TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual The following email addresses are also available, for contacting your TOP Provider Support Services staff: Europe, Middle East & Africa providerseurasiaafrica@internationalsos.com Latin America and Canada providerslatinamerica@internationalsos.com Puerto Rico provider.inquiries.PR@internationalsos.com Asia-Pacific providersasiapacific@internationalsos.com Additionally, Providers can inquire about specific claims issues by sending their questions to the International SOS TOP Claims Processing Department via the Web-based Secure Message Transmission function on the Provider Portal. Please see Section 6: The Provider Portal for additional information about accessing the Secure Message Inbox. Reporting Fraud and Abuse International SOS as part of the TRICARE Overseas Program is committed to detecting, correcting, and preventing health care fraud and abuse. Fraud happens when a person or organization takes action to deliberately deceive others to gain an unauthorized benefit. Health care abuse occurs when Providers supply services or products that are medically unnecessary or that do not meet professional standards. Write to the customer service department for TOP to report suspected fraud and abuse: ATTN: TRICARE Program Integrity 1717 W. Broadway PO Box 7635 Madison, Wisconsin 53707 USA You can also send an email to reportit@wpsic.com or submit an electronic form posted on http://www.tricare-overseas.com/fraud.htm. Be sure to provide as much information as possible. Fraud or abuse issues can also be reported directly to TRICARE by emailing fraudline@dha.osd.mil. If you would like to obtain additional information about International SOS’ Program Integrity mission, please email ToPProgramIntegrity@internationalsos.com. Program Integrity information is also available online at www.tricare-overseas.com/fraud.htm. 8
TRICARE overseas Program Provider Manual SECTIoN 2: TRICARE overseas Program Benefits Identifying TRICARE Patients and Validating Coverage Sample ToP Prime and ToP Prime Remote Enrollment Cards SECTIoN 2 TRICARE overseas Program Benefits TRICARE is available to a range of members serving under the U.S. Department of Defense. It is important to remember that not all U.S. patients are TRICARE patients. Sample ToP Prime Enrollment Card ■ Front of Card Because there are so many types of U.S. military patients who may seek care from you, it is critical to properly identify both the patient and their TRICARE status. TRICARE patients who seek care from you will have some way to prove that they are TRICARE eligible – this can be a U.S. Military Identification Card, a written confirmation from the Military Treatment Facility (MTF), or an Authorization Form from International SOS. ■ Generally, children under 10 will not have their own Military Identification Card. The parent’s valid identification card is considered sufficient. ■ TRICARE Prime Enrollment Cards are only valid when presented with a valid Military ID Card or Common Access Card (CAC). Please ensure that the names on both cards match, that the expiration date on the Military ID Card or CAC has not lapsed, and that the photo on this card accurately represents the patient. ■ Back of Card ■ If you have a concern about an individual patient, you may contact your TOP Regional Call Center for assistance 24/7. ■ Providers are authorized and encouraged to photocopy both sides of a patient’s Military ID Card or TRICARE Enrollment Card. ■ Once the Provider is registered to the online Provider Portal available at www.tricare-overseas.com they will also be able to check a patient’s eligibility through the portal. Sample TOP Prime and TOP Prime Remote Enrollment Cards are included here for your reference. 9
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