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 />
SECTIoN 5:<br />
<strong>Provider</strong> Claims Information<br />
As a TOP Host Nation <strong>Provider</strong>, you will be able to choose one of<br />
four methods for submitting your claims. A Standard U.S. Claim<br />
Form is required when submitting <strong>TRICARE</strong> claims for<br />
reimbursement.<br />
International SOS has designed its systems to support you with<br />
this process, by generating a partially completed Claim Form.<br />
You will receive this partially completed Claim Form with each<br />
authorization issued. This Claim Form must be submitted with an<br />
Itemized Invoice for services rendered.<br />
All Host Nation <strong>Provider</strong>s will be required to submit a Standard<br />
U.S. Claim Form along with the invoice for reimbursement:<br />
■ Non-Institutional <strong>Provider</strong>s will be required to submit a CMS<br />
1500 Claim Form (see Section 7)<br />
■ Institutional <strong>Provider</strong>s (e.g., hospitals) will be required to<br />
submit a UB-04 Claim Form (see Section 7)<br />
International SOS’ TOP <strong>Provider</strong> Support Services staff will work<br />
with you to show you how to complete the Claim Form properly.<br />
Detailed step-by-step instructions and tools are available, to<br />
help simplify the process of filling out and submitting<br />
Claim Forms.<br />
Process for Submitting Claims<br />
You can submit your claim using any of the following four<br />
methods:<br />
1.) online Claim Submission: This is the preferred method for<br />
claims submission, as it significantly reduces the amount of<br />
time it takes for a claim to be received by our TOP Claims<br />
Processing Department and therefore can result in faster<br />
payments. <strong>Provider</strong>s do not need to complete a paper Claim<br />
Form or produce an Itemized Invoice when using the Online<br />
Claim Submission method. After submitting your claim<br />
electronically, it can be tracked within 12 business hours.<br />
Note: A signed Electronic Data Interchange (EDI) Form must<br />
be submitted to International SOS before your claims can be<br />
submitted using the Online Claim Submission method.<br />
2.) Secure Message Transmission: This claims submission<br />
method allows <strong>Provider</strong>s to upload and send their claims and<br />
invoices via a Secure Messaging System. Claim Forms<br />
submitted using Secure Message Transmission can be<br />
tracked within 15 days of receipt. <strong>Provider</strong>s must still complete<br />
the appropriate paper Claim Form and produce an Itemized<br />
Invoice when using this method of submission.<br />
3.) Fax: This method should be used if the <strong>Provider</strong> does not<br />
have an Internet connection. This method will only work if the<br />
fax transmission is legible. Quality can be impacted by fax<br />
transmission and phone line connection. This method is also<br />
subject to overseas toll charges.<br />
Note: Fax submission is still faster than overseas mail.<br />
4.) overseas Mail: This method should be used only when the<br />
other three claims submission methods (above) are not<br />
available. Depending on where the <strong>Provider</strong> is located, using<br />
overseas mail can significantly increase the amount of time it<br />
takes for claims to be received by our TOP Claims Processor<br />
and therefore can result in delayed payment.<br />
The following table details the benefits of each claims submission<br />
method:<br />
Benefits of Each Claims Submission Method<br />
Preference Submission<br />
Method<br />
#1<br />
#2<br />
Online<br />
Claim<br />
Submission<br />
Secure<br />
Message<br />
Transmission<br />
#3 Fax<br />
#4<br />
<strong>Overseas</strong><br />
Mail<br />
Internet<br />
Connection Cost Speed Tracking<br />
Claims<br />
Required<br />
Required<br />
Not<br />
Required<br />
Not<br />
Required<br />
None<br />
None<br />
$$<br />
$<br />
Received<br />
immediately<br />
Received<br />
immediately<br />
Received<br />
immediately<br />
Time it takes<br />
for claims to<br />
arrive depends<br />
on <strong>Provider</strong>’s<br />
location<br />
Within<br />
12<br />
business<br />
hours<br />
of<br />
receipt<br />
Within<br />
15 days<br />
of<br />
receipt<br />
Within<br />
15 days<br />
of<br />
receipt<br />
Within<br />
15 days<br />
of<br />
receipt<br />
SECTIoN 5<br />
<strong>Provider</strong> Claims Information<br />
33