Provider Handbook

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TRICARE covers the North Atlantic Treaty Organization (NATO) foreign nations’ armed forces members who are stationed in or are in the U.S. at the invitation of the U.S. Government. The benefits are the same as for American ADSMs, including no out-of-pocket expenses for care if the care is directed by the MTF. Eligible family members of active ADSMs of  NATO nations who are stationed in, or passing through, the U.S. in connection with their official duties are eligible for outpatient services under TRICARE Standard or TRICARE Extra. A copy of the family member’s ID card will have a Foreign Identification Number (FIN) or an actual Social Security number (SSN) and indicate on the reverse “Outpatient Services Only.”

NATO family members do not needan MTF referral prior to receiving outpatient services from civilian providers. Like all TRICARE Standard beneficiaries, NATO family members are responsible for TRICARE Standard deductibles and cost-shares. To collect charges for services not covered by TRICARE, contracted providers must have the NATO beneficiary agree, in advance and in writing, to accept financial responsibility for any non-covered service. You may obtain a copy of the TRICARE of Non-Covered Services Waiver Form on the Medical Forms for Providers page.

TRICARE will not cover inpatient services for NATO beneficiaries. In order to be reimbursed for inpatient services, have the NATO beneficiary make the appropriate arrangements with the NATO nation embassy or consulate in advance.

The eligibility for NATO beneficiaries is now maintained in the Defense Enrollment Eligibility Reporting System (DEERS). Claims submission procedures are the same as for United States active duty family members.

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VA Health Administration Center
CHAMPVA
P.O. Box 65023
Denver, CO 80206-9023
 

Phone:  1-800-733-8387
 
Web site:  U.S. Dept. of Veterans Affairs Web site 

VA Health Administration Center
CHAMPVA
P.O. Box 65024
Denver, CO 80206-9024

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Humana Military is the contractor for the Continued Health Care Benefit Program (CHCBP) and has partnered with PGBA for processing non-overseas CHCBP claims. CHCBP beneficiaries may request that providers file medical claims on their behalf. For questions and assistance regarding CHCBP claims, call PGBA at 1-800-403-3950.

Please remember that while PGBA is the South Region claims processor for TRICARE Prime, TRICARE Prime Remote, and TRICARE Standard and TRICARE Extra claims, CHCBP claims are filed to a different address within PGBA. Filing claims correctly ensures that your claims are paid in a timely and accurate manner.

File CHCBP claims electronically at the PGBA Web site. File all paper claims at one of the addresses listed in Figure 8.6.
 

Fig. 8.6

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