TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual ® ‘PT Resp’ means Patient’s Responsibility. TOP Prime beneficiaries receive a cashless service. Therefore, the deductibles and cost-shares are listed as $0.00. If any charges are denied, the denial code will be listed here. This is the total amount International SOS will reimburse. These are the dates of the ‘Episodes of Care’ as indicated on the invoice. These are the costs for the treatments the patient received. This is the total amount International SOS will reimburse. These are the CPT procedure codes. International SOS will translate the treatment details from the invoice into CPT codes. These are the costs that are allowed under the beneficiary’s TRICARE policy. If any payments are denied, a denial code will be indicated. An explanation of the code is given on the last page of the EOB. 52
TRICARE overseas Program Provider Manual On the bottom half of the EOB, you will find the payment summary showing the amount International SOS will reimburse and the amount that is still outstanding. A brief explanation of the Denial Codes (if any) will appear here. A full list of Denial Codes is available in Host Nation Languages on www.tricare-overseas.com. No charges have been denied, therefore there are no denial codes listed here. Here, you will find the exchange rate that was used. Exchange rates will be in effect on the last date of service. International SOS uses Citigroup’s exchange rates. This is a sample TOP Standard beneficiary EOB If more than one invoice is submitted, or if a single invoice for multiple procedures is submitted with a single Claim Form, the EOB will appear as follows: SECTIoN 5 Provider Claims Information These are the dates for the ‘Episodes of Care’ indicated on the Itemized Invoice. These are the CPT procedure codes. International SOS will translate the treatment details from the invoice into CPT codes. This EOB is for a Standard beneficiary and some of the services are not covered. Therefore, there is the total which is allowed under the policy; the amount the beneficiary must pay and the amount International SOS will reimburse. 53
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TRICARE Overseas Program Provider Manual

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