TRICARE requires proof of payment for overseas claims
FALLS CHURCH, Va. – After Sept. 1, 2012, TRICARE beneficiaries must send proof of payment with all overseas medical claims, including claims for care received when traveling overseas. Overseas Active Duty Dental Program claims also require proof of payment if the service member pays a provider directly.
Beneficiaries who pay an overseas provider directly should indicate this and the amount paid at the top of the medical claim form to ensure the claim is processed quickly and correctly. Claim forms can be downloaded at www.tricare.mil/forms.
When the claim amount is less than $1,000, beneficiaries can submit a copy of the provider or a pharmacy invoice or bill, if it clearly identifies the amount paid. If not, a copy of the cancelled check, credit card receipt or electronic funds transfer must be submitted as proof. Medical or pharmacy bills for more than $1,000 always require a copy of the cancelled check, credit card receipt or electronic funds transfer as proof of payment in addition to the provider invoice or bill.
If the provider was paid with cash, beneficiaries may be required to show proof of the cash withdrawal from a financial institution. In some cases, the TRICARE Overseas Program (TOP) claims processor may require additional supporting documentation to process the claim.
When TRICARE is the second-payer on a claim, it should include the diagnosis describing why the medical care was needed and an explanation of benefits from the other health insurance provider.
Beneficiaries bundling more than one claim on a single form must submit a proof of payment for each service. Every claim on the form will be reviewed as if it was submitted separately and any items that do not have proof of payment will be returned for additional documentation.
Overseas claims for TRICARE Dental Program and TRICARE Retiree Dental Program (non active duty dental programs) do not require proof of payment. Medicare-eligible TRICARE beneficiaries who get care from a Medicare provider in U.S. Territories are also not affected by this change.
For questions about this policy, contact the appropriate overseas regional call center and select option 2 for claims. For contact information, visit www.tricare.mil/contacts. For more information about proof-of-payment requirements, visit www.tricare.mil/proofofpayment.
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The TRICARE Management Activity administers the worldwide health care plan for 9.7 million eligible beneficiaries of the uniformed services, retirees and their families