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Avoid Claims Processing Problems (Article 2) |
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Follow these simple steps to ensure TRICARE claims are processed correctly the first time.
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1. Use the Correct Social Security Number
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Incorrect Social Security numbers (SSNs) frequently cause claims to be denied. Providers and staff should use the TRICARE sponsor’s SSN when filing a claim, unless the TRICARE eligible beneficiary is the former spouse of a TRICARE sponsor. In that case, use the former spouse’s SSN.
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2. Verify Patient’s Address |
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Service members move or are in transit often. It’s common for providers to have an old or temporary address on file. Ask beneficiaries to update their information during each visit.
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3. Apply Accurate Coding |
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When filing claims, you and your staff should use the [Physician's] Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes that most accurately describe the procedure or service involved. You should not select codes that approximate the service involved, and you should avoid using unlisted or miscellaneous codes. When no code exists, it is likely the procedure or service is not covered.
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4. Assign Primary and Supporting Codes |
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You can avoid claim line denials by assigning primary and supporting codes that denote the reason for the procedure, as well as any diagnosis that affects treatment. |
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5. Use Proper V Codes |
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It is especially important to use the proper V codes for claims reimbursement. A V code designates a primary diagnosis for an outpatient claim that explains the reason for a patient’s visit to your office. Be sure to use the correct V code diagnosis to indicate the reason for the visit. The V code must match the CPT code to indicate the procedure that you are performing as it correlates to the V code diagnosis. |
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6. Submit Supporting Documentation |
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Submit all supporting documentation, as necessary, for the care rendered. You should also ensure the following information is accurate when you are submitting a claim on behalf of your TRICARE patient:
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- The date of service
- The patient’s date of birth
- The total amount billed
- The rendering provider’s ID number [As of Jan. 1, 2006, this can include the National Provider Identifier (NPI).] in Box 24K (CMS-1500) for each service line or in the appropriate segment element in the 837 file. The appropriate ID number can also include the Unique Physician Identification Number (UPIN) or TRICARE provider number, or the name (last name, first name) of the provider.
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Claims Resolution Assistance |
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Humana Military assists providers with claims questions and problems through its toll-free number, 1-800-444-5445. Call this number before initiating any collection action against a TRICARE beneficiary.
More information on claims submission requirements can be found in your TRICARE Provider Handbook.
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Where do I send claims for services provided to beneficiaries displaced by the recent hurricanes? (Article 3) |
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You should submit claims the same way that you normally do. Be certain to use the beneficiary’s permanent address rather than their temporary address.
If you are a network provider, please submit your claims electronically. If you are a non-network provider, we encourage you to submit your claims electronically. However, if you are unable to do so, please mail your claims to:
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TRICARE South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
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For more information, call the South Region’s claims contractor, PGBA, at 1-800-403-3950. |
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Last Reviewed: February 13, 2007
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