TRICARE Overseas Program Provider Manual
TRICARE Overseas Program Provider Manual
TRICARE Overseas Program Provider Manual
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<strong>TRICARE</strong> overseas <strong>Program</strong><br />
<strong>Provider</strong> <strong>Manual</strong><br />
The Pre-Populated Claim Form UB-04<br />
When you receive<br />
an Authorization<br />
Form from<br />
International SOS,<br />
you will also<br />
receive a<br />
pre-populated<br />
Claim Form.<br />
All the fields<br />
highlighted in<br />
purple will be<br />
pre-populated.<br />
All the fields<br />
highlighted in<br />
green can be<br />
left blank.<br />
You will only have<br />
to complete these<br />
few fields shown<br />
here in white.<br />
SECTIoN 5<br />
<strong>Provider</strong> Claims Information<br />
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