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Prime Handbook
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TRICARE for Life
How to Identify TFL Beneficiaries
How TFL Works
How TFL Works with Other Health Insurance
TFL Referrals and Authorizations |
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TRICARE for Life |
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TRICARE For Life (TFL) is TRICARE’s Medicare-wraparound coverage available worldwide to TRICARE beneficiaries who are also entitled to Medicare Part A on the basis of age, disability, or end-stage renal disease and who also have Medicare Part B coverage. TFL is available to TRICARE/Medicare dual-eligible beneficiaries regardless of age, including retired members of the National Guard and Reserve who are in receipt of retired pay, family members, widows/widowers, and certain former spouses. Dependent parents and parents-in-law are not eligible for TFL. TFL coverage is effective the same day that a beneficiary’s Medicare Part B coverage becomes effective. |
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How to Identify TFL Beneficiaries |
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Each TFL beneficiary must present a valid uniformed services ID card, as well as a Medicare card, prior to receiving services. You should copy both sides of the cards and retain the copies for your files. To verify TFL eligibility, contact Wisconsin Physicians Service (WPS) at 1-866-773-0404. You may call 1-800-772-1213 to confirm a patient’s Medicare status.
Note: If a beneficiary using TFL has an ID card that reads “NO” under the box titled “CIVILIAN,” he or she is still eligible to use TFL if they have Medicare Part A and Part B.
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How TFL Works |
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The provider first files claims with Medicare. Medicare pays its portion and electronically forwards the claim to WPS, the TFL claims processor. WPS sends its payment for TRICARE-covered services directly to the provider. Beneficiaries receive a Medicare Summary Notice from Medicare and a TFL explanation of benefits (EOB) from WPS indicating the amounts paid.
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- For services covered by both TRICARE and Medicare, Medicare pays first and TRICARE pays its share of the remaining expenses second.
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- For services covered by TRICARE but not by Medicare, such as care received overseas, Medicare pays nothing and TRICARE becomes the primary payer. The beneficiary is responsible for the TRICARE fiscal year deductible and cost-shares.
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- For services covered by Medicare but not by TRICARE, such as chiropractic services, Medicare is the primary payer and TRICARE pays nothing. The beneficiary is responsible for the Medicare deductibles and cost-shares.
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- For services not covered by Medicare or TRICARE, such as cosmetic surgery, the beneficiary is responsible for the entire bill.
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How TFL Works with Other Health Insurance |
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TRICARE/Medicare beneficiaries with other health insurance (OHI), such as a Medicare supplement or employer-sponsored health plan, may also use TFL. By law, TRICARE pays claims only after any OHI plans have paid. Typically, after Medicare processes a claim, the claim is forwarded to the beneficiary’s OHI. Once the OHI processes the claim, the beneficiary will need to file a paper claim with TRICARE for any out-of-pocket expenses. TRICARE may reimburse the beneficiary for services covered by TRICARE. |
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TFL Referrals and Authorizations |
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Because Medicare is the primary payer, there is usually not a requirement for providers to obtain referrals or prior authorization from Humana Military. If Medicare benefits are exhausted, or if the patient is seeking care covered by TRICARE but not Medicare, you may need an authorization from Humana Military, when applicable. See the Health Care Management and Administration section of this handbook for services requiring a referral or authorization.
If you have questions about TFL, contact WPS at 1-866-773-0404 or visit the WPS Web site.
For information about filing TFL claims, see the Claims Processing and Billing Information section.
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