TRICARE Overseas Program Provider Manual

TRICARE overseas Program
Provider Manual
Part 1: Patient’s and Sponsor’s Details
Always choose the
TRICARE option.
Please enter the patient’s
DOB using the format
MM DD YY and tick M or F to
indicate the patient’s gender.
Enter the sponsor’s ID number (10-digit DOD
Benefit or 9-digit Social Security Number (SSN))
and name using the format Last Name, First
Name, Middle Initial. This information will appear
on the patient’s Military ID Card.
Enter the patient’s name,
using the format Last Name,
First Name, Middle Initial and
the patient’s full physical
address including post code.
Enter the patient’s relationship
to the sponsor.
Fields highlighted in green
can be left blank
Enter the sponsor’s
full address if different than
the patient’s.
If the patient has OHI enter
the name of the insured party
using the format Last Name,
First Name, Middle Initial, the
policy number and in field 9d
enter the name of the
insurance plan.
TRICARE is always the secondary
payer. If the patient has OHI policy,
tick ‘YES’ here and then
complete 9, 9a and 9d.
If the patient does not have OHI
policy, section 9 can be left blank.
Enter the sponsor’s DOB,
using the format MM DD YY
and indicate the sponsor’s
gender marking either M for
Male or F for Female.
SECTIoN 5
Provider Claims Information
Fields highlighted in green
can be left blank
59