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Verifying Eligibility (Article 1) |
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Verifying a patient’s eligibility is a simple, but important part of providing health care to TRICARE beneficiaries. TRICARE Prime beneficiaries may have an enrollment card along with a uniformed services identification (ID) or Common Access Card (CAC).
However, these documents alone are not enough to verify eligibility. In order to be TRICARE eligible, every beneficiary must be registered in the Defense Enrollment Eligibility Reporting System (DEERS).
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Carefully review both sides of every beneficiary’s uniformed services ID card or CAC. You will also want to verify the card’s expiration date. If the card is expired, have the beneficiary contact DEERS to have his or her record updated and a new card issued. It is possible for some eligible beneficiaries to have either an expired ID card or no card at all. This does not necessarily mean that they are no longer entitled to TRICARE benefits.
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Additionally, it is important to photocopy the front and back of every beneficiary’s ID card or CAC. Although some beneficiaries may be reluctant to have their identification cards copied, you can reassure them that it is perfectly acceptable and lawful to photocopy ID cards for authorized purposes—e.g., to facilitate medical care eligibility determination and documentation, or for the purposes of rendering health care services.
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Providers must also verify the eligibility of the card bearer by calling Humana Military at 1-800-444-5445. You’ll need the sponsor’s Social Security number, located on the uniformed services ID card, to verify eligibility. If verifying online, you may wish to print the eligibility verification screen for your records.
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Remember that beneficiary status is subject to change when a sponsor separates from active duty service or retires; when a child who is a full-time college student reaches the age of 23; or when the beneficiary becomes eligible for Medicare. Therefore, it is important to verify patient eligibility before each office visit.
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For more information on verifying patient eligibility, please refer to the TRICARE Provider Handbook.
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Created: May 23, 2007
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