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After an eight-month transition period, all three TRICARE regions are now working with a single, nationwide claims processing contractor—Wisconsin Physicians Service TRICARE For Life (WPS-TFL)—for all dual-eligible beneficiary claims. Dual-eligible beneficiaries are TRICARE beneficiaries who are also entitled to Medicare Part A and Part B. Now that the transition to WPS-TFL is complete, here is some good information to know about dual-eligible claims processing.
Dual-Eligible Beneficiaries Can Be Either Under Age 65 or Age 65 and Over
While most dual-eligible beneficiaries are age 65 and over, it is important to remember that some may be younger. Beneficiaries under the age of 65 may be dual-eligible based on disability or end-stage renal disease.
How to Identify Your Dual-Eligible Patients
Each dual-eligible patient must present a valid uniformed services or military identification card, as well as a Medicare card prior to receiving services. You should copy both sides of the cards and retain them for your files. If you have a question about a patient’s eligibility, you can call the Defense Enrollment Eligibility Reporting System (DEERS) at 1-800-538-9552 to confirm TRICARE status and 1-800-772-1213 to confirm a patient’s Medicare status.
How to Process Claims
Since Medicare is the primary payer, you should continue to follow Medicare rules for claims processing and submit your dual-eligible claims to Medicare. Medicare will electronically transfer claims for dual-eligible (Medicare/TRICARE) beneficiaries, regardless of their age, directly to WPS-TFL. If a beneficiary has other health insurance (OHI), he or she will need to file a paper claim (DD Form 2642) with WPS-TFL, which includes the Medicare Summary of Benefits and an explanation of benefits from their OHI. If you have questions, WPS-TFL can be reached toll free at 1-866-773-0404. You can also visit WPS online. |
