Provider Handbook

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Wisconsin Physicians Service (WPS) is the claims processor for all overseas claims. If filing a claim for a beneficiary who lives in one of the overseas regions, submit it to one of the addresses listed in Figure 8.4.
ADFM claims or TRICARE Standard claims with an overseas address should be sent directly to the WPS overseas claims processor. National Guard and Reserve members on orders of 30 days or less who have claims with an overseas address should also be sent to the WPS overseas claims processor. If the National Guard and Reserve member can provide a copy of their orders and the provider submits a copy of their orders with the claim, the claim processing will be expedited. The orders are important because they verify the member’s eligibility for TRICARE benefits.

ADSM claims with a Puerto Rico address should be forwarded to PGBA. 
 

Fig. 8.4

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WPS is the claims processor for all TFL claims. If you currently submit claims to Medicare on your patient’s behalf, you will not need to submit a claim to WPS. WPS has signed agreements with each Medicare carrier allowing them to submit claims directly to WPS for TRICARE beneficiaries, regardless of age. Claims processed by Medicare are submitted electronically to WPS TFL. Beneficiaries will receive Provider Remittance Advice from WPS once processing has been completed. If you do not participate in Medicare, or the services you perform are not Medicare benefits, you will need to submit claims directly to WPS.

Note: Participating providers accept Medicare’s payment amount. Nonparticipating providers do not accept Medicare’s payment amount and are permitted to charge up to 115 percent of the Medicare-approved amount. Both participating and nonparticipating providers may bill Medicare. 

Figure 8.5 contains important contact information for you or your patients regarding Medicare and TRICARE claims.

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PGBA
Active Duty Claims
P.O. Box 7031
Camden, SC 29020-7031

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Fig. 8.5

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