SECTION 5: Provider Claims Information - TRICARE Overseas

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TRICARE overseas ProgramProvider ManualTransaction Fees Associated withClaim Reimbursement andPaymentsInternational SOS is responsible for any costs associated withissuing payments, such as issuing checks and bank drafts,sending EFT payments (and related transaction fees), andsending the EOBs. Providers are responsible for all of the costsassociated with receiving payments, such as depositing checksand bank drafts, collecting EFT payments, and exchangingpayments into local currency.What if Both Non-Institutional andInstitutional Providers Are Used forthe Same ‘Episode of Care’ andBilled Independently?Two separate Claim Forms will be needed: one from the Non-Institutional Provider (CMS 1500) and one from the InstitutionalProvider (UB-04).Each entity that requests to receive payment independently mustsubmit a separate Claim Form (CMS 1500 for Non-InstitutionalProviders or UB-04 for Institutional Providers) and an ItemizedInvoice.Step-by-Step Instructions forAccurately Completing ClaimFormsTOP Provider Support Services staff will work with you to showyou how to complete each of the following Claim Forms properly.When you receive an International SOS Authorization Form, apre-populated Claim Form will be sent to you simultaneously. Ifyou do not receive an Authorization Form or if you needadditional Claim Forms, these are available to be downloaded onwww.tricare-overseas.com.Note: These Claim Forms will not be pre-populated.Full instructions on how to complete Claim Forms that have notbeen pre-populated are included in this TOP Provider Manualand are also available at www.tricare-overseas.com.Instructions on how to complete a pre-populated Claim Form areavailable at www.tricare-overseas.com.International SOS has also developed an eLearning Module tohelp you complete Claim Forms. Please contact your TOPRegional Call Center and press option #5 to request access tothe eLearning Module.If needed, additional Claim Forms can be downloaded atwww.tricare-overseas.com.What if a Beneficiary Does NotShow for an Appointment?TRICARE beneficiaries are directly responsible for paying noshowfees. You should invoice the patient directly for failing tocancel an appointment (without sufficient advance notice) orfailing to show up for a scheduled appointment.56
TRICARE overseas ProgramProvider ManualThe Claims ProcessCompleting the CMS 1500PART 1Patient’s andSponsor’sDetailsPART 2Patient’s SignaturePART 3Diagnosis andAuthorizationNumberPART 4Provider’s Details{{{{SECTIoN 5Provider Claims Information57
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SECTION 5: Provider Claims Information - TRICARE Overseas

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