TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Emergency Care If the Provider is providing Emergency Care, they will not necessarily have an Authorization Number. In this case, the Provider should write the words ‘Emergency Care’ in this section. EMERGENCY CARE 62
TRICARE overseas Program Provider Manual Part 4: Provider’s Details The ‘Federal Tax ID Number’ is the Provider’s TRICARE ID Number (or TEPRV). Please enter this here. Always indicate ‘Yes’ here. This ensures that payment goes to the Provider. If the patient has OHI, it will be the primary payer for the claim. After the OHI has processed the claim, indicate here how much they have paid. Also include any payments the patient has made towards the claim. If TRICARE is the patient’s only health insurance plan, leave this field blank. This must be signed and dated by the Provider. This does not necessarily have to be the attending physician, but can be signed by an authorized person. Note: The Provider ‘Signature on File’ procedure can be used here. Please enter the patient’s account number. This is generated by the Provider and should not be longer than 18 digits long. Please enter the Provider’s name and full physical address. Fields highlighted in green can be left blank Please enter the Provider’s full billing address if different to the physical address. SECTIoN 5 Provider Claims Information 63
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TRICARE Overseas Program Provider Manual

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