TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Authorization Forms (continued) Authorizations for Cases of Pregnancy All care related to pregnancy and childbirth is covered by one referral from the MTF. Authorization Forms will be issued to for 365 days to the OB/GYN or Medical Practitioner covering care. If any pregnancy and childbirth care (e.g., ultrasound scans) is to be conducted by other Providers, additonal Authorization Forms may be requested. The beneficiary or Provider should contact International SOS directly to request additional Authorization Forms. Patient Records and Privacy International SOS Network Providers must maintain medical health records for all TRICARE beneficiaries they treat. These records should be protected as stipulated by an addendum to the Mutual Cooperation Protocol. When possible, Network Providers should provide English language summaries of their records for inclusion in the patient’s U.S. military medical records. If you have any questions or need assistance in maintaining these records, please contact your TOP Regional Call Center or International SOS. Emergency Assistance Treatment and Authorizations and Payment If a TOP Prime or TOP Prime Remote beneficiary is unable to contact International SOS before receiving emergency care, then no Authorization Form or Authorization Number will be issued. The medical services rendered will be authorized retrospectively. Authorization Forms are not required to treat beneficiaries for Emergency Care. However, the words ‘Emergency Care’ or ‘Emergency Room’ must be written on the Claim Form or Itemized Invoice so that these claims are processed without an Authorization Number. Please refer to the TOP Provider Emergency Care brief available at www.tricare-overseas.com for more information on how to receive retrospective authorization and submit your Emergency Care claims on behalf of TOP Prime or TOP Prime Remote beneficiaries. Clear and Legible Reporting: Issuing a Medical Report Following Patient Care After providing care to a TRICARE beneficiary, please send a medical report of your findings and/or treatment to the referring party. The Authorization Form will clearly indicate whether this should be returned to your local MTF (for TOP Prime beneficiaries) or International SOS (for TOP Prime Remote beneficiaries). Cultural Differences and Host Nation Patient Liaisons Health care delivery in the United States may vary from local overseas practices. Language is the most obvious and challenging difference. Even if your English language skills are considered strong, it is important that any care instructions are clear and fully understood by the patient. You should be aware, language differences may discourage some patients from asking questions when they don’t understand. U.S. patients may have a high degree of modesty and find cultural differences in personal privacy to be uncomfortable, particularly in the hospital setting. Curtains or privacy screens are expected in hospital rooms and examination rooms in the U.S., and U.S. patients may find it very difficult to undress (to any degree) without them. To help make care more comfortable for TRICARE beneficiaries, most MTFs use one or more host nation patient liaisons. These liaisons are fluent in English as well as the local language, and are familiar with how the host nation health care system works. Their primary role is to assist U.S. patients in a hospital setting. They may also be used to assist with particularly difficult outpatient situations. You may already have an existing relationship with your local host nation patient liaison. You can be assured that this relationship will not be interrupted or changed in any way with TOP. 32
TRICARE overseas Program Provider Manual SECTIoN 5: Provider Claims Information As a TOP Host Nation Provider, you will be able to choose one of four methods for submitting your claims. A Standard U.S. Claim Form is required when submitting TRICARE claims for reimbursement. International SOS has designed its systems to support you with this process, by generating a partially completed Claim Form. You will receive this partially completed Claim Form with each authorization issued. This Claim Form must be submitted with an Itemized Invoice for services rendered. All Host Nation Providers will be required to submit a Standard U.S. Claim Form along with the invoice for reimbursement: ■ Non-Institutional Providers will be required to submit a CMS 1500 Claim Form (see Section 7) ■ Institutional Providers (e.g., hospitals) will be required to submit a UB-04 Claim Form (see Section 7) International SOS’ TOP Provider Support Services staff will work with you to show you how to complete the Claim Form properly. Detailed step-by-step instructions and tools are available, to help simplify the process of filling out and submitting Claim Forms. Process for Submitting Claims You can submit your claim using any of the following four methods: 1.) online Claim Submission: This is the preferred method for claims submission, as it significantly reduces the amount of time it takes for a claim to be received by our TOP Claims Processing Department and therefore can result in faster payments. Providers do not need to complete a paper Claim Form or produce an Itemized Invoice when using the Online Claim Submission method. After submitting your claim electronically, it can be tracked within 12 business hours. Note: A signed Electronic Data Interchange (EDI) Form must be submitted to International SOS before your claims can be submitted using the Online Claim Submission method. 2.) Secure Message Transmission: This claims submission method allows Providers to upload and send their claims and invoices via a Secure Messaging System. Claim Forms submitted using Secure Message Transmission can be tracked within 15 days of receipt. Providers must still complete the appropriate paper Claim Form and produce an Itemized Invoice when using this method of submission. 3.) Fax: This method should be used if the Provider does not have an Internet connection. This method will only work if the fax transmission is legible. Quality can be impacted by fax transmission and phone line connection. This method is also subject to overseas toll charges. Note: Fax submission is still faster than overseas mail. 4.) overseas Mail: This method should be used only when the other three claims submission methods (above) are not available. Depending on where the Provider is located, using overseas mail can significantly increase the amount of time it takes for claims to be received by our TOP Claims Processor and therefore can result in delayed payment. The following table details the benefits of each claims submission method: Benefits of Each Claims Submission Method Preference Submission Method #1 #2 Online Claim Submission Secure Message Transmission #3 Fax #4 Overseas Mail Internet Connection Cost Speed Tracking Claims Required Required Not Required Not Required None None $$ $ Received immediately Received immediately Received immediately Time it takes for claims to arrive depends on Provider’s location Within 12 business hours of receipt Within 15 days of receipt Within 15 days of receipt Within 15 days of receipt SECTIoN 5 Provider Claims Information 33
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TRICARE Overseas Program Provider Manual

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