TRICARE-FOR-LIFE

(There is extensive information at www.rafino.org)

ID CARD:

No Special Registration Needed for Tricare for Life: Service officials are advising Medicare-eligible military retirees, spouses and survivors that no special beneficiary card will be needed to receive outpatient care under the Tricare-for-Life program that kicked off October 1. Neither does an existing Uniformed Services Identification card have to be replaced to show eligibility for TFL, regardless of the medical expiration date shown on the back.

A beneficiary needs only the current ID card (validated in the Defense Enrollment Eligibility Reporting System’s database) and a Medicare card showing participation in Medicare Part B. For such beneficiaries, providers who accept Medicare patients and are paid by Medicare will also be paid by Tricare. Medicare will pay first and Tricare second or after other health insurance. Medicare-eligible beneficiaries who did not receive an information package can call

1-888-363-5433.

PHONE NUMBERS:

Call the DEERS Support Office toll-free numbers:

1-800-538-9552

1-800-334-4162 (California only)

1-800-527-5602 (Alaska and Hawaii)

(DEERS Support Office hours of operation are 6 a.m. - 3:30 p.m., Pacific Time, Monday through Friday)

8 MAR 2002

TRICARE for Life (TFL) Claims Update

By the end of February, DoD had received over 7.6 million TFL claims and had completed processing on more than 7 million of them, paying out over $243 million in health care benefits. Claims processing contractors report that nearly all of the initial TFL claims "hiccups" either have been resolved or will be by mid-March. Here’s a recap of the status of the main initial problems:

Electronic Claims Omission. Approximately 13% of TFL beneficiaries were inadvertently left out of TFL’s initial data exchange with Medicare. Because Medicare was initially unaware that these people were TFL beneficiaries, their Medicare claims were not forwarded to TFL. This group was re-entered into the electronic process by mid-December. But the affected beneficiaries needed to file a paper TRICARE claim to receive reimbursement for doctor visits between October 1 and about December 7.

Status: TFL contractors report they have already processed large numbers of these paper claims, but there is no way to tell whether all of them have been submitted.

Beneficiary Action Needed: Affected beneficiaries who had unpaid claims for visits during that period last fall must file a paper TRICARE claim (Form DD2642), plus a copy of the Medicare Summary Notice (MSN) for the relevant visit.

Expired ID Cards. Many older beneficiaries who had let their military ID cards expire had their initial TFL claims denied.

Status: TFL is centrally identifying and reprocessing all claims denied for this reason, and will pay them until July. The vast majority of corrected payments will be completed by mid-March.

Beneficiary Action Needed: Beneficiaries with expired ID cards must renew them by July, or their subsequent TFL claims will be denied. Those who need help getting new ID cards can contact the Defense Manpower Data Center Support Office at 1-800-538-9522.

Excess Charges Payment. 3 to 4 % of TFL beneficiaries visit doctors who do not "accept Medicare assignment." Providers who don’t accept assignment may charge up to 115 % of the Medicare-allowable charge. TFL will cover this extra 15% charge.

However, the TRICARE claims processors initially didn’t get the word, and initially denied the extra payment.

Status: TFL had identified and made corrected payments for all of the previously underpaid claims as of mid-February.

Beneficiary Action Needed: None.

OHI Indicator. Some members who canceled other health insurance (OHI) in conjunction with switching to TFL coverage and advised TFL of the cancellation had initial TFL claims denied because the Medicare claim system still indicated their OHI was active. (By law, the OHI must pay first.) In some cases, this was a simple processing delay. In others, the other insurance company delayed notifying Medicare to avoid missing any delayed claims for medical visits before the cancellation.

Status: TFL processes have been changed to override the Medicare OHI indication if the beneficiary has notified DoD of the OHI cancellation, either by mail or by phone. Erroneously denied claims are being centrally identified and reprocessed. Over 160,000 previously denied claims had been corrected and reprocessed by the end of February.

Beneficiary Action Needed: None.

Beneficiary Notification Failure. Members who canceled their OHI but who did not notify TFL of such cancellation also may have their claims denied as discussed in the previous paragraph.

Status: TFL can’t correct the problem unless they are made aware of the cancellation.

Beneficiary Action Needed: If notified that your TFL claim was denied for this reason, call the TFL call center toll-free at 1-888-363-5433. The call center can provide a phone number for your state/region that you can call to update your TFL records to show your OHI has been canceled. Your claim then can be reprocessed automatically.

TMA leaders report that TFL claim denial rates are dropping. Initially 30%, the rate is now down to 23%, and this trend should continue with correction of initial processing problems.

The single most frequent reason for a denied claim (almost half of all denials) is that something in Medicare or TFL files shows the beneficiary has other health insurance (OHI). Despite intensive efforts by TMA, TROA and many others, only 63% of TFL-eligibles have told DoD of their intent to retain or drop any Medigap insurance coverage they may have had.

If you previously used other insurance, your claims history with Medicare or TRICARE usually will still reflect that you have OHI unless you report its cancellation date. And if the TRICARE system understands you still have Medicare supplemental insurance coverage, your claim will be denied.

Another problem may occur if you have decided to keep your OHI and don’t tell DoD. In some cases, this can cause TFL to make a duplicate payment to your doctor (i.e., in addition to the payment from your other policy) that later may have to be recouped.

This results in administrative problems for DoD, for your doctor, and for you. These administrative problems could result in TFL getting a bad name with providers and that could hurt all military beneficiaries. The success of the program depends on TFL beneficiaries doing their part to make sure that the claims processors have accurate information about their coverage. So it is important for you if you are a Medicare-eligible member to confirm to DoD whether you have OHI and, if so, whether you plan to cancel or retain it, and the effective date of any planned cancellation.

Last summer DoD sent a TFL mailing to all 1.4 million Medicare & 64,979 eligible uniformed services retirees, family members and survivors requesting that they respond with their OHI intentions. If you didn’t respond to the mailing, it is not too late to update your files. You should call DoD today and furnish this important information toll free at 888-363-5433.

Contacting DoD has no effect on your current Medicare supplement. If you wish to make any changes to your existing supplemental coverage, you will still have to contact your insurance carrier to make those arrangements. You are under no obligation to cancel your Medicare supplement, but you do need to communicate your intentions to DoD to guard against having a claims problem. If you need additional TFL information visit the TRICARE

Web site at http://www.tricare.osd.mil/ or call toll free

888-DOD-LIFE (888-363-5433) for assistance with

resolution of any claims problems.

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"© 2002 The Retired Officers Association. Used with permission."

Copyright © 2002, The Retired Officers Association

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