TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Using the Provider Portal: Claim Status: Claim Search Results Near the top of the ‘Claim Search Results’ page is a notice asking if you would like to view any linked documentation in your ‘Search Results’ claim details. Note: You will need Adobe Reader. If you do not have Adobe Reader on your computer, you can download the program by clicking on the ‘Adobe Reader’ link. Immediately following the notice are buttons labeled ‘Edit Search’ or ‘New Search’. If the search you performed does not show the results you wanted, you can click ‘Edit Search’, which will take you back to the Claim Search screen where you previously entered your search criteria. Or you can click on ‘New Search’ which will take you to the blank Claim Search screen where you can enter your search criteria. The screen will update to display your search results. The number of results you receive for any search will depend on the type of claim search performed and the number of claims you have submitted to the TOP Claims Customer Service Department in the last 30 months (based on when the claim is processed). The criteria for the search you just performed will appear immediately above your ‘Claim Search Results’ so that you can verify if the search was performed with the criteria you intended. If the criteria shown are not correct, you can click the ‘Edit Search’ button to modify the criteria and perform a new search. The ‘Location’ filter gives you the option to sort your ‘Claim Search Results’ by Tax ID and Zip Code. Note: There is a paging index that allows you to advance through multiple pages of ‘Claim Search Results.’ Click a page number to advance to that page or use the arrows to navigate through the ‘Claim Search Results’ one page at a time. 88
TRICARE overseas Program Provider Manual The ‘Claim Search Results’ box will list all claims that fit the criteria you selected for the search. The immediate search results display the following fields for each claim returned in the search: ■ Expand/Contract: This button allows you to display and hide additional details and functions for the claim specific to that ‘Claim Search Result’ line. ■ Explanation of Benefits (EoB): If an EOB has been generated for the claim, an icon linking to an Adobe .pdf version of the EOB will appear in this field. ■ Letters: If additional documentation has been generated by the TOP Claims Customer Service Department while processing your claim, an icon linking to an Adobe .pdf version of this documentation will appear in this field. ■ Invoice Number: This field will display your office Invoice Number for the claim if you provided one during the Online Claims submission process or for a claim that you have submitted via postal mail. ■ Date of Service: This field displays the end date for services listed on the claim. This field displays in the MM/DD/YYYY format. ■ Claim Number: This field displays the 14-digit claim control number assigned to your claim when it was received by the TOP Claims Customer Service Department. ■ Patient Name: This field displays the last name and first name of the patient on the claim. ■ Claim Status: This field displays the current status of your claim (i.e., where the claim is in the process of being handled by the TOP Claims Customer Service Department). Possible ‘Claim Status’ values include: ■ Currency: This field displays the currency code in which the claim the claim transaction was processed. Note: A currency code does not indicate there was a payment on the claim. ■ Process Date: This field will display the date on which the TOP Claims Customer Service Department took final action on the claim. If the claim status is In-Process, this field will be left blank. The date displays in the MM/DD/YYYY format. Note: You can expand a claim's record to see more details about how the claim was processed. Click the ‘Plus’ (+) symbol at the start of the record line to view the summary payment details. The expanded record's payment details are presented in 4 columns: ■ The first two columns detail the financial information for the claim: — The billed amount, the ‘Paid by Government’ amount, to whom the payment was directed (if a payment was made), and any beneficiary liability. — The third column gives the information for the Provider of services on record for the claim, including the individual or facility name and address. — The fourth column lists the check details, including the check or EFT transaction number, the issue date, and the payee (i.e., individual or facility recipient) of the payment. Clicking the ‘Full Claim Detail’ button gives you access to patient detail information and claim line item detail information. Note: Claim line item detail information is not available for claims that are labeled ‘In-Process.’ — In-Process — Payment — No Payment — Adjustment — Reissue — Credit ■ Billed Amount: This field displays the sum of all charges that were submitted on this claim. ■ Paid by Government: This field displays the amount of payment the TRICARE benefit program covers and reimbursed or paid on the claim to the Provider and/or patient. This field will display all zeroes (00000) if the claim is In- Process or No Payment could be made on the claim. SECTIoN 6 The Provider Portal 89
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TRICARE Overseas Program Provider Manual

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