TRICARE Overseas Program Provider Manual

TRICARE overseas Program
Provider Manual
Claims for Services Rendered
Before September 1, 2010
Effective September 1, 2010, all claims must be submitted using
one of the International SOS submission methods outlined. This
applies, even if treatment was provided for dates of service
before September 1, 2010.
For services delivered before September 1, 2010, a Claim Form
and Itemized Invoice must be submitted. The correct Claim Form
must be used, to ensure payment.
CMS 1500 (Non-Institutional Providers) and UB-04 (Institutional
Providers) Claim Forms can be downloaded at www.tricareoverseas.com.
Detailed instructions for completing these forms
can be found in Section 5 of this TOP Provider Manual. An online
eLearning Module on how to properly fill out your Claim Forms is
also available. Please contact your TOP Regional Call Center and
select option #5 to request access details on the eLearning
Module.
Claim Tracking and Monitoring
Once you become a registered user on the Provider Portal, you
can track your claims online at www.tricare-overseas.com.
After claims are submitted on this portal, they are entered into
International SOS’ system.
If you submitted your claims by overseas mail, overseas fax or
Secure Message, you can view them online within 15 days of
receipt. If you submitted your claims via Online Claim Submission
using the Provider Portal, you can view them online within
12 business hours.
Providers can search for claims using the patient’s name, the
sponsor’s Social Security Number or DOD Benefits Number, and
DOB, or Dates of Service, or Claim Number.
The claim status will indicate whether the claim is being
processed and if it has been paid. If the claim has been paid, the
claim status update will indicate how much has been paid or if
the claim has been denied. Once the claim has been processed,
the Provider will be able to view the Explanation of Benefits (EOB)
for that claim online.
Full instructions on using the Provider Portal ‘Dashboard’ features
are included in Section 6 of this TOP Provider Manual, see pages
77-85.
Timely Filing of Claims
All claims must be submitted within 1 year of the Date of Service.
Claims must be date stamped/received by International SOS
within 12 months of the last date of treatment in order to be
reimbursed. Any claims exceeding this 12 month timely filing
deadline will be declined.
Claim Reimbursement and
Payment
Provider payments can be made in the following ways:
■ By Check (Local Currency)
■ Bank Draft (Local Currency)
■ Electronic Fund Transfer (EFT) (Local Currency)
Payments will be made in the currency in which the invoice is
submitted, wherever possible. If the Provider submits an invoice in
U.S. Dollars, payment will be made in U.S. Dollar check. If invoices
are submitted in local currency, payment will be made by local
currency bank draft, whenever possible. International SOS can
make payments in over 100 currencies. If your currency is not
available, payment will be made by U.S. Dollar check. Checks and
bank drafts will be sent to the Provider by overseas mail.
If Providers would like to receive payment via Electronic Funds
Transfer (EFT), they must submit a request by completing and
submitting an EFT Form. EFT Forms can be downloaded at
www.tricare-overseas.com or you can contact your TOP
Regional Call Center and select option #5 to speak to a TOP
Provider Support Services staff member to obtain a form.
When completing the EFT Form, please be sure to include the
following information:
■ Provider ID number
■ The name of your bank and the name on the account
■ Account number or IBAN number
■ SWIFT code
Please also include the currency in which you would like to
receive payment. This must be the same as the currency in which
you submit your claims. If any of these details is incomplete or
missing, International SOS will not be able to process your EFT
request. Once your EFT is set up, this will be your default method
of payment.
EFT is our recommended method of payment, as it reduces the
amount of time it takes to receive payments.
Remittance advice will be sent to the Provider in the form of an
Explanation of Benefits (EOB). If the Provider receives payment
by U.S. Dollar check or bank draft, the EOB will be sent to you by
mail with the check or bank draft. If the Provider has an EFT set
up, EOBs will be sent separately by mail. EOBs are also available
to view online, on the Provider Portal available on www.tricareoverseas.com.
Please see Section 6: The Provider Portal for
additional information about viewing your EOB online.
SECTIoN 5
Provider Claims Information
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