TRICARE Overseas Program Provider Manual

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
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