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Using ID Cards to Verify Patient Eligibility (Article 2 ) |
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There are several identification (ID) and enrollment cards you should be familiar with when treating TRICARE beneficiaries so that you and your staff are able to verify a patient’s eligibility for TRICARE. Please see the “Provider Tools” section of your TRICARE Provider Handbook for samples of each of these cards.
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Impact of 2005 Hurricanes |
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Due to the unfortunate circumstances affecting TRICARE beneficiaries impacted by Hurricanes Katrina, Rita and Wilma, TRICARE recognizes that many people will have no form of identification with them. Because of this, providers/facilities should attempt to verify both eligibility and identity using the best information available, and that will depend on each individual’s circumstances.
Contact Humana Military at 1-800-444-5445 for assistance in verifying eligibility.
Once eligibility is determined, identity can be verified by asking other personal identifying information, such as addresses or date of birth, if there is no other form of picture identification.
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Uniformed Services ID Cards
The uniformed services (military) ID card is similar in size to a credit card and incorporates a photographic image of the bearer, bar codes containing pertinent machine-readable data, and printed identification and entitlement information. The beneficiary category determines the ID card’s color:
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- Active duty service members (ADSMs)—green or a white Common Access Card (CAC)
- Active duty family members (ADFMs)—tan
- Members of the Reserve Component (RC) and their eligible family members—red
- Retirees—blue
- Retiree family members—tan
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To verify beneficiary eligibility, check the back of the ID card. The center section should say “YES” under the box entitled “CIVILIAN.” If a beneficiary using TRICARE For Life (TFL) has an ID card that says “NO” in this block, they are still eligible to use TFL if they are enrolled in Medicare Part B. Check the expiration date on the ID card in the box entitled “EXP DATE.” If expired, the beneficiary will need to update their information in the Defense Enrollment Eligibility Reporting System (DEERS) and get a new card.
The Common Access Card (CAC) is replacing this ID card and is being phased in over the next few years. Please honor valid CAC cards—they are valid uniformed services ID cards.
Beneficiaries under the age of 10 are not routinely issued ID cards, so the parent’s ID card may serve as proof of eligibility.
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Make Copies for Your Records
You are encouraged to make copies of the ID and enrollment cards for your records. While some TRICARE beneficiaries may believe that it is illegal to copy uniformed services ID cards, it is in fact legal to copy them for authorized purposes. Authorized purposes include facilitating medical care eligibility determination and documentation, check cashing and administering other military-related benefits.
Per TRICARE Management Activity (TMA) instruction, it is both allowable and advisable for providers to copy the beneficiary’s ID card for proof of eligibility and for the purpose of rendering needed services. TMA recommends that providers copy both sides of the ID cards and retain copies for future reference.
Title 18 of the USC, Section 701 prohibits photographing or possessing uniformed services ID cards in an unauthorized manner. Unauthorized use would exist only if the bearer uses the card in a manner that would enable him or her to obtain benefits, privileges or access to which he or she is not entitled.
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Enrollment Cards
Beneficiaries enrolled in TRICARE Prime, TRICARE Prime Remote (TPR) and TRICARE Prime Remote for Active Duty Family Members (TPRADFM) should present a TRICARE Prime enrollment card to you at the time of service. While not required to receive treatment, the enrollment cards contain important information about the beneficiary. The uniformed services ID card or new CAC card is the source that verifies eligibility for care for TRICARE Prime, TPR or TPRADFM.
The newest enrollment card is the TRICARE Reserve Select (TRS) enrollment card. The TRS enrollment card is similar in design to the TRICARE Prime enrollment card, and it may be used to verify eligibility for TRS, unlike the TRICARE Prime enrollment cards. TRS members must present this card to you before receiving care.
Please contact Humana Military at 1-800-444-5445 for assistance in verifying eligibility for TRICARE.
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New! Permanent ID Cards for Family Members Age 75 and Over |
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A permanent uniformed services ID card became available in September 2005 for all eligible family members and survivors of deceased uniformed services members, who are age 75 and over. Previously, only retired uniformed services members were issued a permanent ID card.
Beneficiaries currently in possession of a valid ID card should obtain the new permanent ID card within 90 days of expiration. If a current ID card is not due to expire for at least another year, it does not need to be replaced with the new ID card until the existing card is within 90 days of expiring.
For additional information about the new permanent ID cards for family members age 75 and over, visit the DEERS Web site.
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