TRICARE Overseas Program Provider Manual

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
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