SECTION 5: Provider Claims Information - TRICARE Overseas

TRICARE overseas ProgramProvider Manualonline Claim Submission: Enter Claim InformationIf you do not know the ICD diagnosis codes for thepatient's diagnosis, you can use the ‘Code Lookup’feature and search for the code by its description.To use the Code Lookup:• Click on ‘Code Lookup’• The ‘Diagnosis Lookup’ pop-up box will appear• Type the description of the diagnosis in the box• Click the ‘Search’ buttonA list of descriptions containing your search word willappear. The ICD code corresponding to eachdescription appears in the column to the left of thedescription. Find the diagnosis description for yourclaim and then click the code to the left to enter it intothe Diagnosis field of the online claim form.The Claim Information page is where you begin entering the dataabout the health care encounter. Required fields are indicatedwith an asterisk.In the Diagnosis section, enter the ICD diagnosis codes thatcorrespond to the reason the patient needed medical care. If youknow the ICD code that represents the patient's diagnosis, it canbe keyed directly into this field.Note: The Principal DX, or diagnosis, field is required for claimsprocessing. There are seven additional fields for entering otherdiagnoses describing the patient's condition. These additionalfields are optional.Select the ‘Assignment of Benefits’ indicator. Select ‘Yes’ if youwant to receive reimbursement directly from TRICARE.If the patient made a payment to you for services on this claimprior to this claim being submitted, you must indicate theirpayment amount in the ‘Patient Paid’ field. The amount enteredhere should be given in the currency you will select below.However, if the patient has OHI, the ‘Patient Paid’ field must becompleted in $USD (United States dollars).Note: This is a required field and must be completed, so if thereis no patient payment prior to claim submission, enter zeroes(0000000) in these fields.In the field ‘Patient has Other Health Insurance (OHI)’, if thepatient does not have another health insurance paying you forthis claim (i.e., before TRICARE will pay), select ‘No’ and continueto the next section of the form.SECTIoN 5Provider Claims Information45