TRICARE Overseas Program Provider Manual

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
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