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. Providers will receive a 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.

When TRICARE is the primary payer, all TRICARE requirements apply.  See Chapter 13 of the TRICARE Reimbursement Manual for details.

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