TRICARE Overseas Program Provider Manual
TRICARE Overseas Program Provider Manual
TRICARE Overseas Program Provider Manual
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<strong>TRICARE</strong> overseas <strong>Program</strong><br />
<strong>Provider</strong> <strong>Manual</strong><br />
Appendix<br />
ToP: Explanation of Benefits Denial Codes and Remarks<br />
Code Description Additional Information<br />
003<br />
See Item Five on Reverse. If you are not satisfied with our determination, you have<br />
the right to request a review within 90 days of the date of this notice.<br />
SECTIoN 8 / APPENDIX<br />
Acronyms<br />
004 Non-prescription drug – see Item Four on Reverse.<br />
008 Routine X-ray not covered – see Item Four on Reverse.<br />
009 Non-covered routine eye examination – see Item Four on Reverse.<br />
010 Routine lab not covered – see Item Four on Reverse.<br />
013 Eyeglasses/lenses not covered – see Item Four on Reverse.<br />
014 Routine foot care not covered – see Item Four on Reverse.<br />
018 <strong>Provider</strong> not <strong>TRICARE</strong>-authorized for this service.<br />
019 Personal comfort item not covered – see Item Four on Reverse.<br />
020 This charge included in a paid service.<br />
This is used when the <strong>Provider</strong> is<br />
billing for a procedure that is<br />
already accounted for in another<br />
procedure. For example, removal<br />
of cerumen (ear wax) is included in<br />
the office visit charge.<br />
027 Authorized service limits exceeded – see Item Four on Reverse.<br />
028 Requested Information Not Received.<br />
030 Service Filed After Time Limit.<br />
032 Non-covered Services.<br />
033 Duplicate of Services Previously Claimed (<strong>Manual</strong>).<br />
Services billed are not a covered<br />
service according to <strong>TRICARE</strong><br />
Policy.<br />
Upon manual review, it was<br />
determined this charge is a<br />
duplicate and has been paid<br />
previously on another line/claim.<br />
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