TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual online Claim Submission: Verify a Patient Please verify that this is the patient’s current and correct address. If you have a more current address for the patient, select the ‘Edit’ button next to the address and input the up-todate correct address you have on file. This will help expedite the claims process. The selected patient's name, date of birth, gender indicator and address will appear on the screen. Please verify that this is the patient that corresponds with your TOP Claim before proceeding. Note: If the TOP Claims Processor has information that indicates the patient may have Other Health Insurance (OHI) that should pay on the claim before TRICARE makes payment, you will receive a notice. If your patient does have OHI that should be paying, you will be responsible for entering the OHI payment information when completing the ‘Claim Information’ section. You have the option to attach an invoice number or code used by your office to identify this claim. To use this feature, enter your invoice or tracking number in the open field provided. A maximum of 20 characters are allowed for the invoice number. Note: Adding an invoice number or code will allow you to easily track this claim on the Secure Claims Portal as you will be able to use the invoice number or code to search for the claim and view its processing status. Once you’ve verified the patient data, click ‘Next.’ 44
TRICARE overseas Program Provider Manual online Claim Submission: Enter Claim Information If you do not know the ICD diagnosis codes for the patient's diagnosis, you can use the ‘Code Lookup’ feature and search for the code by its description. To use the Code Lookup: • Click on ‘Code Lookup’ • The ‘Diagnosis Lookup’ pop-up box will appear • Type the description of the diagnosis in the box • Click the ‘Search’ button A list of descriptions containing your search word will appear. The ICD code corresponding to each description appears in the column to the left of the description. Find the diagnosis description for your claim and then click the code to the left to enter it into the Diagnosis field of the online claim form. The Claim Information page is where you begin entering the data about the health care encounter. Required fields are indicated with an asterisk. In the Diagnosis section, enter the ICD diagnosis codes that correspond to the reason the patient needed medical care. If you know the ICD code that represents the patient's diagnosis, it can be keyed directly into this field. Note: The Principal DX, or diagnosis, field is required for claims processing. There are seven additional fields for entering other diagnoses describing the patient's condition. These additional fields are optional. Select the ‘Assignment of Benefits’ indicator. Select ‘Yes’ if you want to receive reimbursement directly from TRICARE. If the patient made a payment to you for services on this claim prior to this claim being submitted, you must indicate their payment amount in the ‘Patient Paid’ field. The amount entered here should be given in the currency you will select below. However, if the patient has OHI, the ‘Patient Paid’ field must be completed in $USD (United States dollars). Note: This is a required field and must be completed, so if there is no patient payment prior to claim submission, enter zeroes (0000000) in these fields. In the field ‘Patient has Other Health Insurance (OHI)’, if the patient does not have another health insurance paying you for this claim (i.e., before TRICARE will pay), select ‘No’ and continue to the next section of the form. SECTIoN 5 Provider Claims Information 45
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