TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Secure Message Transmission: New Claim/Claim Information Upload Attachments: You must upload at least one of the following: • UB-04 Claim Form • CMS 1500 Claim Form • Claim Development Worksheet *Attachments uploaded through the site, including the claim form or worksheet, must be in one of the file formats listed under the ‘Attachments’ field. There are additional attachment fields available for uploading other documents to accompany your claim. These additional attachment fields are optional. The screen will update to display the data fields you need to fill in along with the basic claim summary data fields for uploading the claim form and any additional attachments you wish to provide. Note: All fields are required unless otherwise noted: ■ Location: Select the physical location address where the service took place. ■ Total Billed Charges: Enter the sum of all charges on the claim form or worksheet. ■ Currency Type: Enter the name or code of the currency in which the claim charges are listed. Note: If the beneficiary has other health insurance, the claim will be paid in $USD (United States Dollars) regardless of the currency type listed here. ■ Invoice Number: This is an optional field to enter your office’s internal tracking number for the claim or bill. When all necessary fields are entered and your attachments have been uploaded, click ‘Next’. 38
TRICARE overseas Program Provider Manual Secure Message Transmission: Patient Information On the ‘Patient Information’ screen, you will be asked to provide the following patient information: • Sponsor Social Security Number (SSN): Select the patient’s benefit type from the drop down menu and then enter the corresponding benefit number in the text field to the right. • Patient First Name and Patient Last Name: Enter the patient’s first and last names in the corresponding fields. • Beginning Date of Service: Enter the earliest date of health care service as it is listed for the procedures being submitted on this claim. The date must be entered in MM/DD/YYYY format or you can click the calendar icon to select the date. • Ending Date of Service: Enter the last date of health care service as it is listed for the procedures being submitted on this claim. This date must be entered in the MM/DD/YYYY format or you can click the calendar icon to select the date. Click ‘Next.’ SECTIoN 5 Provider Claims Information 39
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TRICARE Overseas Program Provider Manual

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