SECTION 5: Provider Claims Information - TRICARE Overseas

TRICARE overseas ProgramProvider ManualClaims for Services RenderedBefore September 1, 2010Effective September 1, 2010, all claims must be submitted usingone of the International SOS submission methods outlined. Thisapplies, even if treatment was provided for dates of servicebefore September 1, 2010.For services delivered before September 1, 2010, a Claim Formand Itemized Invoice must be submitted. The correct Claim Formmust be used, to ensure payment.CMS 1500 (Non-Institutional Providers) and UB-04 (InstitutionalProviders) Claim Forms can be downloaded at www.tricareoverseas.com.Detailed instructions for completing these formscan be found in Section 5 of this TOP Provider Manual. An onlineeLearning Module on how to properly fill out your Claim Forms isalso available. Please contact your TOP Regional Call Center andselect option #5 to request access details on the eLearningModule.Claim Tracking and MonitoringOnce you become a registered user on the Provider Portal, youcan track your claims online at www.tricare-overseas.com.After claims are submitted on this portal, they are entered intoInternational SOS’ system.If you submitted your claims by overseas mail, overseas fax orSecure Message, you can view them online within 15 days ofreceipt. If you submitted your claims via Online Claim Submissionusing the Provider Portal, you can view them online within12 business hours.Providers can search for claims using the patient’s name, thesponsor’s Social Security Number or DOD Benefits Number, andDOB, or Dates of Service, or Claim Number.The claim status will indicate whether the claim is beingprocessed and if it has been paid. If the claim has been paid, theclaim status update will indicate how much has been paid or ifthe claim has been denied. Once the claim has been processed,the Provider will be able to view the Explanation of Benefits (EOB)for that claim online.Full instructions on using the Provider Portal ‘Dashboard’ featuresare included in Section 6 of this TOP Provider Manual, see pages77-85.Timely Filing of ClaimsAll claims must be submitted within 1 year of the Date of Service.Claims must be date stamped/received by International SOSwithin 12 months of the last date of treatment in order to bereimbursed. Any claims exceeding this 12 month timely filingdeadline will be declined.Claim Reimbursement andPaymentProvider payments can be made in the following ways:■ By Check (Local Currency)■ Bank Draft (Local Currency)■ Electronic Fund Transfer (EFT) (Local Currency)Payments will be made in the currency in which the invoice issubmitted, wherever possible. If the Provider submits an invoice inU.S. Dollars, payment will be made in U.S. Dollar check. If invoicesare submitted in local currency, payment will be made by localcurrency bank draft, whenever possible. International SOS canmake payments in over 100 currencies. If your currency is notavailable, payment will be made by U.S. Dollar check. Checks andbank drafts will be sent to the Provider by overseas mail.If Providers would like to receive payment via Electronic FundsTransfer (EFT), they must submit a request by completing andsubmitting an EFT Form. EFT Forms can be downloaded atwww.tricare-overseas.com or you can contact your TOPRegional Call Center and select option #5 to speak to a TOPProvider Support Services staff member to obtain a form.When completing the EFT Form, please be sure to include thefollowing information:■ Provider ID number■ The name of your bank and the name on the account■ Account number or IBAN number■ SWIFT codePlease also include the currency in which you would like toreceive payment. This must be the same as the currency in whichyou submit your claims. If any of these details is incomplete ormissing, International SOS will not be able to process your EFTrequest. Once your EFT is set up, this will be your default methodof payment.EFT is our recommended method of payment, as it reduces theamount of time it takes to receive payments.Remittance advice will be sent to the Provider in the form of anExplanation of Benefits (EOB). If the Provider receives paymentby U.S. Dollar check or bank draft, the EOB will be sent to you bymail with the check or bank draft. If the Provider has an EFT setup, EOBs will be sent separately by mail. EOBs are also availableto view online, on the Provider Portal available on www.tricareoverseas.com.Please see Section 6: The Provider Portal foradditional information about viewing your EOB online.SECTIoN 5Provider Claims Information49