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