TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Using the Provider Portal: Claim Status: Claim Search Details Historical details for each of these items include: - Eligibility - Other Health Insurance - Out-of-Pocket Expenses - Primary Care Manager Clicking the ‘Plus’ (+) symbol to expand the ‘Patient Eligibility’ section will allow you to see the patient's eligibility and benefit information corresponding to the dates of service of the claim. The eligibility record will display any records of any insurance program the beneficiary may have in addition to TRICARE and the dates that insurance program is effective. Out-of-Pocket expenses are also detailed here. Note: Financial values here will be up-to-date with the most recent claim processed for the beneficiary, but ‘In-Process’ claim values will not have been calculated against these benefits. Also, please note that all values appearing here are given in $USD (United States Dollars). Current Primary Care Manager information will be given in the third column. 90
TRICARE overseas Program Provider Manual Using the Provider Portal: Claim Status: Claim Search Details Clicking the ‘Plus’ (+) symbol to expand the ‘Claim Line Items’ section allows you to see details for each service, procedure or supply you billed for on the claim. Details will be listed using the following fields: ■ Service Description: Displays the code and partial description for the service, procedure, or supply. ■ Reason Code: This is a 3-character code indicating message from the TOP Claims Customer Service Department explaining claim processing actions take for that service, procedure or supply. You can select the code to view its explanation. ■ Start Date, Date of Service, and End Date of Service: The dates you provided to indicate the beginning and end of the procedure. ■ Billed Amount: The amount you charged for the service, procedure or supply. ■ Allowed Amount: The amount TRICARE deems the maximum amount for the service, procedure or supply. ■ Units: The number of times the procedure was performed or the supply provided during the dates of service. ■ 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. ■ Provider of Service: This field will list the name of the assigned individual Provider or facility that delivered the medical care on behalf of the beneficiary. Note: ‘Claim Line Item Details’ will not be available on claims that are labeled ‘In-Process.’ Full instructions on how to submit claims via ‘Online Claim Submission’ are included in Section 5 of this TOP Provider Manual (see pages 33-48). SECTIoN 6 The Provider Portal 91
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TRICARE Overseas Program Provider Manual

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