TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Claim Status Using the Provider Portal: Claim Status: Basic Search The ‘Basic Search’ allows you to search for your claim information by your registered locations, including an option for all locations. The default selection is 'All Locations' but you can select a specific location from the drop down menu. If the location you want to look up is not on the drop down menu, you can register this new location by selecting the 'Request a New Location' link. The ‘Claim Status’ function allows you to search for claim information and data for claims you have submitted to the TOP Claims Customer Service Department. Note: The ‘Claim Status’ function has a 500-claim limit for search returns and can only return claim data for the last 18 months (based on when the claim is processed). Please select the appropriate criteria to filter your search to improve search return and portal performance. Next, select the cross-reference search type you would like to perform. The choices here include: ■ Patient Information: Selecting Patient Information allows you to input the data to find claims you submitted for a specific patient. Complete the following fields: — Sponsor Social Security Number (SSN): Enter the patient’s benefit eligibility number. — Patient First Name: Provide the patient’s first name. — Date of Birth: Enter the patient’s date of birth. The date format is MM/DD/YYYY. — Service Start/End Date: The system will default the service date fields to the last 30 days. If necessary, you can change this by typing new dates directly into these fields or by using the calendar icons to select new dates. — Claim Number: Selecting the Claim Number allows you to enter the full 14-digit number assigned to your claim and search for its status. Claim numbers are assigned immediately to your claims when you submit them using the Online Claims submission method on www.tricareoverseas.com ■ Check Number: Selecting the Check Number allows you to enter the full 11-character check number and search for claims processed under that check. Check numbers will appear on your Electronic Funds Transfer (EFT) or Automated Clearing House (ACH) credit advice, your weekly claim summary reports, and your dashboard. You can also find the 86
TRICARE overseas Program Provider Manual check number in the claim detail financial summary section. Note: When searching with an EFT or ACH check number, you must include the asterisk as the first character. ■ Invoice Number: Selecting the Invoice Number allows you to search for a claim with the identification code you have assigned to the claim. The Invoice Number search works for claims you have submitted, for which you have also entered an invoice identification code. Note: The Invoice Number search is limited to 20 characters maximum. Note: There is a ‘Reset Search’ button which will clear the entire page of any inputs or selected options, if needed. Once you are satisfied with the search criteria entered, click the ‘Search’ button to perform the location and patient search. Using the Provider Portal: Claim Status: Advanced Search Selecting the ‘Advanced Search’ tab gives you several additional search options, which include: ■ Individual Patient DEERS Family ID: Selecting this option allows you to search for a patient’s claim data by their 9-digit DEERS Family Identification Number. This option also requires that you enter the patient’s name, date of birth, and a selected date span for the claim search. ■ Individual Patient DoD Benefits Number (DBN): Selecting this option allows you to search for a patient’s claim data by 87 their 10-digit DOD Benefits Number. This option also requires that you enter the patient’s name, date of birth, and a selected date span for the claim search. ■ Process Date: Selecting this option allows you to enter a specific date and view all claims processed on that date. The date can be typed directly into the field in the MM/DD/YYYY format or it can be selected using the calendar icon. ■ All Patients: Selecting this option allows you to search for and view claim data for all patients as cross-referenced with the selected provider location(s). SECTIoN 6 The Provider Portal
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TRICARE Overseas Program Provider Manual

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