TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Secure Message Transmission: New Claim/Confirmation If you need to make changes to either the Claim Information section or the Patient Information section, click the ‘Edit’ button next to the section that requires changes. A Confirmation screen summarizing the data you entered will appear. Verify the information you provided. If all of the information is correct, click ‘Submit’ to send your claim to the TOP Claims Processor. When you click ‘Submit’ the screen will update to confirm that your TOP Claim has been successfully submitted via the Secure Message Transmission method. You will also receive an automated email response confirming your Secure Message Transmission. The automated email response will summarize the claim data you entered and will also provide you with the TOP claim number for your claim. The TOP claim number can be used to track the progress of your claim through the ‘Claim Status and Claims Report’ functions available in your secured account area. Note: The ‘Secure Message Transmission’ function should only be used to submit ONE claim per each secure message. 40
TRICARE overseas Program Provider Manual Claim Forms can be submitted in any language and invoices in any currency. Only one claim can be submitted per Secure Message Transmission transaction (the secure Provider portal will allow a maximum of 15MB total). The following formats are accepted: .doc, .xls, .jpg, .jpeg, .tf, .tiff or .pdf. The claim will be entered into the TOP Claims Processor’s system and can be tracked on the Secure Claims Portal using the patient’s name, the sponsor’s Social Security Number, DOD Benefits Number, DEERS Family ID, and DOB or Dates of Service. Claims will be available for you to review within 15 days of receipt. Secure Message Transmission through the Secure Claims Portal can be used to submit claims for TOP Prime and TOP Prime Remote beneficiaries. This transmission method can also be used if the Provider chooses to submit claims on behalf of TOP Standard beneficiaries. Note: Claims may not be emailed to International SOS directly. If Claim Forms and Itemized Invoices are emailed to International SOS directly, they will not be processed. online Claim Submission Note: Standard Web-based submission software packages such as PC-Ace require that all claims are submitted in U.S. Dollars. These packages are most suitable for Providers located in U.S. Territories familiar with Standard U.S. Claim Form procedures. For this reason, International SOS has developed a customized claims submission program, which is available on the un-secure Provider portal. User-friendly field descriptions and built-in prompts are used on this site to assist Providers in submitting claims. When using the ‘Online Claim’ submission option, claims can be tracked within 12 business hours of receipt. This portal also allows Providers to submit claims in certain foreign currencies. Using the Provider Portal to submit claims electronically is the recommended option for overseas Providers. This option significantly reduces the amount of time it takes to process payments. To use ‘Online Claim’ submission, you must first sign an Electronic Data Interchange (EDI) Agreement. The EDI Form is effectively a record of your signature on file for each claim that you submit through the portal. This form can be obtained from your International SOS TOP Provider Support Services staff, or it can be downloaded from www.tricare-overseas.com. A sample EDI Agreement Form can be found on page 105 of this TOP Provider Manual. All EDI Agreements are subject to acceptance by International SOS and Wisconsin Physicians Service (WPS). The second Web-based claims submission method is also available via the Secure Claims Portal on www.tricareoverseas.com. This portal has a custom-built ‘Online Claim’ submission option, which can be used to submit TOP Claims. Alternatively, Providers may download and submit claims using other Web-based submission software, such as PC-Ace. PC-Ace is available free of charge from International SOS. Please contact your TOP Regional Call Center and press option #5 to speak with a TOP Provider Support Services staff member to request this software. Claim Forms and Itemized Invoices are not required when submitting claims electronically through the Secure Claims Portal. Instead, Providers will be prompted to enter the claim data using ICD diagnosis codes and CPT procedure codes. These requirements vary slightly, depending on whether the claim is for an Institutional or Non-Institutional Provider. Finally, a clearing house or billing agency can be used for claims submission. In this case, it is the Provider’s responsibility to supply all required paperwork for accurate, complete processing of claims. If a clearing house or billing agency is used, a CMS 1500 Form or a UB-04 Form is still required. Note: Please visit www.tricare-overseas.com/provider.htm to download a Computer Based Training Module on Web-based ‘Online Claim’ submission of TOP claims. SECTIoN 5 Provider Claims Information 41
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TRICARE Overseas Program Provider Manual

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