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Prime Remote Handbook
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Pharmacy Claims
Coordinating Benefits with Other Health Insurance
Third-Party Liability |
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Pharmacy Claims |
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If you have other health insurance (OHI), you will need to submit pharmacy claims to Express Scripts, Inc. (ESI) for payment. Claims must be filed within one year of the date of service. Prescription claims require the following information for each drug:
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- Name of the patient
- Name, strength, date filled, days supply, quantity dispensed, and price of each drug
- National Drug Code, if available
- Prescription number of each drug
- Name and address of the pharmacy
- Name and address of the prescribing physician
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You can download forms and instructions from the TRICARE Web site or the TRICARE Pharmacy Claims Web site. |
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Mail the claim to:
Express Scripts, Inc.
TRICARE Claims
P.O. Box 66518
St. Louis, MO, 63166-6518
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If you have additional questions about filing a pharmacy claim, call ESI toll-free at 1-866-DoD-TRRX (1-866-363-8779).
Note: Active duty family members who have prescriptions filled at a non-network pharmacy are using the point of service (POS) option. Active duty service members may be required to pay for the prescriptions in full and will receive a full reimbursement when the claim is filed.
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Coordinating Benefits with Other Health Insurance |
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TRICARE is the primary payer for active duty service members. For active duty family members, TRICARE is the secondary payer to all health benefits and insurance plans, except for Medicaid, TRICARE supplements, the Indian Health Service, and other programs/plans as identified by the TRICARE Management Activity.
If you have OHI, you need to follow the OHI’s rules for filing claims and file the claim with them first. If there is an amount your OHI does not cover, you can file the claim with TRICARE for reimbursement. It is important to follow the requirements of your OHI. If your OHI denies a claim for failure to follow their rules, such as obtaining care without authorization or use of a non-network provider, TRICARE may also deny your claim.
Keep Humana Military and health care providers informed about your OHI so they can better coordinate your benefits and help ensure that there is no delay (or denial) in the payment of your claims.
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Pharmacy Claims and OHI (Processed by ESI) |
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When you have OHI, your OHI pays first for pharmacy coverage, and the rules of that insurer apply. After your OHI has paid, your TRICARE coverage may reimburse you for part or all of your out-of-pocket costs, including copayments. Your best option with OHI is to use a retail pharmacy that is covered by your OHI and is in the TRICARE retail network to avoid using the POS option.
You may not use TRICARE’s mail-order pharmacy if you have prescription drug coverage from OHI, unless the medication is not covered under your OHI, or you exceed the dollar limit of coverage under your OHI.
Contact ESI at 1-866-DoD-TRRX (1-866-363-8779) with questions about filing pharmacy claims with OHI.
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Third-Party Liability |
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The Federal Medical Care Recovery Act allows TRICARE to be reimbursed for its costs of treatment if you are injured in an accident that was caused by someone else. The DD Form 2527 Statement of Personal Injury Third Party Liability will be sent to you if a claim is received that appears to have third-party involvement. Within 35 calendar days, you must complete and sign this form and follow the directions for returning the form to the appropriate claims processor. You can download DD Form 2527 from the TRICARE Claims Web site. |
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