WPS/TFL 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/TFL. WPS/TFL has signed agreements with each Medicare carrier allowing direct, electronic transfer of TRICARE beneficiary claims to WPS/TFL.
Beneficiaries and providers will receive EOBs from WPS/TFL after processing.

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