Leaders at TRICARE Management Activity (TMA) are looking for
ways to implement improvements to claims processing procedures.
In order avoid claims processing problems, there are some basic
rules you need to follow.
TRICARE participating providers are required to file claims for
beneficiaries; however, if the provider is non-participating,
the beneficiary may need to file the claim.
Claims must be filed within one year of the date of service or
within one year of the date of an inpatient discharge. Claims
filed by the beneficiary should include the following: photocopies
of fully itemized bills from the provider, patient’s name,
diagnosis or symptoms, place of service, number/frequency of each
service and date of care. Additionally, the sponsor’s Social
Security number should be on all pieces of correspondence. It
is important to double-check all information for completeness.
Canceled checks or cash register receipts are not acceptable as
itemized bills.
Active duty service members and their families stationed overseas
should file their claims with Wisconsin Physicians Service (WPS).
A WPS claims contractor can be reached at (606) 259-4847. Contractors
are required to complete the claims processing within 30 days.
For more information about filing or appealing claims, call HMC
Charles Houston in the Patient Administration Office of the Naval
Hospital at 72026.