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Claims submission and patient authorization processes for TRICARE For Life (TFL) patients are different than for other TRICARE patients. Here’s a closer look at what you need to know.
TFL is wraparound coverage available to TRICARE beneficiaries who also have Medicare Part A and Part B. (Note: A beneficiary may be eligible for Medicare, but has not signed up or paid their Part B premiums. In this instance, they would not be eligible for TFL.) TRICARE pays second to Medicare for services covered by both Medicare and TRICARE. TRICARE has partnered with Wisconsin Physicians Service (WPS) for TFL claims processing and customer service.
WPS has signed agreements with each state’s Medicare fiscal intermediary and Part B carrier, which allows Medicare to pay its portion and then submit claims directly to WPS TFL for processing. Be sure to submit your claims to Medicare first. WPS TFL will then send its payment for the remaining beneficiary liability directly to you.
If a beneficiary has other health insurance (OHI), then Medicare pays first and forwards the claim to the OHI, which pays second. In these instances, the beneficiary must file a paper claim (DD Form 2642— available online) with WPS TRICARE For Life (P.O. Box 7890, Madison, WI 53707-7890).
If you do not participate in Medicare, or if the services you’ve provided are not Medicare-covered benefits, paper claims must be submitted to WPS TFL.
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