The CHAMPUS Quality and Utilization Review Peer Review Organization program could also be applied by way of contracts administered by the Director, OCHAMPUS. These contractors might embody contractors which have unique functions in the area of utilization and quality evaluation, fiscal middleman contractors , and managed care contractors . Regardless of the contractors involved, utilization and quality evaluate activities follow the same standards, rules and procedures set forth on this part, unless in any other case specifically supplied in this section or elsewhere on this half. Special rule for TRICARE Prime Enrollees. In the case of a TRICARE Prime enrollee (see section 199.17) who receives approved care from a non-participating supplier, the CHAMPUS determined affordable charge will be the CMAC stage as established in paragraph of this section plus any balance billing quantity up to the steadiness billing restrict as referred to in paragraph of this part. The authorization for such care shall be pursuant to the procedures established by the Director, OCHAMPUS .

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