SECTION 5: Provider Claims Information - TRICARE Overseas

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TRICARE overseas ProgramProvider ManualPart 2: Patient’s SignatureThese two fields require the signature of the patient.• The patient and the insured party can be the same person. Even if the patient is not the Active Duty Service Member, the Active Duty FamilyMember is an eligible TRICARE beneficiary and considered the insured party.• The requirement for signature can be met by obtaining a ‘Signature on File’. This means the Provider will have the patient’s signature on file(collected at ‘registration’ at the Provider facility or at first appointment).• If the patient is incapable of signing or under 18 years of age, the parent or legal guardian’s signature will be kept on file.• Signature on File: International SOS will assist Providers with education on how to obtain this in the correct manner and which wording toinclude in collecting the signature. Providers will then simply write ‘Signature on File’ in BOTH fields and will not be required to obtain thebeneficiary’s or insured’s signature when completing the Claim Form.• Laboratories: if the patient is not present, the laboratory should enter ‘Patient not Present’ on the line in both signature fields.• Ambulance Companies: Enter 'Patient Unable to Sign' on the line in both signature fields.IMPoRTANT NoTE: Both boxes must be signed and completed!An example ‘Signature on File’ letter:60
TRICARE overseas ProgramProvider ManualPart 3: Authorization NumberIf you are not able to include the diagnosis on theinvoice, you can write it here. If the diagnosis is onthe invoice, leave this field blank. The diagnosis canbe a written description or an ICD or CPT Code.Please enter the appropriateAuthorization Number. This can befound on the top right corner of theAuthorization Form.The rest of this information should be on the Itemized Invoice which must be submitted with the Claim Form.Fields highlighted in greencan be left blankSECTIoN 5Provider Claims Information61
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SECTION 5: Provider Claims Information - TRICARE Overseas

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