face of the bill or by separate certificate. The acknowledgment must
include the statement. ``Services were received and were satisfactory.''
(3) Claims for reimbursement. To effect reimbursement, also submit
the original and three copies of paid receipts and an SF 1164. Claim for
Reimbursement for Expenditures on Official Business, completed per
paragraphs 046377-2 a and b of the Naval Comptroller Manual (NAVCOMPT
MAN).
(4) Notice of eligibility (NOE) and line of duty (LOD)
determination. When a reservist claims benefits for care received
totally after the completion of either an active duty or active duty for
training period, the claim should also include:
(i) An NOE issued per SECNAVINST 1770.3.
(ii) An LOD determination from the member's commanding officer.
(b) Adjudicating authority's responsibility. Reviewing and
processing properly completed claims and forwarding approved claims to
the appropriate disbursing office should be completed within 30 days of
receipt. Advice may be requested from COMNAVMEDCOM (MEDCOM-333 (A/V 294-
1127)) for medical or MEDCOM-06 (A/V 294-1250)) for dental on unusual or
questionable instances of care. Advise claimants of any delay
experienced in processing claims.
(1) Review. The receiving adjudication authority will carefully
review each claim submitted for payment or reimbursement to verify
whether:
(i) Claimant was entitled to benefits (i.e., was on active duty,
active duty for training, inactive duty training, was not an
unauthorized absentee, etc.). As required by part 728 of this chapter, a
Defense Enrollment Eligibility Reporting System (DEERS) eligibility
check must be performed on claims to all claimants required to be
enrolled in DEERS.
(ii) Care rendered was due to a bona fide emergency. (Note: When
questions arise as to the emergency nature of care, forward the claim
and all supporting documentation to the appropriate clinical specialist
at the nearest naval hospital for review.)
(iii) Prior approval was granted if a bona fide emergency did not
exist. (Note: If prior approval was not obtained and the condition
treated is determined to have been nonemergent, the claim may be
denied.) Consideration should always be given to cases that would have
received prior approval but, due to lack of knowledge of the program,
the member did not submit a request.
(iv) Care rendered was authorized under the provisions of this part.
[[Page 357]]
(v) Care rendered was appropriate for the specific condition
treated. (NOTE: When questions arise regarding appropriateness of care,
forward all documentation to a clinical specialist at the nearest naval
hospital for review. If care is determined to have been inappropriate,
the claim may be denied to the extent the member was negligent.)
(vi) Claimed benefits did not result from a referral by a USMTF. If
the member was an inpatient or an outpatient in a USMTF immediately
prior to being referred to a civilian source of care, the civilian care
is supplemental and may be the responsibility of the referring USMTF.
See Sec. 732.11(p) for the definition of supplemental care.
(2) Dispproval. If a determination is made to disapprove a claim,
provide the member (and provider of care, when applicable) a prompt and
courteous letter stating the reason for the disapproval and the
appropriate avenues of appeal as outlined in Sec. 732.24.
(3) Processing. Subpart C contains the chargeable accounting
classifications and Standard Document Numbers (SDN) to be cited on the
NAVCOMPT 2277, Voucher for Disbursement and/or Collection, on an SF 1164
submitted per paragraph (a)(3) of this section, and on supporting
documents of approved claims before submission to disbursing offices.
(i) For payment to providers of care, a NAV COMPT 2277 will be
prepared and certified approved for payment by the adjudicating
authority. This form must accompany the NAVMED 6320/10 and supporting
documentation per paragraph 046393-1 of the NAVCOMPTMAN.
(ii) Where reimbursement is requested, the SF 1164 submitted per
Sec. 732.19(a)(3) will be completed, per paragraph 046377 of the
NAVCOMPTMAN, and certified approved for payment by the adjudicating
authority. This form must accompany the NAVMED 6320/10 and supporting
documentation.
(c) Amount payable. Amounts payable are those considered reasonable
after taking into consideration all facts. Normally, payment should be
approved at rates generally prevailing within the geographic area where
services or supplies were furnished. Although rates specially
established by the Veterans Administration, CHAMPUS, or those used in
Medicare are not controlling, they should be considered along with other
facts.
(1) Excessive charges. If any charge is excessive, the adjudication
authority will advise the provider of care of the conclusion reached and
afford the provider an opportunity to voluntarily reduce the amount of
the claim. If this does not result in a proper reduction and the claim
is that of a physician or dentist, refer the difference in opinions to
the grievance committee of the provider's professional group for an
opinion of the reasonableness of the charge. If satisfactory settlement
of any claim cannot thus be made, forward all documentation to
COMNAVMEDCOM (MEDCOM-333) for decision. Charges determined to be above
the allowed amount or charges for unauthorized services are the
responsibility of the service member.
(2) Third party payment. Do not withhold payment while seeking funds
from health benefit plans or from insurance policies for which premiums
are paid privately by service members (see Sec. 732.22 for possible
recovery of payments action).
(3) No-fault insurance. In States with no-fault automobile insurance
requirements, adjudication authorities will notify the insurance carrier
identified in item 16 of the NAVMED 6320/10 that Federal payment of the
benefits in this part is secondary to any no-fault insurance coverage
available to the potentially covered member.
(d) Duplicate payments. Adjudication authorities and disbursing
activities should take precautions against duplicate payments per
paragraph 046073 of the NAVCOMPTMAN.
Sec. 732.20 Adjudication authorities.
(a) General. Controlling activities for medical care in the United
States are designated as ``offices of medical affairs'' (OMA) and for
dental care, ``offices of dental affairs'' (ODA). NAVMEDCOMINST 6010.3
delineates responsibilities and functional tasks of OMAs and ODAs,
including monthly reporting of receipt of claims and claims payment.
Commanders of geographic
[[Page 358]]
naval medical commands must communicate with all activities in their
regions to ensure that messages and medical cognizance reports are
properly furnished per higher authority directives.
(b) Within the United States (less Hawaii). For the 48 contiguous
United States, the District of Columbia, and Alaska, the following six
regions are responsible for care rendered or to be rendered within their
areas of responsibility.
(1) Northeast Region. The States of Connecticut, Delaware, Illinois,
Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Minnesota,
Missouri, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode
Island, Vermont, and Wisconsin are served by 1 ODA and 1 OMA:
(i) Responsibility for dental matters for States in the Northeast
Region is vested in: Commander, Naval Medical Command, Northeast Region,
Office of Dental Affairs, Great Lakes, IL 60088, Tele: (A/V) 792-3940 or
(C) (312) 688-3940.
(ii) Responsibility for medical matters for States in the Northeast
Region is vested in: Commander, Naval Medical Command, Northeast Region,
Office of Medical Affairs, Great Lakes, IL 60088, Tele: (A/V) 792-3950
or (C) (312) 688-3950.
(2) National Capital Region. For the States of Maryland and West
Virginia; the Virginia counties of Arlington, Fairfax, Loudoun, and
Prince William; the Virginia cities of Alexandria, Falls Church, and
Fairfax; and the District of Columbia, responsibility for medical and
dental matters is vested in: Commander, Naval Medical Command, National
Capital Region, Office of Medical Affairs, Bethesda, MD 20814, Tele: (A/
V) 295-5322 or (C) (301) 295-5322.
(3) Mid-Atlantic Region. For the States of North Carolina, South
Carolina, and all areas of Virginia south and west of Prince William and
Loudoun counties, responsibility for medical and dental matters is
vested in: Commander, Naval Medical Command, Mid-Atlantic Region, 6500
Hampton Boulevard, Norfolk, VA 23502, Attn: Office of Medical/Dental
Affairs, Tele: (A/V) 565-1074/1075 or (C) (804) 445-1074 or 1075.
(4) Southeast Region. For the States of Alabama, Arkansas, Florida,
Georgia, Louisiana, Mississippi, Oklahoma, Tennessee, and Texas, medical
and dental responsibilities are vested in: Commanding Officer, Naval
Medical Clinic, Code O1A, New Orleans, LA 70146, Tele: (A/V) 485-2406/7/
8 or (C) (504) 361-2406 2407 or 2408.
(5) Southwest Region. For the States of Arizona and New Mexico; the
counties of Kern, San Bernadino, San Luis Obispo, Santa Barbara, and all
other California counties south thereof; the community of Bridgeport,
California (Marine Corps cold-weather training site); and Nevada, except
for NAS Fallon and its immediate area; medical and dental
responsibilities are vested in: Commander, Naval Medical Command,
Southwest Region, Office of Medical Affairs, San Diego, CA 92134-7000,
Tele: (A/V) 987-2611 or (C) 233-2611.
(6) Northwest Region. The States of Alaska, Colorado, Idaho, Kansas,
Montana, Nebraska, North Dakota, Oregon, South Dakota, Utah, Washington,
and Wyoming; the counties of Inyo, Kings, Tulare, and all other counties
of California north thereof; and NAS Fallon, Nevada and its immediate
area are served by 2 OMAs and 1 ODA:
(i) Responsibility for dental matters for the area of responsibility
of the Northwest Region is vested in: Commander, Naval Medical Command,
Northwest Region, Office of Dental Affairs, Oakland, CA 94267-5025,
Tele: (A/V) 855-6200 or (C) (415) 633-6200.
(ii) Responsibility for medical matters for the States of Colorado,
Kansas, and Utah; the California counties of Inyo, Kings, Tulare, and
all other counties of California north thereof; and NAS Fallon, Nevada
and its immediate area is vested in: Commander, Naval Medical Command,
Northwest Region, Oakland, CA 94627-5025, Attn: Office of Medical
Affairs, Tele: (A/V) 855-5705 or (C) (415) 633-5705.
(iii) Responsibility for medical matters for the States of Alaska,
Idaho, Montana, Nebraska, North Dakota, Oregon, South Dakota,
Washington, and Wyoming is vested in: Commanding Officer, Naval Medical
Clinic, Naval Station, Seattle, WA 98115, Attn: Office of Medical
Affairs, Tele: (A/V) 941-3823 or (C) (206) 526-3823.
[[Page 359]]
(c) Outside the United States (plus Hawaii). For all areas outside
the United States plus Hawaii, the following activities are vested with
responsibility for approval or disapproval of requests and claims for
maternity, medical, and dental care:
(1) Executive Director, OCHAMPUSEUR, U.S. Army Medical Command, APO
New York 09102, for care rendered within the U.S. European Command,
Africa, the Malagasy Republic, and the Middle East.
(2) Commanding Officer, U.S. Naval Hospital, FPO San Francisco
96652-1600 (U.S. Naval Hospital, Subic Bay, Luzon, Republic of the
Philippines), for care rendered in Afghanistan, Bangladesh, Hong Kong,
India, Nepal Pakistan, the Philippines, Southeast Asia, Sri Lanka and
Taiwan.
(3) Commanding Officer, U.S. Naval Hospital, FPO Seattle 98765-1600
(U.S. Naval Hospital, Yokosuka, Japan), for care rendered in Japan,
Korea, and Okinawa.
(4) Commanding Officer, U.S. Naval Hospital, FPO San Francisco
96630-1600 (U.S. Naval Hospital, Guam, Mariana Islands), for care
rendered in New Zealand and Guam.
(5) Commanding Officer, U.S. Naval Communications Station, FPO San
Francisco 96680-1800 (U.S. Naval Communications Station, Harold E. Holt,
Exmouth, Western Australia), for care rendered in Australia.
(6) Commanding Officer, U.S. Naval Air Station, FPO New York 09560
(U.S. Naval Air Station, Bermuda), for care rendered in Bermuda.
(7) Commanding Officer, U.S. Naval Hospital, FPO Miami 34051 (U.S.
Naval Hospital, Roosevelt Roads, Puerto Rico), for maternity and medical
care, and Commanding Officer, U.S. Naval Dental Clinic, FPO Miami 34051
(U.S. Naval Dental Clinic, Roosevelt Roads, PR), for dental care
rendered in Puerto Rico, the Virgin Islands, and other Caribbean
Islands.
(8) Commanding Officer, Naval Medical Clinic, Box 121, Pearl Harbor,
HI 96860, for maternity and medical care, and Commanding Officer, Naval
Dental Clinic, Box 111, Pearl Harbor, HI 96860, for dental care rendered
in the State of Hawaii, Midway Island, and the Central Pacific basin.
(9) The OMA for either the Southeast Region or the Southwest Region
for care rendered in Mexico to members stationed within the respective
areas of responsibility of these OMAs. Forward claims for care rendered
in Mexico to all other personnel to Commander, Naval Medical Command,
Washington, DC 20372-5120 (MEDCOM-333).
(10) Commander, Naval Medical Command, Washington, DC 20372-5120
(MEDCOM-333) for inpatient and outpatient emergency and nonemergency
care of active duty Navy and Marine Corps members in Canada and under
the circumstances outlined in paragraph (d) of this section.
(11) Outside the 50 United States, commanding officers of
operational units may either approve claims and direct payment by the
disbursing officer serving the command or forward claims to the
appropriate naval medical command in paragraphs (b)(1) through (c)(9) of
this section. This is a local policy decision to enhance the maintenance
of good public relations.
(12) The appropriate command in paragraphs (b)(1) through (c)(9) of
this section for care rendered aboard commercial vessels en route to a
location within the geographic areas listed.
(13) The commanding officer authorizing care in geographical areas
not specifically delineated elsewhere in this section.
(d) The Commander, Naval Medical Command (MEDCOM-333), Navy
Department, Washington, DC 20372-5120. Under the following
circumstances, responsibility is vested in COMNAVMEDCOM for adjudication
of claims:
(1) For reservists who receive treatment after completion of their
active duty or inactive duty training as prescribed in Sec. 732.12(b).
(2) For care rendered in Mexico to personnel stationed outside the
areas of responsibility of the Southeast and Southwest Regions.
(3) For care rendered to members stationed in or passing through
countries in Central and South America.
(4) For outpatient care rendered NATO active duty members.
(5) When Departmental level review is required prior to approval,
adjudication, or payment. These claims:
(i) Will be considered on appeal.
[[Page 360]]
(ii) Must be forwarded by the member through the adjudication
authority chain of command (In instances of unusual or controversial
denial of claims, the adjudication authority may forward claims to
COMNAVMEDCOM on appeal, via the chain of command, with notification to
the member.).
(6) For all inpatient and outpatient care of active duty Navy and
Marine Corps members stationed in the United States who receive care in
Canada.
Sec. 732.21 Medical board.
When adjudication authorities uncover conditions which may be
chronic or otherwise potentially disabling, they should make a
determination (with help from appropriate clinical specialists) as to
the need for a medical board. Chapter 18 of MANMED and Medical
Disposition and Physical Standards Notes, available from COMNAVMEDCOM
(MEDCOM-25), provide guidance.
(a) Chronic conditions requiring a medical board include (but are
not limited to):
(1) Arthritis,
(2) Asthma,
(3) Diabetes,
(4) Gout,
(5) Heart disease,
(6) Hypertension,
(7) Peptic ulcer disease,
(8) Psychiatric conditions, and
(9) Allergic conditions requiring desensitization.
(b) Other potentially disabling or chronic conditions may be
referred to a medical board by the adjudication authority with the
concurrence of an appropriate naval clinical specialist and the
commander of the regional medical command.
Sec. 732.22 Recovery of medical care payments.
Adjudication authorities must submit evidence of payment to the
action JAG designee per chapter 24 of the Manual of the Judge Advocate
General (JAGMAN), in each instance of payment where a third party may be
legally liable for causing the injury or disease treated, or when a
Government claim is possible under workers compensation, no-fault
insurance, or under medical payments insurance (all automobile accident
cases).
(a) To assist in identifying possible third party liability cases,
item 16 of each NAVMED 6320/10 must be completed whenever benefits are
received in connection with a vehicle accident. Adjudication authorities
should return for completion, as applicable, any claim received without
item 16 completed.
(b) The front of a NAVJAG Form 5890/12 (Hospital and Medical Care,
3rd Party Liability Case) must be completed and submitted by
adjudication authorities with evidence of payment. Block 4 of this form
requires an appended statement of the patient or an accident report, if
available. To ensure that Privacy Act procedures are accomplished and
documented, the person securing such a statement from a recipient of
care must show the recipient the Privacy Act statement printed at the
bottom of the form prior to securing such a statement. The member should
be asked to sign his or her name beneath the statement.
(c) For care rendered in States with no-fault insurance laws, comply
with procedures outlined in Sec. 732.19(c)(3).
Sec. 732.23 Collection for subsistence.
The Navy Pay and Personnel Procedures Manual provides guidance
regarding pay account checkage procedures to liquidate subsistence
charges incurred by members entitled to care under the provisions of
this part. Such members must also be entitled to basic allowance for
subsistence (BAS) while hospitalized at Government expense. The
responsible activity (the adjudication authority or the naval MTF to
which such a member is transferred) should follow procedures outlined in
the Navy Pay and Personnel Procedures Manual when an eligible officer or
enlisted member of the naval service is subsisted at Department of the
Navy expense while hospitalized in a nonnaval treatment facility.
Subpart C contains the creditable accounting classification for
inpatient subsistence collections.
Sec. 732.24 Appeal procedures.
When a claim for care or a request for prior approval for
nonemergency
[[Page 361]]
care is initially denied by an adjudication authority, the member may
appeal the denial as outlined below. Any level in the appeal process may
over-rule the previous decision and order payment of the claim in whole
or in part or grant the request for prior approval of care.
(a) Level I--Reconsideration by the adjudication authority making
the initial denial. The member should submit any additional information
that may mitigate the initial denial.
(b) Level II--Consideration by the commander of the regional medical
command having cognizance over the adjudication authority which upheld
the initial denial on reconsideration.
(c) Level III--Consideration by COMNAVMEDCOM (MEDCOM-333).
Subpart C--Accounting Classifications for Nonnaval Medical and Dental
Care Expenses and Standard Document Numbers
Sec. 732.25 Accounting classifications for nonnaval medical and dental care expenses.
----------------------------------------------------------------------------------------------------------------
OBJ.**
Approp. Sub-Head Class BCN SA AAA TT PAA Cost Code Purpose
----------------------------------------------------------------------------------------------------------------
17*1804 188M 000 00018 M 000179 2D MDQ000 990010000MDQ Outpatient Care
Service
Expenses.\1\ \2
\
17*1804 188M 000 00018 M 000179 2D MDT000 990010000MDT Outpatient Care
Supply
Expenses.\1\ \3
\
17*1804 188M 000 00018 M 000179 2D MDE000 990010000MDE Ambulance
Expenses.\1\
17*1804 188M 000 00018 M 000179 2D MDQI00 990020000MDQ Inpatient Care
Service
Expense.\1\ \2\
17*1804 188M 000 00018 M 000179 2D MDTI00 990020000MDT Inpatient Care
Supply
Expenses.\1\ \3
\
17*1804 188M 006 00018 M 000179 3C MDZI00 990020000MDZ Inpatient
Subsistence
Collections.\1\
----------------------------------------------------------------------------------------------------------------
Notes:
*For the third digit of the appropriation, enter the last digit of the fiscal year current at the time claim is
approved for payment.
**Refer to NAVCOMPT Manual par. 027003 for appropriate Expenditure Category Codes when disbursement or
collection involves a foreign or U.S. Contractor abroad.
\1\ Not applicable when care is procured from non-DOD sources for a patient receiving either inpatient or
outpatient care at a naval medical facility. In such instances, the expenses incurred are payable from
operations and maintenance funds available for support of the naval medical facility.
\2\ Service expenses include: hospital, emergency room clinic, office fees; physician and dentist professional
fees; laboratory, radiology, operating room, anesthesia, physical therapy, and other services provided.
\3\ Supply expenses include: medications and pharmacy charges; IV solutions; whole blood and blood products;
bandages; crutches; prosthetic devices; needles and syringes; and other supplies provided.
Sec. 732.26 Standard document numbers.
Adjudication authorities will assign to each claim approved for
payment, a unique 15 position alpha/numeric standard document number
(SDN). Prominently display this number on the NAVMED 6320/10, the
NAVCOMPT 2277 (Voucher for Disbursement and/or Collection), NAVCOMPT
1164 (Claim for Reimbursement for Expenditures on Official Business) and
on all other documentation accompanying claims. Compose SNDs per the
following example: N0016887MD00001 or N0016887RV00001.
[[Page 362]]
1 2 thru 6 7 & 8 9 & 10 11 thru 15
Position Entry ------------------------------------------------------------
N 00168 87 MD or RV 00001
--------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------
Position Data entry
------------------------------------------------------------------------
1................................. ``N'' identifies Navy.
2 thru 6.......................... Unit Identification Code of document
issuing activity.
7 and 8........................... Last two digits of the fiscal year
in which the claim is approved for
payment.
9 and 10,......................... For NAVCOMPT 2277s, ``MD''
identifies the document as
Miscellaneous Financial Document.
or, ....................................
9 and 10.......................... For SF 1164s, ``RV'' identifies the
document as a Reimbursement
Voucher.
11 thru 15........................ Consecutively assigned five digit
serial number beginning with
``00001'' each fiscal year. Each
subsequent claim will then be
serially numbered ``00002'',
``00003'', etc.
------------------------------------------------------------------------