TRICARE For Life (TFL) is TRICARE’s Medicare wraparound coverage and is administered by Wisconsin Physicians Service (WPS). TFL coverage is available to TRICARE beneficiaries regardless of age, provided they are entitled to premium-free Medicare Part A and also have Medicare Part B. Because TFL is administered and reimbursed differently than other TRICARE program options, it is important to understand how it works and who to contact with questions.
 
Verifying Eligibility and Coverage
Before treating a TFL beneficiary, be sure he or she has a valid uniformed services identification card and a Medicare card. You should copy both sides of the cards and retain the copies for your files. There is no separate enrollment card for TFL.
 
To verify TFL eligibility, call WPS at 1-866-773-0404. You can confirm a patient’s Medicare status by calling the Social Security Administration at 1-800-772-1213. Beneficiaries can also check their own status in the Defense Enrollment Eligibility Reporting System (DEERS).
 
To determine whether Medicare covers a specific service, visit www.medicare.gov or call 1-800-633-4227. For TRICARE coverage details, visit www.tricare.mil or contact WPS at 1-866-773-0404.
 
Claims
If you submit a claim to Medicare for a TFL beneficiary, you will not need to submit the claim to WPS. Medicare will pay its portion and forward the claim electronically to WPS. You will receive a Provider Remittance Advice from WPS once processing has been completed.
 
However, if you do not participate in Medicare or if the services you provide are not Medicare benefits, you will need to submit claims directly to WPS. If a beneficiary has other health insurance (OHI) in addition to TFL and Medicare (e.g., employer-sponsored plan), TRICARE will pay claims only after the OHI plan has paid. Medicare will forward claims to the OHI, and then the beneficiary will need to file
a paper claim with TRICARE.
 
For additional information or if you have questions about TFL, contact WPS at 1-866-773-0404 or visit the WPS Web site at www.TRICARE4u.com.