Avoid Denied or Duplicated Claims

 
By avoiding common claims-filing errors, you can help expedite the reimbursement process. When filing, be sure to adhere to the following guidelines.

• Register to file your claims online. All TRICARE network providers must file claims electronically. All other TRICARE providers are strongly encouraged to file electronically. Filing electronically provides instant feedback, which produces more accurate claims that are efficiently processed.
   
• Check the claim’s status before resubmitting. Do not resubmit your claim before checking the status at TRICARE's web site or by calling Humana Military Healthcare Services, Inc.’s(Humana Military) toll-free Interactive Voice Response system at 1-800-444-5445. Unnecessarily resubmitting a claim can result in duplicate claims.
    
• Do not send a claim to more than one region. If you provide health care services to a TRICARE beneficiary who resides in or is enrolled in a different region, submit reports and claims information to his or her home region, not the region in which he or she received care. Your patient will remain responsible for paying the applicable cost-share for services rendered.
   
• Wisconsin Physicians Service (WPS) is the claims processor for all TRICARE For Life beneficiaries. Submit claims to www.tricare4u.com.  If you submit claims to Medicare for your patients, you will not need to submit claims to WPS.
   
• When submitting claims electronically, be sure to use your National Provider Identifier (NPI). As a provider, you must use your NPI on HIPAA standard electronic transactions. If a patient is referred to you for treatment, include the referring provider’s NPI on your transactions.
   
• Other health insurance (OHI): If the TRICARE beneficiary has OHI, submit claims directly to the OHI. For more information on OHI, visit TRICARE's web site.
   
• Use the correct Social Security number (SSN). An incorrect SSN will likely cause a claim to be denied. TRICARE requires providers to file claims using the sponsor’s SSN, unless the patient is a TRICARE-eligible former spouse. Use the beneficiary’s SSN for former spouses. All TRICARE beneficiaries have uniformed services identification cards that provide the sponsor’s SSN.
   
• Apply accurate coding. Use the Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) codes that most accurately describe the procedure or service performed. Do not select codes that approximate the service, and avoid using unlisted or miscellaneous codes. When no code exists, it is likely the procedure or service is not covered.
   
• Assign primary and supporting codes. You can avoid claims denials by assigning primary and supporting codes that denote the reasons for the procedures, as well as diagnoses that affect treatments.
    
• Use proper V codes. A V code can be submitted as the primary diagnosis when it explains the reason for the visit (e.g., a routine well-child checkup). When submitting a claim with a V code for an ancillary service, list the underlying medical condition as the primary diagnosis. For example, if you submit a claim with the V code for a radiologic exam, you must include a primary diagnosis, such as chest pain, to explain the reason for the X-ray. For preventive services, a V code that describes a personal or family history of a medical condition is sufficient as a primary diagnosis.
    
• Verify important information. When submitting your claim, verify the following: date of service, patient’s name, date of birth, SSN, contact information and address, total amount billed, rendering physician and your Tax Identification Number.
    
• Consult your TRICARE Provider Handbook and the Humana Military Web site  for detailed claims-processing information. Stay up to date on region-specific tools to facilitate the filing process, and reach out to Humana Military when necessary.