SECTION 5: Provider Claims Information - TRICARE Overseas

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TRICARE overseas ProgramProvider ManualSecure Message Transmission: New Claim/Claim InformationUpload Attachments:You must upload at least one of the following:• UB-04 Claim Form• CMS 1500 Claim Form• Claim Development Worksheet*Attachments uploaded through the site,including the claim form or worksheet, mustbe in one of the file formats listed under the‘Attachments’ field. There are additionalattachment fields available for uploading otherdocuments to accompany your claim. Theseadditional attachment fields are optional.The screen will update to display the data fields you need to fill inalong with the basic claim summary data fields for uploading theclaim form and any additional attachments you wish to provide.Note: All fields are required unless otherwise noted:■ Location: Select the physical location address where theservice took place.■ Total Billed Charges: Enter the sum of all charges on theclaim form or worksheet.■ Currency Type: Enter the name or code of the currency inwhich the claim charges are listed. Note: If the beneficiary hasother health insurance, the claim will be paid in $USD (UnitedStates Dollars) regardless of the currency type listed here.■ Invoice Number: This is an optional field to enter your office’sinternal tracking number for the claim or bill.When all necessary fields are entered and your attachments havebeen uploaded, click ‘Next’.38
TRICARE overseas ProgramProvider ManualSecure Message Transmission: Patient InformationOn the ‘Patient Information’ screen, you will be asked to provide the following patientinformation:• Sponsor Social Security Number (SSN): Select the patient’s benefit type from the dropdown menu and then enter the corresponding benefit number in the text field to the right.• Patient First Name and Patient Last Name: Enter the patient’s first and last names in thecorresponding fields.• Beginning Date of Service: Enter the earliest date of health care service as it is listed forthe procedures being submitted on this claim. The date must be entered in MM/DD/YYYYformat or you can click the calendar icon to select the date.• Ending Date of Service: Enter the last date of health care service as it is listed for theprocedures being submitted on this claim. This date must be entered in the MM/DD/YYYYformat or you can click the calendar icon to select the date.Click ‘Next.’SECTIoN 5Provider Claims Information39
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SECTION 5: Provider Claims Information - TRICARE Overseas

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