TRICARE Overseas Program Provider Manual

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
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